Time to and factors associated with insulin initiation in patients with type 2 diabetes mellitus

• We obtained the first information about time to start insuline therapy in Colombia and Latin America.
• A small proportion of people with type-2DM started insulin therapy in Colombia.
• Age, sex and type of oral antidiabetic drug initial management affected the probability of switching to insulin in these patients in Colombia.
• The choice of metformin as the first pharmacological therapy was found to be a protector factor for requirement of insulin therapy.
• The use of metformin + glibenclamide for oral therapy initiation increased the risk for receiving insulin therapy.

AimsDetermine the time between the start of oral antidiabetic therapy (OAD) and the initiation of insulin therapy and to establish factors associated with insulin prescription among patients with type 2 diabetes mellitus (T2DM) in Colombia.MethodsCohort, retrospective, population-based study. We identify patients with T2DM who started OAD therapy between 1 January 2007 and 31 December 2008, and a 5-year follow-up was performed. Kaplan–Meier survival analysis for time to start insulin therapy was generated and factors associated with insulin initiation were determined using logistic regression.ResultsA total of 1042 patients (52.4% women), mean age 63.4 years at the start of pharmacological treatment. After 5 years, 272 patients (26.1%) initiated insulin therapy. Using combination therapy of metformin and glibenclamide was associated with greater risk of insulin initiation (OR: 1.64, 95%CI: 1.12–2.40, p = 0.010), while being a male over 45 years of age (OR: 0.59, 95%CI: 0.37–0.96, p = 0.034) and initiating OAD therapy with metformin (OR: 0.30, 95%CI: 0.20–0.46, p < 0.001) reduced the risk of insulin use.ConclusionsAfter 5 years of OAD treatment, 26.1% of people with T2DM started insulin therapy. Age, sex and type of initial OAD affected the probability of switching to insulin in these patients in Colombia.