Delay Of Insulin Addition To Oral Combination Therapy Despite Inadequate Glycemic Control

Nichols, Gregory A.; Koo, Yuri H.; Shah, Sonali

doi:10.1007/s11606-007-0139-y

Cited by 129 publications

(121 citation statements)

References 26 publications

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“…Currently, ADA guidelines 1 recommend metformin as the first-line oral agent, in large part because it is at least weight neutral and may cause weight loss. Our data provide further support (consistent with prior research [22][23][24] that the use of SUs in the 1st year after diabetes diagnosis should be avoided (when appropriate) if weight is a concern. Patients who initially successfully lost weight appear to need additional support to maintain weight loss, because regain was the norm.…”

Section: Discussionsupporting

confidence: 89%

Weight Change and Glycemic Control After Diagnosis of Type 2 Diabetes

et al. 2008

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Section: Discussionsupporting

confidence: 89%

Weight Change and Glycemic Control After Diagnosis of Type 2 Diabetes

et al. 2008

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“…Studies in patients inadequately responding to oral glucose-lowering agents showed a time to insulin initiation varying between 2 and 8 years (8,9,10). However, these studies were retrospective and were generally based on registries from primary care practices (PCPs) prior to 2005.…”

Section: Introductionmentioning

confidence: 99%

Time to insulin initiation and long-term effects of initiating insulin in people with type 2 diabetes mellitus: the Hoorn Diabetes Care System Cohort Study

Mast

Jansen

Walraven

et al. 2016

European Journal of Endocrinology

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Objective: The aim of this study was to assess the time to insulin initiation in type 2 diabetes mellitus (T2DM) patients treated with oral glucose-lowering agents and to determine the baseline characteristics associated with time to insulin initiation. This was evaluated in T2DM patients with HbA1c levels consistently R7.0% during total follow up and in those with fluctuating HbA1c levels around 7.0%. Design and methods: Prospective, observational study was performed, comprising 2418 persons with T2DM aged R40 years who entered the Diabetes Care System between 1998 and 2012 with a minimum follow up of at least 3 years, following the first HbA1c level R7.0%. Cox regression analyses were performed to assess the determinants of time to insulin initiation. Data related to long-term effects of insulin initiation were studied at baseline and at the end of follow up using descriptive summary statistics. Results: Two-thirds of the patients initiated insulin during follow up. The time to insulin varied from 1.2 years (range 0.3-3.1) in patients with HbA1c levels consistently R7.0% to 5.4 years (range 3.0-7.5) in patients with fluctuating HbA1c levels around 7.0%. Longer diabetes duration (hazard ratio (HR) 1.04 95% CI 1.03-1.05) and lower age (HR 1.00 95% CI 0.99-1.00) at baseline were associated with a shorter time to initiation. More insulin initiators had retinopathy compared with patients that remained on oral glucose-lowering agents during follow up. Conclusion: The time to insulin initiation was short, and most of the patients with HbA1c levels consistently R7.0% were initiating insulin. Longer diabetes duration and younger age shortened the time to insulin.

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“…Physicians who are naive can start their patients with basal insulin analogues with little or no risk of antecedent hypoglycaemia. 17,18,19 In our study, significant difference is existing with respect to years of experience among primary care physicians regarding insulin use which is understandable. Physicians, knowledge on various types of insulin, …”

Section: Discussionmentioning

confidence: 77%

Insulinophobia: Existence of an Infamous Reality In Primary Health Care

Chary¹,

Swaminathan²

2016

JYP

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Objective: To study the knowledge and approach towards insulin use among primary care physicians. Method: This observational study was conducted using a validated questionnaire among primay care physician who had complete their bachelor of medicine and bachelor of surgery and involved in primary care practice at government and private sectors. Physicians with additional specialization were not invited for the study. Results: Among 125 physicians response , Thirty seven (29.6%) physicians responded insulin requirement many not be needed for type II diabetes patients initially irrespective of their blood sugar level and Thirty seven (29.6%) has second opinion to initiate insulin for type II diabetes patients. Significant difference is seen among physicians with less than five years of experience in terms of calculating insulin requirement (p-0.028) initiating insulin regimen (p-0.001) for diabetic patients. 89 (71.2%) physicians are worried of hypoglycaemia to initiate insulin regimen by themselves. Conclusion: More training and encouragement is needed among primary care physician to initiate insulin therapy among diabetes patients which in turn reduces overall diabetes related morbidity and mortality. Special Training should be given from the period of internship regarding diabetes management using insulin protocol.

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Delay Of Insulin Addition To Oral Combination Therapy Despite Inadequate Glycemic Control

Cited by 129 publications

References 26 publications

Weight Change and Glycemic Control After Diagnosis of Type 2 Diabetes

Weight Change and Glycemic Control After Diagnosis of Type 2 Diabetes

Time to insulin initiation and long-term effects of initiating insulin in people with type 2 diabetes mellitus: the Hoorn Diabetes Care System Cohort Study

Insulinophobia: Existence of an Infamous Reality In Primary Health Care

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