Use of Insulin Therapy in VA for Treating Type 2 Diabetic Patients 2002-2013 Open Access

Zhu, Shiyun (2016)

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Objective:Early initiation of insulin can help diabetic 2 patients maintain target glycemic levels, and is associated with other additional benefits. It is informative to understand the current trend of A1c levels at which insulin is initiated and its association with glycemic response after 12 months, as well as the contribution of insulin to glycemic control.

Methods: Retrospective cohort study, using national VA data to examine 948,874 type 2 diabetic patients between 2002 and 2013, among which 210,183 started on insulin. All had 5-year continuity of care and ≥1 A1c measurements per year. All insulin patients initiated insulin in the 3rd year (termed index year) of the 5 year window. Trend analysis of A1c at insulin initiation and 12-month follow-up was performed for insulin patients by index year. Matched analysis was used to compare the 12 months follow-up and mean change in A1c between insulin and non-insulin group.

Results:Patients were predominately White males, with mean age 64.5 and mean BMI 32.1. Median A1c at insulin initiation decreased from 9.3% to 8.9% between 2002 and 2007, but increased from 8.9% to 9.3% between 2008 and 2013 (P<0.001). Glycemic response after 12 month showed an average 1.07% A1c reduction among insulin patients. Matched on baseline A1c and other covariates, mean follow-up A1c was 7.45% (95CI [7.43, 7.48]) for insulin group, compared to 7.53% (95CI [7.51 - 7.55]) for non-insulin group. At an elevated baseline A1c of 8% or more, insulin group showed nearly twice as much A1c reduction as non-insulin group.

Conclusions: The average A1c level at which insulin is initiated among patients with type 2 diabetes changed little between 2002 and 2013, and remain well above optimal A1c goals. Insulin therapy is an important contributor to glycemic control, particularly at an elevated A1c of ≥8%, in which oral agents or other non-insulin injectable medications cannot produce treatment results as effective as insulin.

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