Five-Year Predictors of Insulin Initiation in People with Type 2 Diabetes under Real-Life Conditions
We performed a real-life analysis of clinical and laboratory parameters, in orally treated T2DM patients aiming at identifying predictors of insulin treatment initiation. Overall, 366955 patients (55.8% males, age 65 ± 11 years, diabetes duration 7 ± 8 years) were followed up between 2004 and 2011....
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Journal of Diabetes Research |
| Online Access: | http://dx.doi.org/10.1155/2018/7153087 |
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| author | Sandro Gentile Felice Strollo Francesca Viazzi Giuseppina Russo Pamela Piscitelli Antonio Ceriello Carlo Giorda Piero Guida Paola Fioretto Roberto Pontremoli Salvatore De Cosmo the AMD-Annals Study Group |
| author_facet | Sandro Gentile Felice Strollo Francesca Viazzi Giuseppina Russo Pamela Piscitelli Antonio Ceriello Carlo Giorda Piero Guida Paola Fioretto Roberto Pontremoli Salvatore De Cosmo the AMD-Annals Study Group |
| author_sort | Sandro Gentile |
| collection | DOAJ |
| description | We performed a real-life analysis of clinical and laboratory parameters, in orally treated T2DM patients aiming at identifying predictors of insulin treatment initiation. Overall, 366955 patients (55.8% males, age 65 ± 11 years, diabetes duration 7 ± 8 years) were followed up between 2004 and 2011. Each patient was analyzed step-by-step until either eventually starting insulin treatment or getting to the end of the follow-up period. Patients switching to insulin showed a worse global risk profile, longer disease duration (10 ± 9 years vs. 6 ± 7 years, respectively; p<0.001), higher HbA1c (8.0 ± 1.6% vs. 7.2 ± 1.5%, respectively; p<0.001), higher triglycerides, a greater prevalence of arterial hypertension, antihypertensive, lipid-lowering and aspirin treatment, a higher rate of nonproliferative/proliferative retinopathy, and a nearly 4 times lower prevalence of the “diet alone.” They also showed a higher prevalence of subjects with eGFR < 60 ml/min/1.73 m2 (24.0% vs. 16.2%, respectively; p<0.001). Multivariate analysis identified diabetes duration, HbA1c, triglyceride and low HDL-C values, presence of retinopathy or renal dysfunction, and sulphonylurea utilization (the risk being approximately 3 times greater in the latter case) as independent predictors of insulin treatment initiation. LDL-C, lipid-lowering treatment, and overweight/obese seem to be protective. Results of tree analysis showed that patients on sulphonylurea, with high HbA1c, eGFR below 50 ml/min/1.73 m2, and at least 5-year disease duration, are at very high risk to start insulin treatment. We have to stick to this real-life picture, of course, until enough data are collected on patients treated with innovative medications which are expected to improve beta cell survival and further delay treatment-related insulin requirement. |
| format | Article |
| id | doaj-art-c43798bd0cef4af2b09c7d0abc3c6207 |
| institution | Kabale University |
| issn | 2314-6745 2314-6753 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Diabetes Research |
| spelling | doaj-art-c43798bd0cef4af2b09c7d0abc3c62072025-02-03T01:26:05ZengWileyJournal of Diabetes Research2314-67452314-67532018-01-01201810.1155/2018/71530877153087Five-Year Predictors of Insulin Initiation in People with Type 2 Diabetes under Real-Life ConditionsSandro Gentile0Felice Strollo1Francesca Viazzi2Giuseppina Russo3Pamela Piscitelli4Antonio Ceriello5Carlo Giorda6Piero Guida7Paola Fioretto8Roberto Pontremoli9Salvatore De Cosmo10the AMD-Annals Study Group11Department of Clinical and Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, ItalyDiabetes Center, San Raffaele Termini, Rome, ItalyDepartment of Internal Medicine, University of Genoa and Policlinico San Martino, Genova, ItalyDepartment of Clinical and Experimental Medicine, University of Messina, Messina, ItalyIRCSS Casa Sollievo della Sofferenza-Unit of Internal Medicine, Scientific Institute, San Giovanni Rotondo, ItalyInstitut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, SpainDiabetes and Metabolism Unit ASL Turin 5, Chieri, ItalyStatistical Consultant, Associazione Medici Diabetologi (AMD), Rome, ItalyDepartment of Medicine, University of Padua, Padua, ItalyDepartment of Internal Medicine, University of Genoa and Policlinico San Martino, Genova, ItalyIRCSS Casa Sollievo della Sofferenza-Unit of Internal Medicine, Scientific Institute, San Giovanni Rotondo, ItalyAssociazione Medici Diabetologi (AMD), Rome, ItalyWe performed a real-life analysis of clinical and laboratory parameters, in orally treated T2DM patients aiming at identifying predictors of insulin treatment initiation. Overall, 366955 patients (55.8% males, age 65 ± 11 years, diabetes duration 7 ± 8 years) were followed up between 2004 and 2011. Each patient was analyzed step-by-step until either eventually starting insulin treatment or getting to the end of the follow-up period. Patients switching to insulin showed a worse global risk profile, longer disease duration (10 ± 9 years vs. 6 ± 7 years, respectively; p<0.001), higher HbA1c (8.0 ± 1.6% vs. 7.2 ± 1.5%, respectively; p<0.001), higher triglycerides, a greater prevalence of arterial hypertension, antihypertensive, lipid-lowering and aspirin treatment, a higher rate of nonproliferative/proliferative retinopathy, and a nearly 4 times lower prevalence of the “diet alone.” They also showed a higher prevalence of subjects with eGFR < 60 ml/min/1.73 m2 (24.0% vs. 16.2%, respectively; p<0.001). Multivariate analysis identified diabetes duration, HbA1c, triglyceride and low HDL-C values, presence of retinopathy or renal dysfunction, and sulphonylurea utilization (the risk being approximately 3 times greater in the latter case) as independent predictors of insulin treatment initiation. LDL-C, lipid-lowering treatment, and overweight/obese seem to be protective. Results of tree analysis showed that patients on sulphonylurea, with high HbA1c, eGFR below 50 ml/min/1.73 m2, and at least 5-year disease duration, are at very high risk to start insulin treatment. We have to stick to this real-life picture, of course, until enough data are collected on patients treated with innovative medications which are expected to improve beta cell survival and further delay treatment-related insulin requirement.http://dx.doi.org/10.1155/2018/7153087 |
| spellingShingle | Sandro Gentile Felice Strollo Francesca Viazzi Giuseppina Russo Pamela Piscitelli Antonio Ceriello Carlo Giorda Piero Guida Paola Fioretto Roberto Pontremoli Salvatore De Cosmo the AMD-Annals Study Group Five-Year Predictors of Insulin Initiation in People with Type 2 Diabetes under Real-Life Conditions Journal of Diabetes Research |
| title | Five-Year Predictors of Insulin Initiation in People with Type 2 Diabetes under Real-Life Conditions |
| title_full | Five-Year Predictors of Insulin Initiation in People with Type 2 Diabetes under Real-Life Conditions |
| title_fullStr | Five-Year Predictors of Insulin Initiation in People with Type 2 Diabetes under Real-Life Conditions |
| title_full_unstemmed | Five-Year Predictors of Insulin Initiation in People with Type 2 Diabetes under Real-Life Conditions |
| title_short | Five-Year Predictors of Insulin Initiation in People with Type 2 Diabetes under Real-Life Conditions |
| title_sort | five year predictors of insulin initiation in people with type 2 diabetes under real life conditions |
| url | http://dx.doi.org/10.1155/2018/7153087 |
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