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Updated: Mar 21, 2026

Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Adding glucose-lowering agents delays insulin initiation and prolongs hyperglycemia
Courtney Hugie1, Nancee V Waterbury, Bruce Alexander
1Kaiser Permanente, 20700 Ventura Blvd, Woodland Hills, CA 91364.
The number of glucose-lowering drug classes used before insulin initiation showed a small, non-clinical difference in glycated hemoglobin (A1C) levels for type 2 diabetes patients in the VAHCS. More drug trials were linked to longer exposure to high A1C levels.
Area of Science:
- Endocrinology
- Pharmacology
- Public Health
Background:
- Type 2 diabetes management involves various glucose-lowering agents (GLAs) before insulin therapy.
- Understanding the impact of pre-insulin GLA use on glycemic control is crucial.
Purpose of the Study:
- To investigate the association between the number of GLAs used and glycated hemoglobin (A1C) levels at insulin initiation.
- To analyze this association within the US Department of Veterans Affairs Health Care System (VAHCS).
Main Methods:
- Retrospective cohort study utilizing national VAHCS data.
- Identified 90,497 veterans with type 2 diabetes initiating insulin between 2009-2013.
- Grouped veterans by the number of GLAs used (1, 2, 3, or >3) prior to insulin.
Main Results:
- Mean A1C at insulin initiation was 9.9%.
- Pre-insulin A1C levels showed a slight decrease with an increasing number of GLAs (10.3% for 1 GLA to 9.6% for >3 GLAs).
- Increased GLA trials correlated with longer exposure to A1C > 8%.
Conclusions:
- Multiple GLAs are associated with a numerical, but not clinically significant, difference in A1C at insulin initiation in the VAHCS.
- The number of pre-insulin GLAs did not lead to substantial improvements in glycemic control upon insulin initiation.
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