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Glycemic Control in T2DM Worse With Refusal of Insulin Therapy

In retrospective study of adults with uncontrolled T2DM, 42.7 percent declined insulin therapy

diabetes testing

THURSDAY, Feb. 20, 2020 (HealthDay News) -- For individuals with uncontrolled type 2 diabetes, those who decline insulin therapy have worse glycemic control, according to a study published online Feb. 20 in Diabetic Medicine.

Alexander Turchin, M.D., from Brigham and Women's Hospital in Boston, and colleagues conducted a retrospective study of adults with type 2 diabetes and suboptimal glycemic control who were recommended insulin therapy. Using natural language processing of provider notes, the decline of insulin therapy recommendations was identified.

The researchers found that 42.7 percent of the 5,307 study participants declined insulin therapy. In individuals who declined versus those who started insulin therapy, the median time to hemoglobin A1c (HbA1c) control was 50 and 38 months, respectively. Decline of insulin therapy was associated with a hazard ratio of 0.89 for HbA1c control in a multivariable analysis. Participants with diabetes complications were more likely to accept insulin therapy recommendations if they had diabetes complications or a higher HbA1c (odds ratios, 1.32 and 1.10, respectively), while they were less likely to accept insulin therapy recommendations if they were older or taking more noninsulin diabetes medications (odds ratios, 0.81 and 0.78, respectively).

"Further investigation is needed to establish the optimal approach to discussion of treatment options with individuals with type 2 diabetes to ensure that individuals make fully informed choices while optimizing clinical outcomes," the authors write.

The study was funded by Sanofi.

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