title: The economic and clinical benefits of adequate insulin initiation and intensification in people with type 2 diabetes mellitus.
abstract: OBJECTIVE
  To study the clinical and economic benefits associated with adequate and early initiation and intensification of insulin in people with type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  A systematic review was performed using published articles from January 2000 to August 2010 that linked intervention, disease, study design and outcomes. Studies were further classified as initiation and intensification based on predefined criteria. Individual studies in systematic reviews and meta-analysis were searched and included if relevant.
  
  
  RESULTS
  A total of 2690 articles were screened with 76 (40 initiation and 36 intensification) studies included. Most initiation studies had mean baseline HbA1c values of >8.5%. The endpoint HbA1c values were reduced with insulin treatment in these studies, with endpoint values ranging from 6.6 to 9.8%. Similar results were seen with the intensification studies (endpoint HbA1c: 6.4-9.6%). Addition of insulin to oral antidiabetics (OADs) resulted in better glycaemic control in most studies. Blood glucose levels reduced substantially with OADs + insulin compared with OADs alone. Quality of life outcomes and treatment satisfaction were reported in six studies and not significantly different for insulin vs. OADs. Hypoglycaemic events were manageable with insulin initiation. However, all insulin types were associated with weight gain although the comparison with OADs elicited varying results.
  
  
  CONCLUSIONS
  Proactive management with early insulin initiation and intensification should be considered in people with T2DM in inadequate glycaemic control. The economic benefits with early initiation and intensification have to be fully explored.
authors.affiliation: Centre for Health Outcomes Research, Department of Medicine, University of Illinois College of Medicine, Peoria, IL 61656-1649, USA. cva@uicomp.uic.edu
authors.forename: C V
authors.initials: CV
authors.lastname: Asche
authors.forename: B
authors.initials: B
authors.lastname: Bode
authors.forename: A K
authors.initials: AK
authors.lastname: Busk
authors.forename: S R
authors.initials: SR
authors.lastname: Nair
mesh_terms: D000284:Administration, Oral; D001786:Blood Glucose / Q000187:drug effects*; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D006442:Glycated Hemoglobin / Q000187:drug effects*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007328:Insulin / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D015430:Weight Gain
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin