Present status of insulin therapy for type 2 diabetes treated by general practitioners and diabetes specialists in Japan: Third report of a cross-sectional survey of 15,652 patients.
Aims/Introduction:  Insulin therapy is often required to achieve good glycemic control in patients with type 2 diabetes mellitus. However, some providers, particularly general practitioners (GPs), are reluctant to prescribe insulin to their patients. The aim of the present study was to clarify any differences in, as well as any problems associated with, insulin therapy in patients with type 2 diabetes being treated by either a GP or a diabetes specialist in Japan.


METHODS
Of 15,652 patients across 721 clinics and hospitals, 15,350 were diagnosed with type 2 diabetes (14,312 by GPs and 1038 by specialists). Data regarding glycated hemoglobin (HbA1c) levels, age, height, bodyweight and treatment modality were collected for each patient.


RESULTS
Of the patients with type 2 diabetes, 9.1 and 22.9% had been prescribed insulin monotherapy, and 38.8 and 37.0% were also receiving insulin with an oral antidiabetic (OAD) by GPs or specialists, respectively. Diabetes specialists prescribed analog insulin more frequently than did GPs. GPs chose premixed insulin more frequently than did specialists, and this factor correlated with higher HbA1c levels. A younger age and daily insulin dose in groups being treated by both providers were correlated with high HbA1c levels on insulin monotherapy. Neither type of insulin nor OAD was correlated with HbA1c on insulin plus OAD therapy.


CONCLUSIONS
To achieve better glycemic control with insulin therapy, sufficient insulin dose and intensive treatment regimen, in addition to lifestyle interventions, might be necessary. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2012.00198.x, 2012).
The Japanese Medical and Dental Practitioners for the Improvement of Medical Care, Tokyo.
Keiko
K
Arai
The Japanese Medical and Dental Practitioners for the Improvement of Medical Care, Tokyo.
Masahiko
M
Takai
The Japanese Medical and Dental Practitioners for the Improvement of Medical Care, Tokyo.
Koichi
K
Hirao
The Japanese Medical and Dental Practitioners for the Improvement of Medical Care, Tokyo.
Ikuro
I
Matsuba
The Japanese Medical and Dental Practitioners for the Improvement of Medical Care, Tokyo.
Kiyokazu
K
Matoba
The Japanese Medical and Dental Practitioners for the Improvement of Medical Care, Tokyo.
Hiroshi
H
Takeda
The Japanese Medical and Dental Practitioners for the Improvement of Medical Care, Tokyo.
Akira
A
Kanamori
Health Education Center Science Clinic.
Mikio
M
Yamauchi
The Japanese Medical and Dental Practitioners for the Improvement of Medical Care, Tokyo.
Hisao
H
Mori
Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Yasuo
Y
Terauchi
General practitioner; Insulin therapy; Type 2 diabetes mellitus