Four-year evolution of insulin regimens, glycaemic control, hypoglycaemia and body weight after starting insulin therapy in type 2 diabetes across three continents

- We describe how insulin therapy evolves in clinical practice over 4 years in >2000 people with T2DM.
- Initial insulin was basal 52%, premix 23%, mealtime + basal 14%, mealtime 8%, other 3%.
- At 4 years this was 30%, 25%, 33%, 2% and 5%, with 5% not on insulin.
- HbA1c change was −2.0 (SD 2.2)%, similar by final insulin regimen, and stable over 4 years.
- Hypoglycaemia prevalence was <20% of people in all years (1-4 separately).

AimsIt is of interest to understand how insulin therapy currently evolves in clinical practice, in the years after starting insulin in people with type 2 diabetes. We aimed to describe this evolution prospectively over 4 years, to assist health care planning.MethodsPeople who had started any insulin were identified from 12 countries on three continents. Baseline, then yearly follow-up, data were extracted from clinical records over 4 years.ResultsOf the 2999 eligible people, 2272 were followed over 4 years. When starting insulin, mean (SD) duration of diabetes was 10.6 (7.8) years, HbA1c 9.5 (2.0)% (80 [22] mmol/mol) and BMI 29.3 (6.3) kg/m2. Initial insulin therapy was basal 52%, premix 23%, mealtime + basal 14%, mealtime 8% and other 3%; at 4 years, 30%, 25%, 33%, 2% and 5%, respectively, with 5% not on insulin. Insulin dose was 20.2 U/day at the start and 45.8 U/day at year 4. There were 1258 people (55%) on their original regimen at 4 years, and this percentage differed according to baseline insulin regimen. HbA1c change was −2.0 (2.2)% (−22 [24] mmol/mol) and was similar by final insulin regimen. Hypoglycaemia prevalence was <20% in years 1-4. Body weight change was mostly in year 1, and was very variable, mean +2.7 (7.5) kg at year 4.ConclusionDifferent insulin regimens were started in people with differing characteristics, and they evolved differently; insulin dose, hypoglycaemia and body weight change were diverse and largely independent of regimen.