Prevalence of insulin as a first-line therapy and associated factors in people with type 2 diabetes in German primary care practices.

Abstract

AIM:

To evaluate how many people with type 2 diabetes receive a treatment regimen with insulin as a first-line therapy and the factors associated with this.

METHODS:

This retrospective study was based on data from the Disease Analyzer database and included 10 497 people with type 2 diabetes with an initial prescription of anti-hyperglycaemic therapy from 859 general and diabetologist practices in Germany between January 2014 and December 2018. The main outcome of the study was the prevalence of insulin as a first-line therapy. A multivariable logistic regression model was performed to investigate the association between predefined variables and the probability of receiving insulin as a first-line therapy.

RESULTS:

A total of 7.1% of participants received insulin as a first-line therapy. Diabetologist practice [odds ratio (OR) 2.71, 95% confidence interval (CI) 1.81-4.06], age > 80 years (OR 2.35, 95% CI 1.20-4.61) compared with age ≤ 40 years, HbA1c ≥ 86 mmol/mol (10%) (OR 2.99, 95% CI 1.81-4.95) compared with HbA1c < 48 mmol/mol (6.5%), renal complications (OR 1.91, 95% CI 1.29-2.81), peripheral artery disease (OR 1.94, 95% CI 1.30-2.81), neurological complications (OR 1.45, 95% CI 1.00-2.09), Charlson Comorbidity Index (OR 1.16, 95% CI 1.08-1.25) and higher number of different drugs prescribed within 12 months prior-the index date (OR 1.09, 95% CI 1.05-1.12) were significantly associated with the probability of receiving insulin as a first-line therapy.

CONCLUSION:

Insulin is rarely used as a first-line therapy in people with type 2 diabetes. Furthermore, a person's likelihood of receiving insulin as a first-line therapy is significantly influenced by diabetologist practice, age, HbA1c ≥ 86 mmol/mol (10%), renal, neurological and vascular complications, higher multimorbidity, and polypharmacy.

• Authors: L van den Boom, M Kaiser, K Kostev
• Journal: Diabetic medicine : a journal of the British Diabetic Association (Diabet Med) Vol. 37 Issue 8 Pg. 1333-1339 (08 2020) ISSN: 1464-5491 [Electronic] England
• PMID: 32506471 (Publication Type: Journal Article)
• Copyright: © 2020 Diabetes UK.

Chemical References

• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin
• hemoglobin A1c protein, human

Topics

• Adolescent
• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Dementia (epidemiology)
• Diabetes Mellitus, Type 2 (drug therapy, epidemiology, metabolism)
• Diabetic Angiopathies (epidemiology)
• Diabetic Nephropathies (epidemiology)
• Endocrinologists
• Female
• General Practitioners
• Germany
• Glycated Hemoglobin (metabolism)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Insulin (therapeutic use)
• Logistic Models
• Male
• Middle Aged
• Multimorbidity
• Nervous System Diseases (epidemiology)
• Peripheral Arterial Disease (epidemiology)
• Polypharmacy
• Practice Patterns, Physicians' (statistics & numerical data)
• Primary Health Care
• Young Adult