Real-life glycemic control in patients with type 2 diabetes treated with insulin therapy: A prospective, longitudinal cohort study (Diabetes Distress and Care Registry at Tenri [DDCRT 9])

Aims/Introduction We investigated the association between four insulin regimens and increase in HbA1c and insulin dose in a real-life clinical setting because there is no data about them among insulin regimens. Materials and Methods Subjects included 757 patients with type 2 diabetes having been treated with insulin therapy for more than 1 year. The four insulin regimens were regimen 1 (long-acting insulin, once daily), regimen 2 (biphasic insulin, twice daily), regimen 3 (biphasic insulin, three times daily), and regimen 4 (basal-bolus therapy). Main outcomes were increases in HbA1c levels >0.5% and increases in daily insulin units after 1 year. We performed multivariable analyses to examine differences in glycemic control and insulin dose with adjustment for possible confounders. Results Mean HbA1c level and duration of insulin therapy were 7.8% and 11.3 years, respectively. HbA1c levels increased by >0.5% at follow-up in 22.8%, 24.9%, 20.7%, and 29.3% of subjects using regimen 1, 2, 3, and 4, respectively, with no significant differences between groups. Daily insulin doses increased in 62.3%, 68.8%, 65.3%, and 38.6% of patients, respectively (P<0.001). Multivariable regression analysis showed that patients who received regimen 4 had significantly lower odds of requiring future insulin dose increases than those who had received regimen 2 (adjusted odds ratio, 0.24; 95% confidence interval, 0.14–0.41; P<0.001). Conclusions Many patients receiving insulin therapy showed increases in HbA1c levels and insulin doses 1 year later. The smallest increase in insulin dose was observed in the basal-bolus therapy group compared with other regimens. This article is protected by copyright. All rights reserved.