A continuous quality improvement initiative in place in Italy since 2005 (AMD Annals) previously showed that patients with type 2 diabetes (DM2) attending diabetes clinics and treated with insulin had poor metabolic control. Aim of this study was to evaluate the percentage of patients with DM2 treated with insulin, their clinical characteristics, and their level of metabolic control.
Observational, real-world study based on data extracted from electronic medical records relative to all patients with DM2 seen in 222 diabetes centers in 2016.
Out of 402,700 patients, 140,716 were treated with insulin (34.9%). Of these, 37.5% had HbA1c values> 8.0% and 23.8% had values <7.0%. The most frequently used schemes (± other glucose-lowering agents) were the basal-bolus (basal + 3 injections of short-acting insulin; 46.1%) and basal insulin alone (32.8%). Significant proportions of patients, ranging between 29.9% and 46.0% in the various schemes, presented inadequate metabolic control. The median doses of insulin varied between 0.2 and 0.4 IU/kg in most of the schemes adopted, and rose to 0.6 IU/kg in the case of basal-bolus. Doses increased slightly as the average levels of HbA1c increased. The prevalence of complications was markedly higher in subjects on insulin therapy, indicating a generally late use of this therapy.
This analysis confirms the failure to reach adequate therapeutic targets in high percentages of subjects with DM2 treated with insulin, in disagreement with guidelines recommendations. The late use of insulin and the use of moderately low doses reaffirm the problem of therapeutic inertia.