O15 Insulin therapy in type 2 diabetes. how do specialists insulinize?

Abstract

Introduction: Insulin therapy is an effective tool to achieve the glycemic goal (A1c). The percentage of people with T2D treated with insulin and the regimens used vary by country.

Aim: To identify the frequency, types and schemes of insulin therapy in the treatment of type 2 diabetes in Argentina.

Material and methods: Descriptive, observational cross-sectional study in people with T2D in 28 centers treated by specialists in Argentina (FRADYC III Group) year 2018. It was evaluated: clinical examination, laboratory and treatment in routine practice. Univariate analysis and multiple logistic regression were performed, any value of p<0,05 (2 tails) was considered significant with the STATA Intercooler Software.

Results: In 1329 T2D persons, aged 61.7 ± 11.6 ys, years of T2D diagnosis 9.6 ± 7.4 ys, A1c 7 ± 1.4%, FPG: 135 ± 40,4 mg/dl, BMI: 31.7 ± 5.7 kg/m2, with ±arterial hypertension 81%, dyslipidemia 81.4%, self-monitored blood glucose 76%, with cardiovascular disease 37.2%, neuropathy 19.1%, nephropathy 12.64%, retinopathy 10%. Rates of mild/moderate hypoglycemia in last week was 4.3% and of severe hypoglycemia last year was 0.38%. Were treated with insulin 38.1%, of which in 63.8% insulin was combined with oral antihyperglycemic agents and/or GLP-1 analogs. Insulin therapy start time: 8 years. Self-monitoring of blood glucose 90.9%. Insulin regimens: Basal 65.1%, Basal-Bolus 30.7%, Premixes 4.2%. Types of insulin and average dose: NPH in 58.7% (40.0 ± 27.3 U/day), Glargine U-100 25.2% (37.9 ± 18.8 U/day), Detemir 6.5% (40.5 ± 23.9 U/day), Degludec 3.5% (38.1 ± 19.9 U/day), Glargina U-300 1,8% (62.9 ± 31.6 U/day), Premixes 4.2%. Regular 3% (14.9 ± 12.0 U/day), Lispro U-100 3.5% (14.0 ± 6.2 U/day), Aspart 18.7% (13.6 ± 8.7 U/day), Glulisine 5.5% (15.7 ± 13.6 U/day). Insulinized T2D persons versus non insulinized persons had worst A1c (8.06 ± 1.7 vs 6.86 ± 1.1% (p<0.0001) and higher frequency of mild/moderate hypoglycemia in the last week 12.68% vs 1.36% (p< 0.0001), without differences in severe hypoglycemia in the
last year. Insulin start time was associated with: younger age (OR: 0.94, p<0.0001), male gender (OR:1.33, p<0.029), longer time from diagnosis (OR: 1.11, p<0.001), having arterial hypertension (OR: 1.99, p<0.001), retinopathy (OR:3, p<0.001), and neuropathy (OR:2, p< 0.001).

Conclusions: Received insulin 38.1%, 63.8% in combination with other antihyperglycemic agents. NPH insulin was the most utilized, followed by Glargine U100. Insulin treated T2D persons had worse A1c and more mild/moderate hypoglycemia. Insulin therapy start time was associated with younger age, male gender, longer time from diagnosis, worst A1c, arterial hypertension, retinopathy and neuropathy.