Insulin Inertia Among Type 2 Diabetes Patients In Qatar- The INERT-Q study

Abstract Background: - Diabetes-related complications result from cumulative exposure to hyperglycemia. Hence, achieving and maintaining adequate glycaemic control is critical. Insulin is a necessary treatment in DM-2 patients who did not achieve glycaemic targets on oral agents. Inertia in starting insulin has been reported in many populations. Aim:- To assess the degree of inertia related to insulin initiation and intensification in patients with DM-2. Methods:- We performed a retrospective longitudinal cohort study and followed DM-2 two years before and two years after the start of insulin. The primary outcome was the proportion of patients who achieved glycaemic targets ( HbA1c ≤ 7.5%) at 6 months, 1 year and 2 years. Results:- We included 374 patients who were predominantly males (62%). The mean age was 55.3 ± 11.3 years, the mean duration of DM-2 was 12.0 ± 7.3 years, the mean age of DM-2 onset was 41.2 ± 9.6 years, 64.4 % were obese,47.6% had a microvascular disease, and 24.3% had a macrovascular disease. The mean HbA1c at (-2 years) and (-1 year) were 9.2±2.1% and 9.3±2.0%, respectively. The mean HbA1c at the time of insulin initiation was 10.4 ±2.1%. The mean HbA1c at 6,12 months and 2 years was 8.5±1.8% %, 8.4±1.8% % and 8.5±1.7%, respectively. The proportion of patients who achieved HbA1c targets at 6, 12 months and 2 years were 32.9%, 31.0%, and 32.9%. According to the multivariate regression analysis ; for every unit increase in BMI, HbA1c at (-1 year), and HbA1c at the start of inulin , the HbA1c levels at 6 months increase by 0.05% (p 0.023), 0.17% (p0.017), and 0.19% (p=0.011), respectively; while it is reduced by 0.03% (p=0.013).for every 1-year increase in the age of DM-2 onset. Multivariate logistic regression analysis showed that the achieving HbA1c targets at 6 months and 1 year increases the odds of achieving HbA1c targets at 2 years ; (OR 4.87(2.4-9.6) p<0.001) and ( OR 6.2 (3.2-12.0), p<0.001) respectively. Conclusion : - In patients with DM-2, there was an alarming delay in starting and titrating insulin. The reduction in HbA1c plateaued at 6 months. Earlier initiation and intensification of insulin therapy are critical to achieving glycaemic targets. More studies are needed to examine the causes of therapeutic inertia from physicians, patients, and systems point of view.