- When patients with type 2 diabetes (T2D) decline insulin therapy, clinicians still have some options for them.
- Specific patient characteristics such as baseline glucose levels and therapeutic actions, such as lifestyle changes and adherence to noninsulin treatments, can improve glycemic control.
Why this matters
- Many patients with T2D decline to initiate insulin therapy, but their subsequent clinical progression is not known.
- Retrospective study at 2 academic medical centers of 300 patients with T2D who declined insulin therapy during 1993-2014, including 150 whose HbA1c then declined.
- Funding: None.
- Baseline HbA1c was higher among those whose HbA1c dropped after declining insulin (9.5% vs 8.5%; P<.001>
- In multivariable analysis adjusted for demographics, comorbidities, and clustering within providers, greater HbA1c decrease seen with:
- Higher baseline HbA1c: OR, 1.83 (P<.001 and>
- Lifestyle changes implemented after the initial decline of insulin therapy: OR, 8.39 (P<.001>
- Nonadherence to diabetes medications: OR, 0.014 (P<.001 and>
- Discontinuation of noninsulin diabetes medications: OR, 0.30 (P=.016).
- Observational, cannot prove causation.
- Possible residual confounders.
- 2 groups not matched on baseline HbA1c.
- No data on intensity of lifestyle intervention, magnitude of medication nonadherence.
- Might not be generalizable.