Type 2 diabetes is the most common type of diabetes in adults and is characterized by both peripheral insulin resistance and impaired insulin secretion. Treatment of type 2 diabetes include education, lifestyle changes and oral medications to maintain good glycemic control. As the disease progresses with worsening hyperglycemia and deterioration in beta cell function and loss of beta cell mass most T2DM patients will eventually require insulin to reach glycemic target. Most common indication of insulin initiation is when glycemic control has deteriorated despite maximally tolerated oral agents. Aim The aim of our study was to examine the following:1. Indications for insulin initiation 2. Initial insulin regimen prescribed 3. Effect on glycemic control Method This was a prospective study conducted at an Endocrine Center in Kathmandu, Nepal . A total of 101 patients( 55 male and 101 female)with type 2 diabetes were enrolled in our study. Patients already on insulin use, not willing for insulin therapy and type 1 diabetic patients were excluded from this study. Baseline FBS, PP blood sugar and HbA1c were analyzed at the time of initiation and compared after 3 months using paired t test. Results In total 101 eligible adults (55 males, 46 females; mean age 55.02 ± 12.7; mean baseline HbA1c 10.68 ± 3.44) initiated insulin. Premixed insulin(55.4%) was the most common prescribed insulin followed by basal insulin (28.43%) and basal bolus insulin (15.8%). The most common indication of insulin initiation was poorly controlled diabetes (72.2%)followed by high HbA1c at diagnosis (11.8%), diabetes complications 8.9% and OHA failure 6.9%. The mean HbA1c at 3 months follow up was 7.72±1.506. Conclusion In our study poorly controlled diabetes was the most common indication for insulin initiation and premixed insulin was the most common insulin prescribed insulin followed by basal insulin. Patients who were started on insulin therapy achieved good glycemic control at 3 months followup. Initiating insulin therapy in type 2 diabetes patients can lead to good glycemic control and reduce risk for long term complications.
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