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30-03-2010 | Diabetes | Article

Factors influencing rate of change to insulin therapy for Type 2 diabetics clarified


Free abstract

MedWire News: Swedish patients with Type 2 diabetes progress to insulin treatment more quickly if they are young at the age of oral antidiabetes drug (OAD) initiation, have high initial glycated hemoglobin (HbA1c), and start treatment with more than one OAD, say researchers.

As Type 2 diabetes is a progressive condition, most patients will eventually have to progress from taking OADs such as metformin to being treated with insulin.

However, the time this takes varies considerably from person to person and little is known about the factors predicting rate of progression to insulin therapy, comment Anna Ringborg (Karolinska Institutet, Stockholm, Sweden) and colleagues.

The team carried out a retrospective, population-based analysis of 5403 patients from the Swedish Real-Life Effectiveness and Care Patterns of Diabetes Management (RECAP-DM) study who had Type 2 diabetes and who started OAD treatment during the RECAP-DM study period (1993–2005).

The average age of the patients at OAD initiation was 66 years, the average HbA1c was 8.33%, and the average body mass index was 30.0 kg/m2.

In total, 1115 patients were subsequently prescribed insulin therapy during the study period, 181 of whom were given insulin at baseline along with their OAD treatment.

Patients aged less than 65 years at OAD prescription were 24% more likely to be prescribed insulin during the study period than older patients. In addition, patients who started treatment with a combination of different OADs were 2.77-fold more likely to start insulin therapy before study completion than those who started on just one OAD. Patients with the highest levels of HbA1c at baseline were also more likely to be prescribed insulin than those with the lowest levels.

From their results, the authors estimate that within 6 years of starting treatment with OADs, 25% of Swedish patients will be on insulin treatment and within 10 years this will have risen to 42%.

“Knowledge of these real-life treatment patterns is useful for explaining treatment outcomes and may also form a basis for assessing the influence of new therapies,” conclude Ringborg et al in the journal Diabetes and Metabolism.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Helen Albert