Insulin initiation for patients with poorly controlled type 2 diabetes mellitus

We examined the initiation of insulin therapy in patients with poorly controlled type 2 diabetes mellitus (T2DM), analyzed their glycemic responses, and compared patient profiles based on glycemic outcomes.

Patients with T2DM initiated on insulin therapy were retrospectively analyzed. Data were collected from endocrinology clinic before and 3 and 6 months after insulin initiation. The primary outcome was hemoglobin A1c (HbA1c) level 6 months after commencing insulin treatment. Secondary outcomes included HbA1c levels at 3 months after insulin treatment and fasting blood glucose levels at 3 and 6 months after treatment. We analyzed the effects of insulin initiation and categorized patients based on their 6-month HbA1c levels: below the median of 7.8% (better response) and above 7.8% (worse response). Additionally, we evaluated patients based on HbA1c changes at 6 months, with greater or lesser changes defined by the cohort's median change of -1.4%.

Insulin therapy significantly reduced HbA1c (from 9.8% to 8.2%) and fasting blood glucose levels (from 221.4 to 147.2 mg/dL) within 3 months. After 6 months, HbA1c and fasting blood glucose levels decreased by 2.1% (9.8%-7.7%) and 77.2 mg/dL (221.4-144.2 mg/dL), respectively. Patients who responded better to insulin treatment showed lower fasting blood glucose levels by 6 months after insulin initiation and lower HbA1c levels as soon as 3 months after initiation. Patients with higher baseline glycemic profiles experienced significantly greater HbA1c reductions at 6 months post-treatment.

Insulin therapy significantly improved glycemic control in patients with T2DM within 3 months after initiation. Patients with higher baseline glycemic profiles experienced greater responses to insulin therapy.