Trial reportJournal of general internal medicine2018
Predictors of Insulin Initiation in Patients with Type 2 Diabetes: An Analysis of the Look AHEAD Randomized Trial.
Trial report in Journal of general internal medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 15 citations in OpenAlex.
- Insulin use promotes pro-inflammatory changes in the transcriptome of atherosclerotic plaques in patients with diabetes mellitus.Journal of molecular and cellular cardiology plus · 2025Article
- Sociodemographic and biological determinants of insulin initiation in type 2 diabetes: a cohort study using routinely collected primary care data.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- An omics-based machine learning approach to predict diabetes progression: a RHAPSODY study.Diabetologia · 2024Article
- Diabetes, gaps in care coordination, and preventable adverse events.The American journal of managed care · 2023Article
- Precision Medicine in Diabetes.Handbook of experimental pharmacology · 2023Article
- The impact of phenotype, ethnicity and genotype on progression of type 2 diabetes mellitus.Endocrinology, diabetes & metabolism · 2020Review
- Time to Insulin Initiation in Type 2 Diabetes Patients in 2010/2011 and 2016/2017 in Germany.Journal of diabetes science and technology · 2019Article
- Differences in National Diabetes Treatment Patterns and Trends between Older and Younger Adults.Journal of the American Geriatrics Society · 2019Article
- Capsule Commentary on Pilla et al., Predictors of Insulin Initiation in Patients with Type 2 Diabetes: an Analysis of the Look AHEAD Randomized Trial.Journal of general internal medicine · 2018Article
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThe decision to initiate insulin in patients with type 2 diabetes is a challenging escalation of care that requires an individualized approach. However, the sociodemographic and clinical factors affecting insulin initiation are not well understood.
objectiveWe sought to identify patient factors that were independent predictors of insulin initiation among participants in the Look AHEAD (Action for Health in Diabetes) clinical trial.
designRetrospective analysis of a randomized clinical trial.
participantsBeginning in 2001, Look AHEAD enrolled ambulatory U.S. adults with type 2 diabetes who were overweight or obese and had a primary healthcare provider. Participants were randomized (1:1) to an intensive lifestyle intervention, or diabetes support and education. This study examined 3913 participants across the two trial arms who were not using insulin at baseline. MAIN MEASURES: We used Cox proportional hazards models to estimate the association between participant characteristics and time to insulin initiation. We performed time-varying adjustment for HbA1c measured eight times over the 10-year study period, as well as for multiple clinical and socioeconomic factors. KEY
resultsA total of 1087 participants (27.8%) initiated insulin during a median follow-up of 8.0 years. Age was inversely associated with insulin initiation (adjusted hazard ratio [aHR] 0.88 per 10 years, P = 0.025). The risk of insulin initiation was greater with a higher number of diabetes complications (P < 0.001 for trend); chronic kidney disease and cardiovascular disease were independently associated with insulin initiation. There was a lower risk of insulin initiation in black (aHR 0.77, P = 0.008) and Hispanic participants (aHR 0.66, P < 0.001) relative to white participants. Socioeconomic factors were not associated with insulin initiation.
conclusionsPatient age, race/ethnicity, and diabetes complications may influence insulin initiation in type 2 diabetes, independent of glycemic control. Future work is needed to understand the drivers of racial differences in antihyperglycemic treatment, and to identify patients who benefit most from insulin.
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