title: Influence of macro- and microvascular comorbidity on time to insulin initiation in type 2 diabetes patients: a retrospective database analysis in Germany, France, and UK.
abstract: OBJECTIVE
  To investigate if micro- and macrovascular co-morbidity has an influence on the time to insulin initiation in type 2 diabetes patients.
  
  
  METHODS
  Longitudinal data from general practices in Germany, France and UK (Disease Analyzer) from 1995 to 2009 were analyzed, including 44,440 patients in Germany, 10,148 patients in France, and 25,499 patients in UK with newly diagnosed diabetes (index date). Cox regression was used to investigate the association of newly diagnosed micro- and macrovascular complications (ICD-10) on the time to insulin initiation adjusting for age, sex, antidiabetic therapy, and co-morbidity (hypertension, lipid disorders).
  
  
  RESULTS
  Insulin treatment was started in 9747 (22%) patients in Germany within 10 years after index date (France: n=702, 7%; UK: 3936, 14%). In all three countries, occurrence of microvascular complications was significantly associated with a higher likelihood to have insulin initiated (hazard ratio (HR), 95%CI: neuropathy: Germany 1.6; 1.5-1.8; France: 2.1; 1.1-3.9; UK: 1.5; 1.3-1.9; nephropathy: Germany 1.4; 1.3-1.6; France: 2.7; 1.4-3.8; UK: 1.2; 1.1-1.3). Among macrovascular complications, only coronary heart disease was related to insulin initiation in all three countries (Germany 1.2; 1.1-1.3; France: 1.5; 1.2-2.0; UK: 1.5; 1.3-1.7).
  
  
  CONCLUSIONS
  A more rapid progression to insulin therapy was found in patients with microvascular complications.
authors.affiliation: IMS HEALTH, Frankfurt, Germany. kkostev@de.imshealth.com
authors.forename: Karel
authors.initials: K
authors.lastname: Kostev
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rathmann
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008833:Microcirculation; D055806:Microvessels / Q000503:physiopathology; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin