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Comparative Study
. 2015 May;63(5):893-901.
doi: 10.1111/jgs.13388. Epub 2015 May 8.

A real-world study of the effect of timing of insulin initiation on outcomes in older medicare beneficiaries with type 2 diabetes mellitus

Rituparna Bhattacharya  1 , Steve Zhou  2 , Wenhui Wei  2 , Mayank Ajmera  3 , Usha Sambamoorthi  1
Affiliations
Comparative Study

A real-world study of the effect of timing of insulin initiation on outcomes in older medicare beneficiaries with type 2 diabetes mellitus

Rituparna Bhattacharya et al. J Am Geriatr Soc. 2015 May.

Abstract

Objectives: To compare clinical and economic outcomes of early insulin initiation with those of delayed initiation in older adults with type 2 diabetes mellitus (T2DM).

Design: Retrospective cohort study.

Setting: Humana Medicare Advantage health insurance plan.

Participants: Older (≥65) Medicare beneficiaries with T2DM.

Measurements: Subjects were grouped according to number of classes of oral antidiabetes drugs (OADs) they had taken before initiation of insulin: one (early insulin initiators), two, or three or more (delayed insulin initiators). One-year follow-up outcomes included change in glycosylated hemoglobin (HbA1c), percentage of older adults with HbA1c less than 8.0%, hypoglycemic events, and total healthcare costs.

Results: Overall, 14,669 individuals were included in the analysis. Baseline and 1-year follow-up HbA1c levels were available for 4,028 (27.5%) individuals. Insulin was initiated early in 32% and delayed in 20%. At follow-up, unadjusted reduction in HbA1c was 0.9±3.7% for the group with one OAD, 0.7±2.4% for those with two, and 0.5±3.6% for those with three or more. Early insulin initiation was associated with significantly greater reduction in HbA1c (0.4%; adjusted P<.001), 30% greater likelihood of achieving HbA1c less than 8.0% (adjusted odds ratio=1.30, 95% confidence interval=1.18-1.43), and no significant differences in total costs or hypoglycemia events (11.5% of early initiators vs 10.2% of delayed initiators; P=.32).

Conclusion: This study suggests beneficial effects of early insulin initiation in older adults with T2DM who do not have adequate glycemic control, without increasing the risk of hypoglycemia or greater total direct healthcare costs.

Keywords: delayed insulin initiation; diabetes; early insulin initiation; hypoglycemia.

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Conflict of interest statement

Conflicts of Interest: Wei and Zhou are employees of Sanofi US, Inc., and Wei is a shareholder of Sanofi US, Inc. The study was funded by Sanofi US, Inc.

Figures

Figure 1
Figure 1
Mean (standard error) reduction in glycosylated hemoglobin (HbA1c) at 1-year follow-up compared with baseline, after use of 1, 2, and ≥3 oral antidiabetes drugs (OADs) according to baseline HbA1c categories. Asterisks represent significant group differences from delayed insulin initiation (≥3 OADs) in mean HbA1c reduction according to insulin initiation category (1 OAD and 2 OADs) based on unadjusted ordinary least squares regression with inverse probability treatment weights: ***P ≤ .001; **P < .01; *P < .05.
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