Delayed initiation of subcutaneous insulin therapy after failure of oral glucose‐lowering agents in patients with Type 2 diabetes: a population‐based analysis in the UK

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Abstract
Aims The aim of this retrospective cohort study was to estimate the time to insulin initiation in patients with Type 2 diabetes inadequately controlled on oral glucose-lowering agents (OGLAs). Methods Insulin-naïve patients failing on OGLAs were identified from The Health Improvement Network database, which collects records from general practices throughout the UK. Patients were included if they were aged ≥ 40 years, had concomitant prescriptions for ≥ 2 OGLAs, and ≥ 1 year of available records prior to the first occurrence of HbA1c ≥ 8.0% after ≥ 90 days of OGLA polytherapy at ≥ 50% of maximum recommended dosages. Results A total of 2501 eligible patients with Type 2 diabetes who had an HbA1c above the OGLA failure threshold of ≥ 8.0% were identified (54.0% male; 30.9% aged 60–69 years). It was estimated that if all the eligible patients were followed for 5 years, 25% would initiate insulin within 1.8 years of OGLA failure (95% CI 1.6–2.0), and 50% within 4.9 years (95% CI 4.6–5.8). The presence of diabetes-related complications had no substantial impact on the time to insulin initiation. Conclusions This study found that 25% of patients with Type 2 diabetes had insulin initiation delayed for at least 1.8 years, and 50% of patients delayed starting insulin for almost 5 years after failure of glycaemic control with OGLA polytherapy, even in the presence of diabetes-related complications. Interventions that reduce this delay to insulin initiation are required to help achieve and maintain recommended glycaemic targets in patients with Type 2 diabetes.