Delay of insulin therapy in type 2 diabetics

Abstract

Type 2 diabetes (T2DM) is a progressive disease. Insulin appears early in the therapeutic intensification algorithm, but is still a last resort. This delay is frequent but its duration has been little studied in the Tunisian population. The main objective of this study was to identify and evaluate, in a specialized center, the delay in insulin therapy in type 2 diabetics.
This was a retrospective, cross-sectional study of 140 patients. DT2 were included as oral antidiabetic agents, including at least one optimal dose sulfonamide, hospitalized for insulin therapy between January 1, 2014 and December 31, 2015. The delay in insulin therapy was defined by the succession of two HbA1c values ≥8% at least 3 months apart. Its duration, in months, calculated in 90 patients, corresponds to that passed between T0 where HbA1c ≥8% and T1 at the insulin initiation.
Our population was 74 women and 66 men, mean age 58.2 ± 11.7 years. The average duration of diabetes was 10.3 ± 6.1 years; mean fasting glucose and HbA1c were 11.9 ± 3.6 mmol / l and 11.3 ± 2%, respectively. The delay in insulin therapy concerned all patients. Its average duration was 39 ± 29 months with extremes of 6 months to 10 years. Mean HbA1c increased significantly from 10 ± 1.5% to 11.2 ± 2% between T0 and T1 (p <10-3). A shift to insulin beyond three years was associated with the duration of diabetes (p = 0.03) and dyslipidemia (p = 0.04).
Insulin therapy is late even in a specialized center. This therapeutic inertia is universal. Its causes should be better studied to be better mastered.