Determinants and consequences of insulin initiation for type 2 diabetes in France: analysis of the National Health and Wellness Survey

Abstract

BackgroundThe aim of the study was to identify the intrinsic patient characteristics and extrinsic environmental factors predicting prescription and use and, more specifically, early initiation (up to 5 years of disease duration) of insulin for type 2 diabetes in France. A secondary objective was to evaluate the impact of insulin therapy on mental and physical quality of life and patient adherence.MethodsThe data used in this study were derived from the 2008, 2010, and 2011 France National Health and Wellness Survey. This survey is an annual, cross-sectional, self-administered, Internet-based questionnaire among a nationwide representative sample of adults (aged 18 years or older). Of the total of 45,958 persons recruited in France, 1,933 respondents (deduped) were identified as diagnosed with type 2 diabetes. All unique respondents from the three waves, currently using insulin or oral bitherapy or tritherapy at the time of assessment, were included in this analysis.ResultsEarly (versus late) initiation of insulin therapy was 9.9 times more likely to be prescribed by an endocrinologist or diabetologist than by a primary care physician (P < 0.0001). Younger age at diagnosis and current smoking habits were significant predictors of early (versus late) insulin initiation (odds ratio [OR] 1.031, 95% confidence interval [CI] 1.005–1.059, P = 0.0196, and OR 2.537, 95% CI 1.165–5.524, P = 0.0191, respectively). Patients with a yearly income ≥€50,000 were less likely to be put on insulin early (P = 0.0399). A link between insulin prescription and complications was shown only in univariate analysis. Mental quality of life was lower in patients on early (versus late) insulin, but only in patients with diabetes-related complications. Insulin users (versus oral bitherapy or tritherapy users) had 3.0 times greater odds of being adherent than uncontrolled oral bitherapy or tritherapy users (OR 2.983, 95% CI 1.37–6.495, P = 0.0059).ConclusionThis study confirms the role of specialists in early initiation of insulin, and the data presented herein reflect the fact that early initiation is more frequent in younger patients, patients with diabetes-related complications, and current smokers, and less frequent in patients with a higher income. Moreover, we observed that being treated with insulin was not associated with deterioration in quality of life, and insulin-treated patients were more often adherent than uncontrolled oral bitherapy or tritherapy users. These data suggest that doctors’ concerns about patient adherence and detrimental effects on quality of life should not be a barrier to their decision regarding early initiation of insulin therapy. Due to the nature of this cross-sectional survey (eg, inability to assess treatment flow), further research is needed to confirm its findings.

Progression to insulin therapy among patients with type 2 diabetes treated with sitagliptin or sulphonylurea plus metformin dual therapy

“…After controlling for treatment type, patient characteristics and laboratory assessments, the only significant comorbid condition associated with earlier insulin use was obesity. This is actually contrary to other literature that did find a positive association between insulin use and a range of other comorbidities 4, 7, 9, 11, 13; however, none of these previous studies used propensity score matching. Notably, Fu et al.…”

“…The finding that HbA1c was significantly associated with insulin initiation is not surprising and is consistent with a number of previous studies 2, 8, 9, 10, 11, 12, 13, 14, 15. After controlling for treatment type, patient characteristics and laboratory assessments, the only significant comorbid condition associated with earlier insulin use was obesity.…”

Heterogeneity of change in state affect following insulin therapy initiation in type 2 diabetic patients

“…In developed countries the peak incidence for type 2 diabetes is noted in adults aged about 65 years (Wild, Roglic, Green, Sicree, & King, 2004). Thus, patients significantly younger may perceive the disease as more burdensome and stigmatizing (Skinner et al, 2011), and insulin therapy as interfering with their occupational career (Reach et al, 2013) or social life, which would contribute to increasing NA. As compared to the "no response" subgroup, patients from the ambivalent subgroup representing "challenge response" rated their material status lower and more often had vocational education.…”

“…Some studies reported either no change in the patients' quality of life (de Grauw, van de Lisdonk, van Gerwen, van den Hoogen, & van Weel, 2001;UKPDS 37, 1999) or negative mood changes including problems with social functioning, greater emotional fatigue and perceived burdensomeness of the treatment (Goddjin et al, 1999;Reach, Le Pautremat, & Gupta, 2013;de Sonnaville et al, 1998), as well as increased tension, but only in patients with more frequent hypoglycemic episodes (UKPDS 37, 1999). Opposite effects were also noted, i.e.…”

Patients' perspectives on taking insulin in diabetes - Perspectives of convergence

“…Clinicians recommend insulin therapy to achieve successful glycemic control for diabetes mellitus (DM), as it can compensate for adequate plasma glucose levels and reduce the micro/macrovascular complications of DM [1]. Unfortunately, many patients may delay beginning insulin therapy because of misconceptions about insulin and attitudinal barriers such as fears of needles or social stigma [1,2,3,4,5].…”