Delays in insulin initiation among patients with type 2 diabetes mellitus in southeast china: A retrospective, real-world study

Abstract

Purpose: To describe the extent of delays in insulin initiation, analyze its impact on glycemic control, and explore factors influencing delayed insulin initiation among Chinese type 2 diabetes mellitus (T2DM) patients. Methods: A real-world, retrospective cohort study with regional electronic health records from Fuzhou, southeast China was conducted among T2DM patients. Adult patients uncon-trolled with oral antidiabetic drugs (OADs; HbA1c ≥7%) and initiated on insulin treatment were included. Time to insulin initiation was described. After propensity-score matching, Wilcoxon rank-sum test and chi-square test were used to compare follow-up HbA1c (first HbA1c 3 months after insulin initiation) between timely (initiated insulin within 6 months after OAD failure) and delayed (initiated after 6 months) insulin-initiation groups. Sensitivity analysis was also performed by linear and logistic regression. Factors associated with delayed insulin initiation were explored using logistic regression. Results: A total of 940 patients were included, with mean±SD age 66.3±11.9 years. In sum, 328 had HbA1c recorded 3 months after insulin initiation. After propensity-score matching (1:1 matching), 184 patients were included for further analysis. Median follow-up HbA1c was lower in the timely-initiation group than the delayed-initiation group (7.25% vs 8.25%, P=0.009). Patients in the timely initiation group also had higher odds of achieving HbA1c <7% (OR=3.15, P=0.001). Results were confirmed by logistic regression. Hypertension, coronary artery disease, baseline HbA1c, and hospital level at insulin initiation were associated with delays in insulin initiation. Conclusion: Timely insulin initiation after OAD failure is associated with better glycemic control.