title: Characteristics of patients with type 2 diabetes mellitus initiating insulin therapy: baseline data from the INSTIGATE study.
abstract: OBJECTIVE
  To describe the characteristics at baseline of patients with type 2 diabetes mellitus who are initiating insulin.
  
  
  METHODS
  Prospective, observational multi-centre, open-label study in five European countries of patients with type 2 diabetes who were initiating insulin as part of their usual care.
  
  
  RESULTS
  A total of 1172 patients were enrolled, with mean age 63.3 years and body mass index 29.9 kg/m(2). The majority (90%) of patients were taking one or more oral anti-diabetic agents; the percentage not taking anti-diabetic medication in the previous four weeks was highest in Germany (23.4%) and Spain (15.1%). The prevalence of microvascular diseases (range: 16.1%-36.1%) varied considerably between countries but for macrovascular (30.4%-38.6%) and other diabetes-related diagnoses (72.6%-76.6%) such as hypertension and dyslipidaemia the differences were less pronounced. In Germany, reported use of lipid-lowering (26.7%) and anti-platelet (27.1%) therapies was much less than in other countries (ranges: 53.2%-78.1% and 48.3%-61.1%, respectively). The majority of evaluable patients in each country had demonstrated poor control over a long period of time. Prior to initiating insulin, the most recent mean (+/-SD) HbA1(c) was 9.58 +/- 1.81%, fasting plasma glucose was 12.18 +/- 4.32 mmol/L and 78.5% had metabolic syndrome. IDF targets for HDL- and LDL-cholesterol, and blood pressure were met in 76.8%, 33.1% and 18.9% of patients, respectively.
  
  
  CONCLUSIONS
  Insulin treatment was only initiated after HbA1(c) values were considerably higher than recommended in treatment guidelines for a sustained period of time.
authors.affiliation: The Academic Centre, James Cook University Hospital, Middlesbrough, UK. stephen.jones@stees.nhs.uk
authors.forename: Stephen
authors.initials: S
authors.lastname: Jones
authors.forename: Marian
authors.initials: M
authors.lastname: Benroubi
authors.forename: Conxa
authors.initials: C
authors.lastname: Castell
authors.forename: Albert
authors.initials: A
authors.lastname: Goday
authors.forename: Andreas
authors.initials: A
authors.lastname: Liebl
authors.forename: Louise
authors.initials: L
authors.lastname: Timlin
authors.forename: Claudia
authors.initials: C
authors.lastname: Nicolay
authors.forename: Alexander
authors.initials: A
authors.lastname: Simpson
authors.forename: Aodan
authors.initials: A
authors.lastname: Tynan
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin