Effect of delay in treatment intensification in people with type 2 diabetes and suboptimal glycaemia after basal insulin initiation: A real-world observational study
Shabnam, Sharmin Abner, Sophia Gillies, Clare L. Davies, Melanie J. Dex, Terry Khunti, Kamlesh Webb, David R. Zaccardi, Francesco Seidu, Samuel
Shabnam, Sharmin
Abner, Sophia
Gillies, Clare L.
Davies, Melanie J.
Dex, Terry
Khunti, Kamlesh
Webb, David R.
Zaccardi, Francesco
Seidu, Samuel
Abstract
Aim: Despite global recommendations for type 2 diabetes mellitus treatment to maintain optimal glycaemic targets, a significant proportion of people remain in suboptimal glycaemic control. Our objective was to investigate the impact of intensification delay after basal insulin (BI) initiation on long-term complications in people with suboptimal glycaemia.
Materials and methods: We conducted a retrospective cohort study in individuals with type 2 diabetes mellitus initiated on BI. Those with suboptimal glycaemia (glycated haemoglobin ≥7% or ≥53 mmol/mol) within 12 months of BI initiation were divided into early (treatment intensified within 5 years), or late (≥5 years) intensification groups. We estimated the age-stratified risks of micro- and macrovascular complications among these groups compared with those with optimal glycaemia (glycated haemoglobin <7%).
Results: Of the 13 916 people with suboptimal glycaemia, 52.5% (n = 7304) did not receive any treatment intensification. In those aged <65 years, compared with the optimal glycaemia group late intensification was associated with a 56% higher risk of macrovascular complications (adjusted hazard ratio 1.56; 95% confidence intervals 1.08, 2.26). In elderly people (≥65 years), late intensification was associated with a higher risk of cardiovascular-related death (1.62; 1.03, 2.54) and a lower risk of microvascular complications (0.26; 0.08, 0.83).
Conclusions: Those who had late intensification were at an increased risk of cardiovascular death if they were ≥65 years and an increased risk of macrovascular complications if they were <65 years. These findings highlight the critical need for earlier intensification of treatment and adopting personalized treatment strategies to improve patient outcomes.
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Date
2023-10-19
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Shabnam, S., Abner, S., Gillies, C. L., Davies, M. J., Dex, T., Khunti, K., Webb, D. R., Zaccardi, F., & Seidu, S. (2023). Effect of delay in treatment intensification in people with type 2 diabetes and suboptimal glycaemia after basal insulin initiation: A real-world observational study. Diabetes, obesity & metabolism, 10.1111/dom.15337. Advance online publication. https://doi.org/10.1111/dom.15337