Intensifying Treatment Does Not Negatively Affect Type 2 Diabetes

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Younger age at diagnosis and longer duration of disease, worse glycemic control, and a greater risk for complications including retinopathy and coronary heart disease was associated with more intensiv
Younger age at diagnosis and longer duration of disease, worse glycemic control, and a greater risk for complications including retinopathy and coronary heart disease was associated with more intensiv

Intensifying treatment, including initiation of insulin, does not have an adverse impact on the well-being of community-dwelling patients with type 2 diabetes, according to a study published in Diabetes Research and Clinical Practice.

Previous research shows that the initiation of insulin did not affect health status or quality of life (QoL), although patients on chronic insulin therapy have demonstrated lower health status and diabetes-associated QoL vs those on other therapies. With the new classes of oral glucose-lowering medication (OGLMs) and more reliably absorbed long-acting basal insulins, along with better methods of assessing patient perceptions of the effect of type 2 diabetes, investigators are now re-evaluating the effect of insulin initiation on health status and QoL.

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The longitudinal observational Fremantle Diabetes Study Phase II included 930 participants with a mean duration of diabetes of 8 years. The primary outcome measures were the Short Form-12 version, 2 physical and mental health composite scores (PCS, MCS) and the average weighted impact (AWI) score from the Audit of Diabetes Dependent QoL.

Investigators observed reductions in PCS by year 4 vs baseline and at year 2 among those on stable diet-based management (n=160), OGLM, (n=387), and insulin with/without OGLM (n=168; P <.05), but there were no temporal changes in MCS/AWI that reached statistical significance. Patients treated with insulin had the lowest PCS, MCS, and AWI vs other subgroups at each time point (P ≤.012). In participants initiating OGLM (n=84) or insulin (n=85), no differences were observed in any of the measurements at the biennial assessments (P ≥.08).

These “real-life findings” should be able to “reassure health professionals who may be reluctant to start new treatments, especially insulin, because of the perception that they will have negative impacts on important aspects of their patients' lives such as self-care, work-related and recreational activity, and relationships,” noted the researchers.

Reference

Davis TME, Bruce DG, Curtis BH, Barraclough H, Davis WA. The relationship between intensification of blood glucose-lowering therapies, health status and quality of life in type 2 diabetes: the Fremantle Diabetes Study Phase II. Diabetes Res Clin Pract. 2018;142:294-302.

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