What happens after patients with T2D decline insulin therapy?

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

  • International Clinical Digest
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  • 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).


  • 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. 

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