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Erschienen in:
01.09.2012 | Original article
The initiation of insulin therapy in type 2 diabetic patients treated with oral anti-diabetic drugs: an observational study in multiple institutes across Japan (JDDM27)
Erschienen in: Diabetology International | Ausgabe 3/2012
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Introduction
We examined the clinical characteristics of type 2 diabetes mellitus (T2D) patients requiring insulin therapy and evaluated the efficacy of adding insulin therapy regimens to oral anti-diabetic drugs.
Materials and methods
Members of the Japan Diabetes Data Management Study Group across 55 institutes specializing in diabetes entered their clinical data into the CoDiC® database. Of 19,800 patients treated with oral drugs from 1 May to 31 July 2006, we analyzed the data from 15,589 patients whose data input was continued until 31 July 2009.
Results
A total of 1,014 patients out of those studied were started on insulin therapy during 2006–2009. Age and age-of-onset were lower in the insulin-initiated patients compared with patients who continued on oral drugs (P < 0.001). Insulin therapy was initiated at a mean HbA1c level of 9.18 %. The HbA1c levels at 6 months after initiation of insulin treatment and at the end of the study were lowest in patients treated with a prandial rapid-acting insulin analog (RA) (P < 0.001). Only 7 patients were started on the basal-bolus therapy, while 95 patients were transferred to this therapy from their original insulin regimen. These patients had the lowest age and age-of-onset, and the highest body mass index (P < 0.001, P = 0.003 and P = 0.013, respectively).
Conclusion
The initiation rate of insulin therapy in patients treated with oral drugs is estimated to be 2.2/100 per year in Japan, and the therapy is initiated at an HbA1c level far from the target level. The significant characteristics of patients who started on insulin therapy were a relatively low age and age-of-onset, and long diabetes duration. Prandial RA insulin treatment is superior for glycemic control, and this therapy can be transferred to basal-bolus therapy based on the severity of T2D.