Does Rapid Transition to Insulin Therapy in Subjects with Newly Diagnosed Type 2 Diabetes Mellitus Benefit Glycaemic Control and Diabetes-related Complications? A German Population-based Study

Abstract

Using actual real world clinical practice data, the present study found that the immediate use of insulin in patients with type 2 diabetes improved blood glucose control as measured by the AUC for HbA1c readings. This, in turn, reduced the risk of diabetes-related complications. In contrast, we observed that a stepwise transition treatment pattern (switching from diet and exercise to sulfonylureas and then perhaps to antihyperglycaemic agents and finally insulin) increased the risk of diabetes-related complications. Greater effort is required to remove some of the barriers currently preventing earlier initiation of insulin therapy in patients with type 2 diabetes.

An Economic Evaluation of Colesevelam when Added to Metformin-, Insulin- or Sulfonylurea-Based Therapies in Patients with Uncontrolled Type 2 Diabetes Mellitus

“…[17] To address these shortcomings, we developed and validated three diabetic risk equations (DREs) using generalized estimating equations (GEEs) [17] that make use of all available HbA 1c measurements and their variability across time. Those validated equations replicated the coefficients within 1/100th in newly diagnosed patients with T2DM in the UK, [18] Germany [19] and the US [20] for the relationship between treatment and effects on HbA 1c and consequently the effects of HbA 1c on incremental changes in diabetes-related complications, [20] thus improving precision, specificity and consistency. We used the US-validated DRE to evaluate the number of diabetic complications avoided due to better glycaemic control in patients treated with colesevelam who had previously not achieved control despite ongoing treatment with metformin-, insulin-or sulfonylurea-based therapies (monotherapy or combination therapy with other oral antidiabetic [OAD] agents).…”

“…Impact of pharmacological interventions on glycaemic control (glycosylated haemoglobin [HbA 1c ]) as well as the relationships for incremental changes in HbA 1c (i.e. a 1% change in HbA 1c ) and the risk of diabetes mellitus-related complications, predicted using the Diabetic Risk Equations Study country/primary endpoint UK study [18] German study [19] US database [20] Population size 2137 3190 497 716…”

Comparative Effectiveness of Hypoglycemic Medications Among Veterans

“…Recent data suggest that earlier use of insulin may be beneficial; replacing oral medications with insulin at onset of treatment of diabetes may lead to better control of hemoglobin A1c and reduced complications. 16 However, despite better glycemic control, all-cause mortality (from hypoglycemia, weight gain, and colorectal cancer) may increase. 17 Our data, while not directly addressing the timing of start of insulin, suggest that exposure to insulin is associated with higher all-cause mortality, even after adjusting for severity of illness.…”

Is Basal Insulin Always the First Choice for Initiation of Insulin Therapy in Type 2 Diabetic Patients?

“…Increments of insulin doses are suggested until fasting glucose reaches the target of 7.22 mmol / l; the use of rapid-acting meal-time insulin is considered only when the HbA1c target is not reached despite optimal control of fasting glucose [1] . The use of insulin in patients with metformin monotherapy failure has been questioned by some authors; in fact, while many specialists prefer the addition of insulin secretagogues and / or thiazolidinediones in patients inadequately controlled with metformin alone, others propose insulin as a fi rst-line treatment in drug-na ï ve patients [2] . Furthermore, the relative contribution of fasting and postprandial hyperglycemia to the elevation of HbA1c in type 2 diabetic patients is controversial [3 -5] .…”