Treatment inertia remains a problem after insulin initiation in type 2 diabetes
medwireNews: Healthcare providers can remain slow to intensify type 2 diabetes medication even after making the jump to basal insulin, with consequences for glycemic control and potentially cardiovascular risk, study results show.
The research was presented as a late-breaking poster at the virtual ADA 80th Scientific Sessions, by Muna Adan (University of Leicester, UK) and team. Their conclusions were drawn from data concerning nearly 8000 people, recorded in the UK Clinical Practice Research Datalink, who first started basal insulin for type 2 diabetes between January 2004 and December 2016 but whose glycated hemoglobin (HbA1c) level nevertheless remained at 7.0% (53 mmol/mol) or higher.
Of these study participants, 32.4% were early intensifiers, having either prandial insulin or an additional antidiabetic agent added to their treatment regimen within 1 year (median 3 months). Their average HbA1c was 9.7% at the point of intensification and 8.3% at 6 months post-intensification, a reduction of 1.4%.
A further 26.2% of participants were late intensifiers, having their regimen altered at a median of 28 months, and as a result their HbA1c fell from 9.4% to 8.5%, equating to a decline of 0.9%.
In unadjusted analyses, early intensifiers had a reduced rate of cardiovascular outcomes compared with the 41.4% of the cohort who remained without intensification despite uncontrolled HbA1c, at nonsignificant 23% and 18% reductions for myocardial infarction and heart failure, respectively, and a significant 28% risk reduction for stroke.
And even people with late intensification fared better than those with none, at a nonsignificant 26% risk reduction for myocardial infarction, and significant 29% and 33% reductions for stroke and heart failure, respectively.
People whose treatment regimen was not intensified were older, on average, than the early and delayed intensifiers, at approximately 67 versus 61 years. They also had a longer duration of diabetes (average 9 vs 7 years), the highest rates of neuropathy, renal disease, and chronic obstructive pulmonary disease, and were more likely to be taking lipid-lowering agents.
“The importance of early timing of treatment initiation and the careful selection of patients for optimal treatment outcomes is evident,” concluded the researchers.
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