title: Delay in starting insulin after failure of other treatments in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  In type 2 diabetes mellitus (T2DM), therapies to maintain blood glucose control usually fail after several years. The aim of this study was to estimate the time to insulin initiation, the glycemic burden that patients are exposed prior to conversion to insulin and their HbA1c level at that time and a year later.
  
  
  METHODS
  Five hundred nine patients were included in this retrospective study. We identified patients with T2DM who started insulin therapy from 01/01/2002 to 30/06/2011, from the Scottish Care Information-Diabetes Collaboration (SCI-DC) database of Western General Hospital, Edinburgh, Scotland. We estimated the duration of diabetes prior to conversion to insulin therapy, the months they spent with glycated hemoglobin (HbA1c) above 7%, 8% or 9% until starting insulin, HbA1c and body weight (BW) at the time of conversion, at 6 and at 12 months before and after conversion.
  
  
  RESULTS
  Patients started insulin therapy after a median period of 6.2 (1-30) years after diagnosis of T2DM. Median HbA1c was 10% (range 7.2-17.9) at the time of conversion, 8.8% (5. 8-16.9) at six months before and 8.3% (5.2-15) at 12 months before conversion, and 8.4% (4.7-14.3) at 6 months and 8.2% (5-14.7) at 12 months after conversion. Body weight (BW) was 86.6 kg (39.6-179.8) at the time of conversion and 91 kg (42.7-196) at 12 months after conversion. Patients spent a median period of 49 (0-325) months with HbA1c >7%, 25 (0-163) months with HbA1c >8% and 10 (0-135) months with HbA1c >9%. Insulin treatment resulted in a decrease in HbA1c at 12 months of 1.8% (p<0.05) but in an increase in BW by 2.9 kg (p<0.05).
  
  
  CONCLUSIONS
  Healthcare professionals delay the initiation of insulin in patients with type 2 diabetes until their HbA1c exceeds 10%. As a result, patients are exposed to a significant glycemic burden. Change in treatment improves their glycemic control for the next 12 months. Hippokratia 2014; 18 (4): 306-309.
authors.affiliation: Metabolic Unit, Western General Hospital, Edinburgh, Scotland, UK.
authors.forename: I
authors.initials: I
authors.lastname: Zografou
authors.affiliation: Metabolic Unit, Western General Hospital, Edinburgh, Scotland, UK.
authors.forename: Mwj
authors.initials: M
authors.lastname: Strachan
authors.affiliation: Metabolic Unit, Western General Hospital, Edinburgh, Scotland, UK.
authors.forename: J
authors.initials: J
authors.lastname: McKnight
keywords: Diabetes mellitus type 2; glycemic burden; insulin therapy