Benefits for early insulin initiation without increasing risk of hypoglycemia, health care costs
MONDAY, May 18, 2015 (HealthDay News) — For older Medicare beneficiaries with type 2 diabetes mellitus (T2DM), early insulin initiation offers clinical benefit, according to a study published online May 8 in the Journal of the American Geriatrics Society.
Rituparna Bhattacharya, Ph.D., from West Virginia University in Morgantown, and colleagues examined the impact of the timing of insulin initiation in a cohort of older (≥65 years) Medicare beneficiaries with T2DM. Participants were classified according to the number of oral antidiabetes drugs (OADs) that they had taken before initiation of insulin: one (early insulin initiators), two, or three or more (delayed insulin initiators). Data were included for 14,669 individuals; baseline and one-year follow-up hemoglobin A1c (HbA1c) levels were available for 27.5 percent of participants.
The researchers found that for the groups with one, two, and three or more OADs, the unadjusted reduction in HbA1c at follow-up was 0.9 ± 3.7 percent, 0.7 ± 2.4 percent, and 0.5 ± 3.6 percent, respectively. Early insulin initiation correlated with significantly greater decline in HbA1c (0.4 percent; P < 0.001) and increased odds of achieving HbA1c less than 8.0 percent (adjusted odds ratio, 1.30). There were no significant differences in total costs or hypoglycemia events for early versus delayed initiators (P = 0.32).
“These findings fill a crucial knowledge gap regarding the association between early insulin initiation and clinical and economic outcomes in older adults with T2DM,” the authors write.
Two authors are employees of Sanofi, and one is a shareholder; the study was funded by Sanofi.
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