An evaluation of insulin therapy initiation among patients with type 2 diabetes attending a public health facility in South Africa

Abstract

Background: Clinically effective interventions that could reduce diabetic patients’ risk of long-term complications are needed to contain the rising cost of diabetes care associated with the increasing prevalence of this condition. Good glycaemic control needs to be rapidly attained and maintained by the appropriate initiation and adjustment of glucoselowering therapy. In patients with insulin-requiring type 2 diabetes who are not at goal glycaemia, this translates to the initiation and intensification of insulin therapy. The aim of this study was to evaluate the appropriateness of the initiation of insulin therapy in patients with poorly controlled insulin-requiring type 2 diabetes. Method: This descriptive retrospective study evaluated treatment regimens, dose adjustments and glycated haemoglobin A_1c (HbA_1c) measurements extracted from records of patients with type 2 diabetes suitable for inclusion. The observation period spanned the 24 months retrospective to study start. Data collected were transcribed into a spreadsheet suitable for statistical analysis. Results: Of the overall cohort of patients with insulin-requiring type 2 diabetes (n = 131), only 45.8% (n = 60) were commenced on insulin during the observation period, of whom 51.7% had subsequent adjustment of insulin dosage. Mean HbA_1c at insulin initiation was 10.29% (± 2.42), and 10.63% (± 1.93) after adjustment of insulin dose (p-value > 0.05). Of those who remained on oral glucose-lowering therapy (n = 71), 57.7% had no change in medication dosage throughout the study period. Overall, 81.35% remained ≥ 1% above goal HbA_1c by the end of the study period. Conclusion: This study found a discrepancy in the appropriate use and adjustment of insulin therapy according to metabolic status.