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Time before initiation of insulin therapy 'increasing'

The time to insulin therapy has increased in type 2 diabetes patients, but the reasons for this ‘unfavourable trend’ are unclear, claim researchers.

The time to insulin therapy has increased in type 2 diabetes patients, but the reasons for this ‘unfavourable trend’ are unclear, claim researchers.

The study

British and German researchers looked at whether the time to insulin therapy in type 2 diabetes patients had increased in primary care between 2005 and 2010. Data from general practices was collected on the time from first diabetes diagnosis (index date) and the first insulin prescription in 1,998 and 6,368 patients in the UK and Germany, respectively. All patients were over the age of 40 at their index date.

The findings

The median time to insulin therapy in primary care practices significantly increased in the UK and Germany, with the median time to insulin therapy increased from 1,700 days to 2,061 days between 2005 and 2010 in British patients. Mean final HbA1c values also significantly increased in both countries, with a value of 9.5% in 2005 to 9.8% in 2010 in British patients.

What this means for GPs

The researchers say that further research is required to determine the underlying reasons for this ‘unfavourable trend’ and noted that ‘the present study confirms previous results that insulin therapy is initiated in patients with type 2 diabetes at a point where HbA1c levels are high above target levels, resulting in an increased risk of developing diabetes complications.’ The researchers warn that ‘larger efforts are required to remove the barriers currently preventing earlier initiation of insulin therapy in patients with type 2 diabetes.’

Primary Care Diabetes 2013, online 20 April

Readers' comments (2)

  • Is the trend really so unfavourable? With the selection of oral therapy available,it gives the clinician an extended opportunity to work on lifestyle changes because, once insulin is started, there is rarely any going back. We need to take into acount the patient's perspective too. Before starting insulin, it seems sensible to try a GLP-1 (if guidelines are met), because the patient can be acclimatized to the process of a daily injection, which is often the main objection to commencing insulin therapy, rather than the insulin itself.

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  • Vinci Ho

    I must say I belong to the school which believes insulin should be initiated earlier rather than as soon as control of HBA1c is not achieved despite maximum oral therapy in Type 2 DM . All oral medications have their own problems . Controversy over pioglitazone ( the only thiozolidinedione left) and recent debates about pancreatitis and pancreatitic cancer on GLP-1 analogue (hence gliptins) cast doubts on oral therapies .
    Insulin resistance wil eventually burn out the beta islet cells in pancreas with time anyway. Yes , insulin will make the weight more difficult to come off and it is not the preference of most patients . But on the balance , I support early than late initiation

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