ArticleJournal of the American Geriatrics Society2015
A real-world study of the effect of timing of insulin initiation on outcomes in older medicare beneficiaries with type 2 diabetes mellitus.
Article in Journal of the American Geriatrics Society, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Glycaemic control and hypoglycaemia burden in patients with type 2 diabetes initiating basal insulin in Europe and the USA.Diabetes, obesity & metabolism · 2017Pooled it
- Glycaemic outcomes of an Individualized treatMent aPproach for oldER vulnerable patIents: A randomized, controlled stUdy in type 2 diabetes Mellitus (IMPERIUM).Diabetes, obesity & metabolism · 2018Trial
- An Effectiveness Study of a Primary Care-embedded Clinical Pharmacist-Led Intervention Among Patients With Diabetes and Medicaid Coverage.Journal of pharmacy practice · 2024Article
- Pharmacist-Led Diabetes Control Intervention and Health Outcomes in Hispanic Patients With Diabetes.JAMA network open · 2023Article
- An Effectiveness Evaluation of a Primary Care-Embedded Clinical Pharmacist-Led Intervention Among Blacks with Diabetes.Journal of general internal medicine · 2020Article
- Effects of conformance to type 2 diabetes guidelines on health care resource utilization, clinical outcomes, and cost: A retrospective claims analysis.Journal of clinical & translational endocrinology · 2020Article
- Delays in Insulin Initiation among Patients with Type 2 Diabetes Mellitus in Southeast China: A Retrospective, Real-World Study.Diabetes, metabolic syndrome and obesity : targets and therapy · 2020Article
- Appropriateness of insulin commencement and adequacy of glycemic control among ambulatory patients with type 2 diabetes in Ethiopia.Journal of diabetes and metabolic disorders · 2019Article
- HbA1c target achievement in the elderly: results of the Titration and Optimization trial for initiation of insulin glargine 100 U/mL in patients with type 2 diabetes poorly controlled on oral antidiabetic drugs.BMJ open diabetes research & care · 2019Observational
- Insulin Glargine and Acarbose in the treatment of elderly patients with diabetes.Pakistan journal of medical sciences · 2019Article
- Key factors for overcoming psychological insulin resistance: an examination of patient perspectives through content analysis.BMJ open diabetes research & care · 2019Article
- Polypharmacy and Multimorbidity Among Medicaid Enrollees: A Multistate Analysis.Population health management · 2018Article
- Prevalence and Geographic Variations of Polypharmacy Among West Virginia Medicaid Beneficiaries.The Annals of pharmacotherapy · 2017Article
- Review of basal-plus insulin regimen options for simpler insulin intensification in people with Type 2 diabetes mellitus.Diabetic medicine : a journal of the British Diabetic Association · 2017Review
- Recombinant Human Insulin in Global Diabetes Management - Focus on Clinical Efficacy.European endocrinology · 2017Review
- Determinants of weight change in patients on basal insulin treatment: an analysis of the DIVE registry.BMJ open diabetes research & care · 2017Article
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesTo compare clinical and economic outcomes of early insulin initiation with those of delayed initiation in older adults with type 2 diabetes mellitus (T2DM).
designRetrospective cohort study.
settingHumana Medicare Advantage health insurance plan.
participantsOlder (≥65) Medicare beneficiaries with T2DM. MEASUREMENTS: Subjects were grouped according to number of classes of oral antidiabetes drugs (OADs) they had taken before initiation of insulin: one (early insulin initiators), two, or three or more (delayed insulin initiators). One-year follow-up outcomes included change in glycosylated hemoglobin (HbA1c), percentage of older adults with HbA1c less than 8.0%, hypoglycemic events, and total healthcare costs.
resultsOverall, 14,669 individuals were included in the analysis. Baseline and 1-year follow-up HbA1c levels were available for 4,028 (27.5%) individuals. Insulin was initiated early in 32% and delayed in 20%. At follow-up, unadjusted reduction in HbA1c was 0.9±3.7% for the group with one OAD, 0.7±2.4% for those with two, and 0.5±3.6% for those with three or more. Early insulin initiation was associated with significantly greater reduction in HbA1c (0.4%; adjusted P<.001), 30% greater likelihood of achieving HbA1c less than 8.0% (adjusted odds ratio=1.30, 95% confidence interval=1.18-1.43), and no significant differences in total costs or hypoglycemia events (11.5% of early initiators vs 10.2% of delayed initiators; P=.32).
conclusionThis study suggests beneficial effects of early insulin initiation in older adults with T2DM who do not have adequate glycemic control, without increasing the risk of hypoglycemia or greater total direct healthcare costs.
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