Type 2 Diabetes Insulin Initiation: Predictors Identified

Syringe with Insulin
Syringe with Insulin
Researchers identified several patient factors that independently predict the likelihood of insulin initiation in patients with type 2 diabetes.

Researchers have identified several patient factors that independently predict the likelihood of insulin initiation in patients with type 2 diabetes (T2D) in a study published in the Journal of General Internal Medicine.

Scott J. Pilla, MD, MHS, from the Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues analyzed data from participants of the Look AHEAD (Action for Health in Diabetes) study (ClinicalTrials.gov: NCT00017953) in order to identify patient factors that may provide criteria for the individualization of insulin initiation.

The researchers examined data from 3913 participants with T2D who were overweight or obese and were not using insulin at baseline and sought to analyze the link between participant characteristics and insulin initiation over a 10-year study period.

Over the course of 10 years, 1087 participants (27.8%) initiated insulin. Age was inversely associated with insulin initiation (adjusted hazard ratio [aHR] 0.88 per 10 years; P =.025). There was a significantly lower risk for insulin initiation in black and Hispanic study participants (aHR 0.77; P =.008 and 0.66; P <.001, respectively), when compared with white study participants.

The risk of insulin initiation was greater with higher hemoglobin A1c (HbA1c) (HR 1.40 per 1%; P <.001), body mass index (HR 1.05 per 5 kg/m2; P =.036), and number of antihyperglycemic drugs (global P <.001).

Additional factors associated with insulin initiation were the presence of hypertension (HR 1.46; P =.017), chronic kidney disease (HR 1.17; P =.015), cardiovascular disease (HR 1.56; P <.001), and a family history of diabetes (HR 1.15; P =.034). A higher number of diabetes-related complications increased the risk for insulin initiation, with an HR of 1.16 per additional complication (P <.001 for trend).

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Socioeconomic status and gender were not found to predict insulin initiation.

Researchers noted that “the transition to insulin therapy involves both provider practice and patient preference, and this study is not able to distinguish between these factors,” which remains a limitation of the research.

“The predictors of insulin initiation identified in this study should … inform evidence-based strategies for tailoring the use of insulin to a patient’s characteristics and needs,” concluded the researchers.


Pilla SJ, Yeh HC, Juraschek SP, Clark JM, Maruthur NM. Predictors of insulin initiation in patients with type 2 diabetes: an analysis of the Look AHEAD randomized trial [published online January 19, 2018]. J Gen Intern Med. doi:10.1007/s11606-017-4282-9