title: Factors affecting the efficacy of starting insulin treatment in Type 2 diabetic patients. A retrospective evaluation.
abstract: OBJECTIVE
  To assess the efficacy and practices of insulin treatment in Type 2 diabetes mellitus in primary health care.
  
  
  METHODS
  Primary health care in southwest Finland (population 250,000).
  
  
  METHODS
  Cases in the target area with insulin treatment initiated in 1991-1997 were identified and the patient records were analysed retrospectively for up to 5 years from treatment.
  
  
  METHODS
  A total of 883 patients with Type 2 diabetes (aged 40-91 years) were identified.
  
  
  METHODS
  HbA1c and body weight.
  
  
  RESULTS
  HbA1c declined by 2.0 percentage points from 10.0% to 8.0% (p < 0.001) at 12 months from the initiation of insulin, irrespective of age. The decrease was smaller in obese patients (BMI > 34 kg/m2). A slightly better glycaemic control was achieved when the treatment was initiated by a specialist rather than by a general practitioner. The improvement in HbA1c was essentially unchanged at 4 years. The decrease in HbA1c was largely independent of the type of the insulin regimen (insulin alone, combined insulin and oral therapy). The daily insulin dose increased markedly and the proportion of patients on combination therapy decreased from 57% to 38% at 4 years. The mean body weight of the patients increased (3.7 kg at 12 months, 5.7 kg at 4 years). The weight increase was highest in patients treated with insulin alone.
  
  
  CONCLUSIONS
  Introducing insulin therapy in poorly controlled Type 2 diabetic patients results in a marked decrease in HbA1c. Insulin therapy can be initiated in all age groups with equal results. Insulin treatment can be initiated and improved metabolic control maintained in primary health care.
authors.affiliation: Turku Health Centre, Turku, Finland. vahatalo@iki.fi
authors.forename: Markku
authors.initials: M
authors.lastname: Vähätalo
authors.forename: Tapani
authors.initials: T
authors.lastname: Rönnemaa
authors.forename: Jorma
authors.initials: J
authors.lastname: Viikari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005387:Finland; D006302:Health Services Research; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D016896:Treatment Outcome
chemical_list: D007328:Insulin