Prevalence of insulin as a first‐line therapy and associated factors in people with type 2 diabetes in German primary care practices

• DOI: 10.1111/dme.14338
• Publication Date: 2020-06-07T14:52:16Z
• Authors: L. van den Boom; M. Kaiser; K. Kostev
• Keywords: Adult; Aged, 80 and over; Glycated Hemoglobin; Male; Adolescent; Age Factors; Middle Aged; 3. Good health; 03 medical and health sciences; Endocrinologists; Logistic Models; 0302 clinical medicine; Diabetes Mellitus, Type 2; General Practitioners; Germany; Humans; Hypoglycemic Agents; Insulin; Dementia; Diabetic Nephropathies; Female; Diabetic Angiopathies; Aged

AbstractAimTo evaluate how many people with type 2 diabetes receive a treatment regimen with insulin as a first‐line therapy and the factors associated with this.MethodsThis retrospective study was based on data from the Disease Analyzer database and included 10 497 people with type 2 diabetes with an initial prescription of anti‐hyperglycaemic therapy from 859 general and diabetologist practices in Germany between January 2014 and December 2018. The main outcome of the study was the prevalence of insulin as a first‐line therapy. A multivariable logistic regression model was performed to investigate the association between predefined variables and the probability of receiving insulin as a first‐line therapy.ResultsA total of 7.1% of participants received insulin as a first‐line therapy. Diabetologist practice [odds ratio (OR) 2.71, 95% confidence interval (CI) 1.81–4.06], age > 80 years (OR 2.35, 95% CI 1.20–4.61) compared with age ≤ 40 years, HbA1c ≥ 86 mmol/mol (10%) (OR 2.99, 95% CI 1.81–4.95) compared with HbA1c < 48 mmol/mol (6.5%), renal complications (OR 1.91, 95% CI 1.29–2.81), peripheral artery disease (OR 1.94, 95% CI 1.30–2.81), neurological complications (OR 1.45, 95% CI 1.00–2.09), Charlson Comorbidity Index (OR 1.16, 95% CI 1.08–1.25) and higher number of different drugs prescribed within 12 months prior–the index date (OR 1.09, 95% CI 1.05–1.12) were significantly associated with the probability of receiving insulin as a first‐line therapy.ConclusionInsulin is rarely used as a first‐line therapy in people with type 2 diabetes. Furthermore, a person’s likelihood of receiving insulin as a first‐line therapy is significantly influenced by diabetologist practice, age, HbA1c ≥ 86 mmol/mol (10%), renal, neurological and vascular complications, higher multimorbidity, and polypharmacy.