title: Clinical outcomes after insulin initiation in patients with type 2 diabetes: 6-month data from the INSTIGATE observational study in five European countries.
abstract: OBJECTIVE
  To examine insulin regimens and factors that affect glycaemic control at 6 months after initiation of insulin therapy in patients with type 2 diabetes mellitus.
  
  
  METHODS
  Information on patients requiring insulin initiation as part of usual care was collected in a prospective, observational, open-label study in five European countries. Univariate and multiple regression analyses were used to investigate factors associated with HbA1c achieved at 6 months.
  
  
  RESULTS
  Mean HbA1c for all patients at baseline was 9.6 ± 1.8%. Long/intermediate-acting insulin only was most commonly initiated in France and Spain, while long/intermediate or pre-mixed formulations were initiated in Greece and UK. This was consistent with guidelines used in those countries and there was little change in insulin regimen at 6 months in these countries. In Germany, short-acting insulin only was favoured at baseline and there was a shift towards basal/bolus regimens at 6 months, which reflected the local guidelines for insulin initiation in Germany. Mean HbA1c reduction was greatest in Germany (-2.3%), which was the only country to achieve a mean of <7% at 6 months. In all countries, HbA1c achieved at 6 months was associated with baseline HbA1c. Differences between countries were seen for influence of factors such as BMI, duration of diabetes, insulin regimen, insulin dose and number of oral anti-diabetes drugs on HbA1c achieved. Explained variability for the factors ranged from 5.6% to 22.9%.
  
  
  CONCLUSIONS
  Differences in insulin regimen were observed between countries, and appeared to reflect the guidelines and treatment regimens used.
authors.affiliation: Centre for Diabetes and Metabolism, Fachklinik Bad Heilbrunn, Bad Heilbrunn, Germany. andreas.liebl@fachklinik-bad-heilbrunn.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Liebl
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: Marie
authors.initials: M
authors.lastname: Aline Charles
authors.forename: Helen T
authors.initials: HT
authors.lastname: Smith
authors.forename: Claudia
authors.initials: C
authors.lastname: Nicolay
authors.forename: Alexander
authors.initials: A
authors.lastname: Simpson
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy*; D005060:Europe; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human