title: Time to and factors associated with insulin initiation in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  Determine the time between the start of oral antidiabetic therapy (OAD) and the initiation of insulin therapy and to establish factors associated with insulin prescription among patients with type 2 diabetes mellitus (T2DM) in Colombia.
  
  
  METHODS
  Cohort, retrospective, population-based study. We identify patients with T2DM who started OAD therapy between 1 January 2007 and 31 December 2008, and a 5-year follow-up was performed. Kaplan-Meier survival analysis for time to start insulin therapy was generated and factors associated with insulin initiation were determined using logistic regression.
  
  
  RESULTS
  A total of 1042 patients (52.4% women), mean age 63.4 years at the start of pharmacological treatment. After 5 years, 272 patients (26.1%) initiated insulin therapy. Using combination therapy of metformin and glibenclamide was associated with greater risk of insulin initiation (OR: 1.64, 95% CI: 1.12-2.40, p=0.010), while being a male over 45 years of age (OR: 0.59, 95% CI: 0.37-0.96, p=0.034) and initiating OAD therapy with metformin (OR: 0.30, 95% CI: 0.20-0.46, p<0.001) reduced the risk of insulin use.
  
  
  CONCLUSIONS
  After 5 years of OAD treatment, 26.1% of people with T2DM started insulin therapy. Age, sex and type of initial OAD affected the probability of switching to insulin in these patients in Colombia.
authors: Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira, Audifarma S.A, Paraje la Julita, AA: 97, 660003 Pereira, Risaralda, Colombia. Electronic address: machado@utp.edu.co.
authors: Jorge Enrique
authors: JE
authors: Machado-Alba
authors: Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira, Pereira, Colombia.
authors: Manuel Enrique
authors: ME
authors: Machado-Duque
authors: Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia. Universidad Tecnológica de Pereira, Audifarma S.A., Pereira, Colombia.
authors: Paula Andrea
authors: PA
authors: Moreno-Gutierrez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003105:Colombia / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D005905:Glyburide / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D005905:Glyburide
keywords: Colombia. (MeSH); Hyperglycemia; Hypoglycemic agents; Insulin; Pharmacoepidemiology; Type 2 diabetes mellitus