Trends in Insulin Therapy—A1C and Age at the Time of Insulin Initiation in the Real-World Setting

Majority of T2DM patients will eventually require insulin; yet not much is known about the trends and type of insulin choice for initiation in different geographies. We analyzed databases at two specialized diabetes care centers in urban India and identified patients initiated on insulin. A total of 673 eligible patients [males (N= 342), females (N=331)]initiated on insulin during the period of Jan to Dec 2017, were analyzed. Among trends observed, there was a predominant usage of premix insulin for initiation as compared to basal insulin (4.96:1),indicating the physician preference. Results are presented in the Table. Patients in two groups, receiving basal insulin and premix insulin were further divided on the basis of age into sub-groups of less than 60 years and more than 60 years. In the premix insulin group, a statistically significant difference in the A1C levels at initiation was observed in between the age groups defined earlier [Mean A1C in < 60-year group was 9.5% vs. 9.2% in > 60-year group, p = 0.03.] High A1C at initiation reflects the physician-patient inertia in insulin initiation, despite several guidelines recommending early insulinization. Although our study has the limitation of being a two-center evaluation, the utilization pattern reflects a delay in insulin initiation and predominant premix insulin usage in the Indian population, in view of the high carbohydrate content of the Indian diet. Mean Age and A1C at Insulin Initiation in Different GroupsMean ± SD95% CIMin, MaxAge (years) at Premix Initiation (N=560)57 ± 1356-5817, 86Age (years) at Basal Initiation (N=113)57 ± 1454-5918, 82Mean Age at Initiation (N=673)57 ± 1356-5817, 86HbA1c (%) at Premix Initiation (N=560)9.4 ± 1.89.2-9.54.1, 16HbA1c (%) at Basal Initiation (N=113)9.8 ± 1.89.5-106.4, 15Mean A1C at Initiation (N=673)9.5 ± 1.89.3-9.64.1, 16 Disclosure R. Kovil: Speaker's Bureau; Self; Eli Lilly and Company, Novo Nordisk A/S, Sanofi, Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca, Janssen Pharmaceuticals, Inc., MSD Pharmaceuticals Pvt. Ltd. M.S. Chawla: Speaker's Bureau; Self; IPCA Laboratories, Eli Lilly and Company, Novo Nordisk A/S, MSD Pharmaceutical Pvt. Ltd., Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca. Speaker's Bureau; Spouse/Partner; Sanofi. P.M. Chawla: Speaker's Bureau; Self; Sanofi. Speaker's Bureau; Spouse/Partner; Eli Lilly and Company, IPCA LABORATORIES, Novo Nordisk A/S, MSD PHARMACEUTICALS PVT. LTD., Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca. M.C. Kothari: None. A.F. Shaikh: None.