What happens after patients with T2D decline insulin therapy?

  • Florez L & al.
  • J Diabetes Complicat
  • 19 Aug 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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>
  • Probability of HbA1c decrease after declining insulin was lower with:
    • Nonadherence to diabetes medications: OR, 0.014 (P<.001 and>
    • Discontinuation of noninsulin diabetes medications: OR, 0.30 (P=.016).

Limitations

  • 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. 

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit