A retrospective cohort study of people aged over 65 years with type 2 diabetes has shown that switching to insulin earlier results in improved HbA1c without affecting the risk of hypoglycaemia or healthcare costs.
Data on 4028 Medicare beneficiaries in the US were evaluated. Participants were classified according to the number of oral antidiabetes drugs (OADs) they had taken before switching to insulin. Early switchers were defined as those who switched after one OAD.
At 1 year after switching, mean HbA1c had fallen by 9.8 mmol/mol (0.9%) in the group who switched after one OAD, 7.6 mmol/mol (0.7%) in those who switched after two OADs and 5.4 mmol/mol (0.5%) in those who switched after three or more OADs. Early initiation was associated with a significantly greater reduction in HbA1c (4.3 mmol/mol [0.4%]; adjusted P<0.001) and a 30% greater likelihood of achieving an HbA1c <64 mmol/mol (8.0%). There were no significant differences between early and later initiators in terms of hypoglycaemic events (11.5% vs 10.2% of participants) or healthcare costs.
The study can be read in full here.
