An analysis of the UK Clinical Practice Research Datalink has shown that the majority of people with type 2 diabetes on basal insulin therapy who are clinically eligible for treatment intensification experience long delays or fail to intensify insulin at all. This may have a negative impact on long-term outcomes.
The authors evaluated a total of 11 696 people with type 2 diabetes who had started basal insulin therapy between January 2004 and December 2011, with final follow-up in December 2013. Among these, 6072 became eligible for treatment intensification (HbA1c, ≥59 mmol/mol [7.5%]). However, only 30.9% of these underwent intensification (bolus insulin, premixed insulin or a glucagon-like peptide-1 receptor agonist), and the median time to intensification in this group was 3.7 years after HbA1c first exceeded the target. Many (46.5%) stopped basal insulin completely.
These findings suggest that, rather than treating to target, many clinicians are allowing their patients to have excessive HbA1c for extended periods before intensifying treatment. While the authors note that some of these may have been prudent decisions by clinicians who wanted to avoid complications such as hypoglycaemia in frail people (increased age was associated with delays in treatment intensification), failure to improve glycaemic control may have negative consequences itself.
The study was supported by Novo Nordisk. It can be read in full here.
