Blonde L, et al. – Researchers intended to present how insulin therapy evolves in type 2 diabetes (T2DM) in clinical practice in regions of Europe. The data indicated HbA1c and prevalence of complications were higher in eastern Europe (EEur) when starting insulin. Regional differences exist in choice of insulin regimens in Europe. Nevertheless, people starting insulin enhanced and sustained their glycemic control regardless of regional differences or insulin regimens applied.

Methods

• Researchers collected data from people starting any insulin in eastern Europe (EEur: Croatia, Russia, Ukraine), northern Europe (NEur: Finland, Germany, UK) and southern Europe (SEur: France, Italy, Portugal, Spain).
• They extracted retrospective data on starting insulin and prospective follow–up data from clinical records.

Results

• 1699 (76.0%) of 2236 eligible people had data at 4 years.
• It was demonstrated that EEur participants were mostly female, younger and had shorter diabetes duration on starting insulin, yet had highest baseline HbA1c and more micro–/macro–vascular disease.
• A majority (60%–64%) in all regions started on basal insulin alone, declining to 30%–38% at 4 years, with most switching to basal+mealtime insulin regimen (24%–40%).
• They found higher baseline (28%) and 4–year use (34%) of premix insulin in NEur.
• Alteration in HbA1c (SD) ranged from –1.2 (2.1)% (–13 [23] mmol/mol) in NEur to –2.4 (2.0)% (–26 [22] mmol/mol) in EEur.
• Remarkably, weight change ranged from +1.9 (8.3) kg in NEur to +3.2 (7.0) kg in SEur.
• As per the data, overall documented hypoglycemia ranged from 0.3 (1.3) to 1.3 (4.4) events/person/6–months (NEur vs. EEur, respectively) and was stable with time.
• It was indicated that severe hypoglycemia rates remained low.