新生児・小児医学

抽象的な

A Long-term Retrospective Real-World Evidence to Understand the Pattern of Insulin Prescription in Patients with Type 2 Diabetes (T2d) - Insulinitiation Study

Shishir Kumar

Background: Rationale use of insulin and oral anti-diabetic medications (OADs) improves glycaemic control.

Aims and objective: Evaluate the efficacy and prescription pattern of anti-diabetic medications in achieving

glycaemic control among people attending a tertiary care centre in India.

Materials and methods: This cross-sectional observational study was conducted on people with diabetes (PwD) over 9 years. Demographic profiles, anthropometry, biochemical parameters [HbA1c, fasting blood plasma glucose (FPG) and post-prandial glucose (PPG)], insulin types and doses, and OADs prescriptions were recorded at baseline (2011) and, 2015 and 2019.

Results: Among 647 PwDs majority were males (75.9% in 2011, 71.3% in 2015 and 67.7% in 2019), with T2DM

(214 in 2011, 214 in 2015 and 209 in 2019), and BMI >25 kg/m2. Subjects’ group with “diabetes under control” (FPG

<130 mg/dL, PPG <180 mg/dL, and HbA1c <7%) were comparable [13 subjects (5.9%) in 2011, 16 subjects (7.0%) in 2015, 14 subjects (6.0%) in 2019]. The number of subjects in “uncontrolled diabetes” group (FPG >130 mg/dL, PPG

>180 mg/dL, and HbA1c >7%) decreased significantly (p<0.05) from baseline over years of monitoring [100 subjects (45.6%) in 2011, 112 subjects (50.9%) in 2015, 72 subjects (34.1%) in 2019s. Sub-group analysis revealed increase in insulin prescriptions (30 folds) with further titration. 20 units of basal insulin prescribed at study initiation increased to

39.9 ± 15.7 in 2015 and maintained at 36.7 ± 10.5 in 2019. Doses of Bolus and premixed insulin increased from 20.93

± 9.6 and 41.85 ± 14.6 at baseline to 21.8 ± 13.6 and 43.1 ± 9.8 in 2015 and titrated to 43.1 ± 9.8 and 39.63 ± 10.8, respectively by 2019. SGLT-2i and DPP-4i prescriptions increased significantly (p<0.05) from 2011 to 2019, though total OADs remained same.

Conclusion: The proportion of subjects with uncontrolled diabetes decreased significantly over the study, which can be attributed to the shifting trend of increased insulin prescription or insulinization, leading to better glycaemic control.