Clinical outcomes and resource use after 24 months of insulin therapy in Turkish patients with type 2 diabetes: subgroup analysis of the TREAT study

Abstract

PurposeThis study evaluated levels of metabolic control, resource use and quality of life in Turkish patients with type 2 diabetes initiated on insulin in routine care. Patients and methodsThe prospective, observational TREAT study evaluated patients from five different countries who were initiated on insulin and followed for 24months. In this paper, we present the results of a cohort analysis specific to Turkish patients from the study. ResultsA total of 211 patients in the Turkish multicenter cohort [male patients 50.2%, age 56.5year8.9 SD, body mass index (BMI) 30.6kg/m(2)5.4 SD, diabetes duration 9.7year +/- 5.9 SD] initiated insulin at baseline. Oral antidiabetic drugs had been used by 93.4% of patients prior to insulin initiation, and 65.9% had used more than one regimen. Pre-existing metformin therapy was continued by 68.7% of patients after insulin initiation. In the three most common insulin regimens, glycosylated haemoglobin (HbA(1C)) declined over 24months from 10.27% to 7.82% (long/intermediate acting), from 10.82% to 7.52% (premixed) and from 10.42% to 7.67% (basal-bolus). Less than 25% achieved a glycaemic goal of HbA(1C) 7.0% and changes in insulin dose or regimen rarely occurred. Premixed insulin regimens were associated with greatest weight gain. Hypoglycaemic episodes were reported by more patients at 3, 6 and 12months than at baseline or at 18 or 24months. Healthcare use increased over baseline levels in the first 6months, but was closer to baseline levels at subsequent assessments. Patient recorded health profiles improved after initiating insulin, particularly quality of life scores related to psychological distress and pain/discomfort. Morisky scores predictive of medication adherence and treatment persistence also improved. ConclusionsIn Turkish patients with type 2 diabetes, metabolic control remained suboptimal after initiating insulin as part of routine care even after 24months of insulin treatment. Apparent shortcomings in routine care in most patients included a high baseline HbA(1C) because of delayed insulin initiation and an unwillingness to individualise insulin regimens.