A comparison of duration of first prescribed insulin therapy in uncontrolled type 2 diabetes

Abstract

AimsWe investigated whether differences in duration of first insulin use in type 2 diabetes remain after adjustment for potential confounders, and what factors are associated with longer use. MethodsPeople prescribed a first insulin (2000–2007) after 2–3 non-insulin glucose lowering treatments (OGLD) were identified from the THIN UK primary care database and grouped by insulin, detemir (n=165), glargine (n=1011) or NPH (n=420). Time from beginning insulin to the prescription of another insulin type or a glucagon-like peptide was compared between insulins in a Cox model adjusting for: demographics, HbA1c, history of vascular complications and cardiovascular risk factors. The strength of association between duration of use and these variables was investigated. ResultsThe adjusted hazard ratios compared to glargine for treatment change were 1.58 (95% CI 1.25, 2.00) for detemir and 1.49 (1.25, 1.78) for NPH. Lower mean treatment HbA1c correlated with longer time to a different insulin regimen (Spearman rank correlation −0.30, p<0.01) as were continuing OGLDs, older age, longer time from diagnosis, lower body mass index, lower HbA1c, and no heart failure at baseline. ConclusionsPeople who began treatment with glargine and those with better on-treatment HbA1c remained on their first insulin for longer than those who began detemir or NPH.