A real-world study of the effect of timing of insulin initiation on outcomes in older medicare beneficiaries with type 2 diabetes mellitus

作者: Rituparna Bhattacharya , Steve Zhou , Wenhui Wei , Mayank Ajmera , Usha Sambamoorthi

DOI: 10.1111/JGS.13388

关键词:

摘要: Objectives To compare clinical and economic outcomes of early insulin initiation with those delayed in older adults type 2 diabetes mellitus (T2DM). Design Retrospective cohort study. Setting Humana Medicare Advantage health insurance plan. Participants Older (≥65) beneficiaries T2DM. Measurements Subjects were grouped according to number classes oral antidiabetes drugs (OADs) they had taken before insulin: one (early initiators), two, or three more (delayed initiators). One-year follow-up included change glycosylated hemoglobin (HbA1c), percentage HbA1c less than 8.0%, hypoglycemic events, total healthcare costs. Results Overall, 14,669 individuals the analysis. Baseline 1-year levels available for 4,028 (27.5%) individuals. Insulin was initiated 32% 20%. At follow-up, unadjusted reduction 0.9 ± 3.7% group OAD, 0.7 ± 2.4% 0.5 ± 3.6% more. Early associated significantly greater (0.4%; adjusted P <.001), 30% likelihood achieving 8.0% (adjusted odds ratio = 1.30, 95% confidence interval = 1.18–1.43), no significant differences costs hypoglycemia events (11.5% initiators vs 10.2% initiators; P = .32). Conclusion This study suggests beneficial effects T2DM who do not have adequate glycemic control, without increasing risk direct costs.

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