SUN-162 Long-Term Evaluation of Intensive Insulin Therapy in Patients with Type 2 Diabetes Mellitus (Value-It Study)

Abstract

Background: This study aimed to determine long-term effect of intensive insulin therapy on prevention, progression, and development of chronic diabetes complications, both micro- and macrovascular events. This study also aimed to evaluate long-term sustainability of glycemic control of patients on intensive insulin treatment. Methods: A retrospective review of adult Type 2 diabetes mellitus (T2DM) patients on intensive insulin therapy for ≥7 years. Demographic data, co-morbidities, body mass index (BMI), HbA1c, hospitalization were collated. Majority received intensive insulin therapy with combination of premixed 70/30 given two times a day and fast short acting analogue given premeals three times a day, with the addition of glargine or degludec once a day in some. Results: Among 76 patients, 62% were males and 38% were females. Mean age at diagnosis and last visit were 53 and 65 years, respectively. At time of diagnosis, patient had the following co-morbidities: hypertension (32%), dyslipidemia (13%), non-dialyzable chronic kidney disease (4%), thyroid disease (1%), pulmonary tuberculosis (1%). In terms of long-term complications, only one patient had an acute coronary event, 2 patients had CKD needing dialysis with only 9% recorded to have cerebro-vascular accident during follow-up. There were no blindness and amputation observed. There is a statistical difference between HbA1c levels at time of diagnosis (8.53 ± 1.86) and last follow up (7.83 ± 1.71) ( P = 0.00). After a median follow up of 12 years (7-22 years), glycemic control was sustained with an HbA1c of ≤ 7% and ≤ 8% in 32% and 45% of patients, respectively. Conclusion: With intensive insulin therapy, micro- and macrovascular complications can be prevented significantly. Long-term sustainability of glycemic control was also achieved.