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Five-Year Predictors of Insulin Initiation in People with Type 2 Diabetes under Real-Life Conditions.

Department of Clinical and Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy. Diabetes Center, San Raffaele Termini, Rome, Italy. Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genova, Italy. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. IRCSS Casa Sollievo della Sofferenza-Unit of Internal Medicine, Scientific Institute, San Giovanni Rotondo, Italy. Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain. Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica, Milan, Italy. Diabetes and Metabolism Unit ASL Turin 5, Chieri, Italy. Statistical Consultant, Associazione Medici Diabetologi (AMD), Rome, Italy. Department of Medicine, University of Padua, Padua, Italy. Associazione Medici Diabetologi (AMD), Rome, Italy.

Journal of diabetes research. 2018;:7153087
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Abstract

We performed a real-life analysis of clinical and laboratory parameters, in orally treated T2DM patients aiming at identifying predictors of insulin treatment initiation. Overall, 366955 patients (55.8% males, age 65 ± 11 years, diabetes duration 7 ± 8 years) were followed up between 2004 and 2011. Each patient was analyzed step-by-step until either eventually starting insulin treatment or getting to the end of the follow-up period. Patients switching to insulin showed a worse global risk profile, longer disease duration (10 ± 9 years vs. 6 ± 7 years, respectively; p < 0.001), higher HbA1c (8.0 ± 1.6% vs. 7.2 ± 1.5%, respectively; p < 0.001), higher triglycerides, a greater prevalence of arterial hypertension, antihypertensive, lipid-lowering and aspirin treatment, a higher rate of nonproliferative/proliferative retinopathy, and a nearly 4 times lower prevalence of the "diet alone." They also showed a higher prevalence of subjects with eGFR < 60 ml/min/1.73 m2 (24.0% vs. 16.2%, respectively; p < 0.001). Multivariate analysis identified diabetes duration, HbA1c, triglyceride and low HDL-C values, presence of retinopathy or renal dysfunction, and sulphonylurea utilization (the risk being approximately 3 times greater in the latter case) as independent predictors of insulin treatment initiation. LDL-C, lipid-lowering treatment, and overweight/obese seem to be protective. Results of tree analysis showed that patients on sulphonylurea, with high HbA1c, eGFR below 50 ml/min/1.73 m2, and at least 5-year disease duration, are at very high risk to start insulin treatment. We have to stick to this real-life picture, of course, until enough data are collected on patients treated with innovative medications which are expected to improve beta cell survival and further delay treatment-related insulin requirement.