Delays in Insulin Initiation among Patients with Type 2 Diabetes Mellitus in Southeast China: A Retrospective, Real-World Study

Pin Chen,1 Xiao Ma,2 Hong Chen,2 Ke Wang,2 Li Zhou2 1Department of Endocrinology, 900 Hospital of the Joint Logistics Team, Fuzhou Clinical Medical College of Fujian Medical University, Fuzhou, People’s Republic of China; 2Lilly Suzhou Pharmaceutical, Shanghai, People’s Republic...

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Autores principales:	Chen P, Ma X, Chen H, Wang K, Zhou L
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	type 2 diabetes mellitus therapeutic inertia delayed insulin initiation glycemic control hba1c Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/9d295af7edac47aa9c3ae30e85e1ef89
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spelling	oai:doaj.org-article:9d295af7edac47aa9c3ae30e85e1ef892021-12-02T10:26:12ZDelays in Insulin Initiation among Patients with Type 2 Diabetes Mellitus in Southeast China: A Retrospective, Real-World Study1178-7007https://doaj.org/article/9d295af7edac47aa9c3ae30e85e1ef892020-08-01T00:00:00Zhttps://www.dovepress.com/delays-in-insulin-initiation-among-patients-with-type-2-diabetes-melli-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Pin Chen,1 Xiao Ma,2 Hong Chen,2 Ke Wang,2 Li Zhou2 1Department of Endocrinology, 900 Hospital of the Joint Logistics Team, Fuzhou Clinical Medical College of Fujian Medical University, Fuzhou, People’s Republic of China; 2Lilly Suzhou Pharmaceutical, Shanghai, People’s Republic of ChinaCorrespondence: Li ZhouLilly Suzhou Pharmaceutical, Shanghai, People’s Republic of ChinaEmail zhou_li7@lilly.comPurpose: To describe the extent of delays in insulin initiation, analyze its impact on glycemic control, and explore factors influencing delayed insulin initiation among Chinese type 2 diabetes mellitus (T2DM) patients.Methods: A real-world, retrospective cohort study with regional electronic health records from Fuzhou, southeast China was conducted among T2DM patients. Adult patients uncontrolled with oral antidiabetic drugs (OADs; HbA1c ≥ 7%) and initiated on insulin treatment were included. Time to insulin initiation was described. After propensity-score matching, Wilcoxon rank-sum test and chi-square test were used to compare follow-up HbA1c (first HbA1c 3 months after insulin initiation) between timely (initiated insulin within 6 months after OAD failure) and delayed (initiated after 6 months) insulin-initiation groups. Sensitivity analysis was also performed by linear and logistic regression. Factors associated with delayed insulin initiation were explored using logistic regression.Results: A total of 940 patients were included, with mean±SD age 66.3± 11.9 years. In sum, 328 had HbA1c recorded 3 months after insulin initiation. After propensity-score matching (1:1 matching), 184 patients were included for further analysis. Median follow-up HbA1c was lower in the timely-initiation group than the delayed-initiation group (7.25% vs 8.25%, P=0.009). Patients in the timely initiation group also had higher odds of achieving HbA1c < 7% (OR=3.15, P=0.001). Results were confirmed by logistic regression. Hypertension, coronary artery disease, baseline HbA1c, and hospital level at insulin initiation were associated with delays in insulin initiation.Conclusion: Timely insulin initiation after OAD failure is associated with better glycemic control.Keywords: type 2 diabetes mellitus, therapeutic inertia, delayed insulin initiation, glycemic control, HbA1cChen PMa XChen HWang KZhou LDove Medical Pressarticletype 2 diabetes mellitustherapeutic inertiadelayed insulin initiationglycemic controlhba1cSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 13, Pp 3059-3068 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	type 2 diabetes mellitus therapeutic inertia delayed insulin initiation glycemic control hba1c Specialties of internal medicine RC581-951
spellingShingle	type 2 diabetes mellitus therapeutic inertia delayed insulin initiation glycemic control hba1c Specialties of internal medicine RC581-951 Chen P Ma X Chen H Wang K Zhou L Delays in Insulin Initiation among Patients with Type 2 Diabetes Mellitus in Southeast China: A Retrospective, Real-World Study
description	Pin Chen,1 Xiao Ma,2 Hong Chen,2 Ke Wang,2 Li Zhou2 1Department of Endocrinology, 900 Hospital of the Joint Logistics Team, Fuzhou Clinical Medical College of Fujian Medical University, Fuzhou, People’s Republic of China; 2Lilly Suzhou Pharmaceutical, Shanghai, People’s Republic of ChinaCorrespondence: Li ZhouLilly Suzhou Pharmaceutical, Shanghai, People’s Republic of ChinaEmail zhou_li7@lilly.comPurpose: To describe the extent of delays in insulin initiation, analyze its impact on glycemic control, and explore factors influencing delayed insulin initiation among Chinese type 2 diabetes mellitus (T2DM) patients.Methods: A real-world, retrospective cohort study with regional electronic health records from Fuzhou, southeast China was conducted among T2DM patients. Adult patients uncontrolled with oral antidiabetic drugs (OADs; HbA1c ≥ 7%) and initiated on insulin treatment were included. Time to insulin initiation was described. After propensity-score matching, Wilcoxon rank-sum test and chi-square test were used to compare follow-up HbA1c (first HbA1c 3 months after insulin initiation) between timely (initiated insulin within 6 months after OAD failure) and delayed (initiated after 6 months) insulin-initiation groups. Sensitivity analysis was also performed by linear and logistic regression. Factors associated with delayed insulin initiation were explored using logistic regression.Results: A total of 940 patients were included, with mean±SD age 66.3± 11.9 years. In sum, 328 had HbA1c recorded 3 months after insulin initiation. After propensity-score matching (1:1 matching), 184 patients were included for further analysis. Median follow-up HbA1c was lower in the timely-initiation group than the delayed-initiation group (7.25% vs 8.25%, P=0.009). Patients in the timely initiation group also had higher odds of achieving HbA1c < 7% (OR=3.15, P=0.001). Results were confirmed by logistic regression. Hypertension, coronary artery disease, baseline HbA1c, and hospital level at insulin initiation were associated with delays in insulin initiation.Conclusion: Timely insulin initiation after OAD failure is associated with better glycemic control.Keywords: type 2 diabetes mellitus, therapeutic inertia, delayed insulin initiation, glycemic control, HbA1c
format	article
author	Chen P Ma X Chen H Wang K Zhou L
author_facet	Chen P Ma X Chen H Wang K Zhou L
author_sort	Chen P
title	Delays in Insulin Initiation among Patients with Type 2 Diabetes Mellitus in Southeast China: A Retrospective, Real-World Study
title_short	Delays in Insulin Initiation among Patients with Type 2 Diabetes Mellitus in Southeast China: A Retrospective, Real-World Study
title_full	Delays in Insulin Initiation among Patients with Type 2 Diabetes Mellitus in Southeast China: A Retrospective, Real-World Study
title_fullStr	Delays in Insulin Initiation among Patients with Type 2 Diabetes Mellitus in Southeast China: A Retrospective, Real-World Study
title_full_unstemmed	Delays in Insulin Initiation among Patients with Type 2 Diabetes Mellitus in Southeast China: A Retrospective, Real-World Study
title_sort	delays in insulin initiation among patients with type 2 diabetes mellitus in southeast china: a retrospective, real-world study
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/9d295af7edac47aa9c3ae30e85e1ef89
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Delays in Insulin Initiation among Patients with Type 2 Diabetes Mellitus in Southeast China: A Retrospective, Real-World Study

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