title: A retrospective database study of insulin initiation in patients with Type 2 diabetes in UK primary care.
abstract: OBJECTIVE
  This study characterized UK primary care patients with Type 2 diabetes who initiated insulin treatment, and described the initial insulin regimens used, overall metabolic changes and health-care resource usage.
  
  
  METHODS
  A retrospective cohort study was performed using quality-checked patient data from The Health Improvement Network database. Eligible patients who initiated insulin for the first time between 2004 and 2006 were grouped into four cohorts according to the type of insulin regimen initiated. Data on patient characteristics, metabolic and clinical outcomes and health-care resource use were collected at baseline and during 6 months of follow-up.
  
  
  RESULTS
  In total, 4045 eligible adults [2269 male, 1776 female; mean age 62.6 ± 13.3 years; mean baseline HbA(1c) 82 ± 22 mmol/mol (9.6% ± 2.0%)] initiated insulin. Approximately half (52.4%) initiated insulin as basal insulin only, 41.6% as premixed only, 4.0% as basal-bolus and 2.1% as prandial insulin only. Among patients with ≥ 180 days follow-up (n=3815), the initial insulin regimen was not changed during follow-up in 75.1% of patients, while 13.7% discontinued, 7.0% switched and 4.7% intensified insulin therapy. The mean change in HbA(1c) was -14 mmol/mol (-1.3%, n=2881), with 17.3% of patients achieving an HbA(1c) of <53 mmol/mol (7%, n=3024). The mean weight change was +0.9 kg (n=2345).
  
  
  CONCLUSIONS
  Basal and premixed insulin were the most common types of insulin initiated and in most patients no changes were made to the initial regimen over 6 months. However, few patients achieved glycemic control targets.
authors.affiliation: Cegedim Strategic Data Medical Research Ltd, London, UK. betina.blak@gmail.com
authors.forename: B T
authors.initials: BT
authors.lastname: Blak
authors.forename: H T
authors.initials: HT
authors.lastname: Smith
authors.forename: M
authors.initials: M
authors.lastname: Hards
authors.forename: A
authors.initials: A
authors.lastname: Maguire
authors.forename: V
authors.initials: V
authors.lastname: Gimeno
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D057915:Drug Substitution; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D006113:United Kingdom
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin