Time to insulin treatment and factors associated with insulin prescription in Swedish patients with type 2 diabetes

• Published in: Diabetes & metabolism Vol. 36; no. 3; pp. 198 - 203
• Main Authors: Ringborg, A, Lindgren, P, Yin, D.D, Martinell, M, Stålhammar, J
• Format: Journal Article
• Language: English
• Published: Paris Elsevier Masson SAS 01.06.2010; Masson
• Subjects: Aged; Aged, 80 and over; Antidiabétiques oraux; Biological and medical sciences; Body Mass Index; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetes. Impaired glucose tolerance; Diabète de type 2; Endocrine pancreas. Apud cells (diseases); Endocrinology & Metabolism; Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glycated Hemoglobin A - metabolism; Humans; Hyperglycaemia; Hyperglycémie; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Insulin treatment; Insuline; Internal Medicine; Kaplan-Meier Estimate; Male; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Oral antidiabetic agents; Proportional Hazards Models; Retrospective Studies; Secondary failure; Suède; Sweden; Sweden - epidemiology; Time Factors; Treatment Outcome; Type 2 diabetes mellitus; Échec secondaire; Sweden; Europe; Real-Life Effectiveness and Care Patterns in Diabetes Management; Hyperglycaemia; Oral antidiabetic agents; CI; S.D; HR; hazards ratio; Type 2 diabetes mellitus; RECAP-DM; Suède; Sweden; Diabète de type 2; OAD; Secondary failure; Insuline; Insulin treatment; confidence interval; Antidiabétiques oraux; Échec secondaire; oral antidiabetic drug; Hyperglycémie; standard deviation; Endocrinopathy; Type 2 diabetes; Human; Pancreatic hormone; Hyperglycemia; Treatment; Metabolic diseases; Insulin; Swedish
• ISSN: 1262-3636; 1878-1780; 1878-1780
• DOI: 10.1016/j.diabet.2009.11.006

Abstract Aims The purpose of this study was to investigate the time between the start of OAD treatment and the initiation of insulin therapy and to identify the factors associated with insulin prescription among Swedish patients with type 2 diabetes in Uppsala County. Methods Retrospective, population-based, primary-care data gathered within the Swedish RECAP-DM study were used to identify type 2 diabetic patients who initiated OAD treatment. A Kaplan-Meier survival estimate for time to initiation of insulin therapy was generated and factors associated with insulin prescription were tested using a Cox proportional-hazards model. Results Within 6 years of starting OAD treatment, an estimated 25% of Swedish patients with type 2 diabetes will be prescribed insulin (95% CI: 0.23–0.26) and, within 10 years, this figure will rise to 42% (95% CI: 0.39–0.45). The probability of insulin prescription was increased in patients aged less than 65 years (HR = 1.24, 95% CI: 1.03–1.50) and in those who initiated OAD treatment with more than one agent (HR = 2.71, 95% CI: 2.15–3.43). HbA 1c at the time of starting OAD treatment was also related to the probability of insulin prescription (HR = 1.20, 95% CI: 1.146–1.25). Conclusion Many type 2 diabetic patients who begin treatment with an OAD will eventually be prescribed insulin. Age, disease severity and the type of prior treatment may affect the rate of the transition.