Abstract
AimTo use baseline characteristics of the Cardiovascular Risk Evaluation in people with type 2 Diabetes on Insulin Therapy study population to identify factors that could explain the choice of insulin therapy when beginning insulin.MethodsThe source, non-interventional, longitudinal, long-term study involves 314 centres in 12 countries in five regions. People were enrolled having started any insulin regimen in the previous 12 months. To identify factors associated with the choice of insulin regimen, multivariable backward logistic regression was performed on eligible physician and participant explanatory variables.ResultsParticipants (N = 3031) had mean age 62 years, diabetes duration 11 years, body mass index 29.3 kg/m2 and an HbA1c of 9.5%. Participants in Japan had less hypertension, smoked more and used fewer concomitant medications than those of other regions. Only physician location (rural or urban) influenced the choice of insulin in Japan. In the other four-regions-combined, physician location, specialty, sex and practice type influenced choice of insulin as did participant location, baseline HbA1c, use of glucose-lowering therapies and prior insulin secretagogue use.ConclusionChoice of initial insulin regimen was influenced by several physician and participant characteristics in Canada and Europe, but only by physician location in Japan.
Highlights
Landmark clinical trials have established that good glycaemic control in people with type 2 diabetes mellitus (T2DM) can prevent long-term microvascular complications and may prevent macrovascular problems, associated with the condition [1,2,3]
An expert consensus group with representatives from The American Diabetes Association and the European Association for the Study of Diabetes recommended that people with T2DM begin insulin with a basal insulin regimen [4]
Thirty people were excluded from the analysis population (N = 3031) due to receiving insulin for >12 months before study entry (n = 23), having type 1 diabetes (n = 3) or diabetes due to pancreatitis (n = 2) or pregnancy (n = 1) and having no time between starting insulin and study entry (n = 1)
Summary
Landmark clinical trials have established that good glycaemic control in people with type 2 diabetes mellitus (T2DM) can prevent long-term microvascular complications and may prevent macrovascular problems, associated with the condition [1,2,3]. When the target levels cannot be maintained by multiple OGLDs, insulin therapy is often commenced. An expert consensus group with representatives from The American Diabetes Association and the European Association for the Study of Diabetes recommended that people with T2DM begin insulin with a basal insulin regimen [4]. The recommendation from the International Diabetes Federation Clinical Guidelines Task Force is broader and includes beginning with basal insulin, premix insulin or basal + mealtime insulin regimens [5]. While a number of both qualitative and quantitative factors have been identified as important for initiating any insulin therapy [8], it is of interest to investigate what factors are predictive for the initial choice of an insulin regimen
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