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- Title
Time to Insulin Treatment and Factors Influencing Prescription in Swedish Type 2 Diabetics.
- Authors
Ringborg, Anna; Lindgren, Peter; Yin, Donald D.; Martinell, Mats; Stålhammar, Jan
- Abstract
Progressive decline in β-cell function and the ensuing deterioration of glycaemic control in type 2 diabetes requires revision and intensification of treatment over the course of time. The aim of this study was to examine time to initiation of insulin treatment and factors influencing insulin prescription among Swedish patients started on oral anti-diabetic drug (OAD) treatment using data from the Real-Life Effectiveness and Care Patterns in Diabetes Management (RECAP-DM) study. RECAP-DM was a multi-centre study of 11,856 patients with type 2 diabetes retrospectively identified in computerised medical records at 26 primary care centres in Uppsala county, Sweden (≈300,000 inhabitants) between 1993 and 2005. The average length of follow-up was 5.1 years. Time to initiation of insulin treatment was evaluated through survival regression for the 5,403 patients started on OAD treatment during the study period. 1,115 of these patients were subsequently prescribed insulin. A Cox proportional hazards model was developed to test the impact of sex, age, type of initial OAD and baseline HbA1c on the probability of insulin being prescribed. At 2,200 days, 75% of patients had been prescribed insulin treatment according to the estimated survivor function. The results of the Cox model indicated that very old age (>=85 years) at OAD treatment initiation decreased the chance of being prescribed insulin (hazard ratio (HR)=0.709; p=0.084) as did moderately old age (75-84 years)(HR=0.848; p=0.082). HbA1c at OAD treatment initiation had a significant impact on the probability of insulin prescription (HR=1.161; p<0.001). Metformin as first-line OAD was associated with a decreased probability of insulin prescription compared to other OADs (mainly sulphonylurea) as first-line treatment (HR=0.796; p=0.010). Further, being started on more than one OAD more than doubled the chance of insulin prescription (HR=2.478; p<0.001), reflecting the advanced disease progression of patients initiating on a combination of OADs.
- Subjects
UPPSALA (Sweden); SWEDEN; INSULIN therapy; DRUG prescribing; TYPE 2 diabetes; PANCREATIC beta cells; HYPOGLYCEMIC agents
- Publication
Diabetes, 2007, Vol 56, pA156
- ISSN
0012-1797
- Publication type
Article