title: Four-year evolution of insulin regimens, glycaemic control, hypoglycaemia and body weight after starting insulin therapy in type 2 diabetes across three continents.
abstract: OBJECTIVE
  It is of interest to understand how insulin therapy currently evolves in clinical practice, in the years after starting insulin in people with type 2 diabetes. We aimed to describe this evolution prospectively over 4 years, to assist health care planning.
  
  
  METHODS
  People who had started any insulin were identified from 12 countries on three continents. Baseline, then yearly follow-up, data were extracted from clinical records over 4 years.
  
  
  RESULTS
  Of the 2999 eligible people, 2272 were followed over 4 years. When starting insulin, mean (SD) duration of diabetes was 10.6 (7.8) years, HbA1c 9.5 (2.0)% (80 [22]mmol/mol) and BMI 29.3 (6.3)kg/m(2). Initial insulin therapy was basal 52%, premix 23%, mealtime+basal 14%, mealtime 8% and other 3%; at 4 years, 30%, 25%, 33%, 2% and 5%, respectively, with 5% not on insulin. Insulin dose was 20.2U/day at the start and 45.8U/day at year 4. There were 1258 people (55%) on their original regimen at 4 years, and this percentage differed according to baseline insulin regimen. HbA1c change was -2.0 (2.2)% (-22 [24]mmol/mol) and was similar by final insulin regimen. Hypoglycaemia prevalence was <20% in years 1-4. Body weight change was mostly in year 1, and was very variable, mean +2.7 (7.5)kg at year 4.
  
  
  CONCLUSIONS
  Different insulin regimens were started in people with differing characteristics, and they evolved differently; insulin dose, hypoglycaemia and body weight change were diverse and largely independent of regimen.
authors.affiliation: Newcastle University, Newcastle upon Tyne, United Kingdom. Electronic address: philip.home@ncl.ac.uk.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Home
authors.affiliation: Sanofi, Paris, France.
authors.forename: Marie-Paule
authors.initials: MP
authors.lastname: Dain
authors.affiliation: Department of Primary Care and Population Health, University College London, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Freemantle
authors.affiliation: Department of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Kawamori
authors.affiliation: Evangelisches Bethesda-Krankenhaus zu Duisburg GmbH, Duisburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Pfohl
authors.affiliation: Lincoln, Boulogne-Billancourt, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Brette
authors.affiliation: Sanofi, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Pilorget
authors.affiliation: Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany.
authors.forename: Werner A
authors.initials: WA
authors.lastname: Scherbaum
authors.affiliation: Diabetology and Metabolic Disorders Centre, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Vespasiani
authors.affiliation: Sanofi, Paris, France.
authors.forename: Maya
authors.initials: M
authors.lastname: Vincent
authors.affiliation: INSERM, U1018, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France.
authors.forename: Beverley
authors.initials: B
authors.lastname: Balkau
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning / Q000639:trends; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: CREDIT; Glucose-lowering mediations; Glycaemic control; Hypoglycaemia; Insulin regimens; Non-interventional study