부산대학교 도서관

Aim: To evaluate how many people with type 2 diabetes receive a treatment regimen with insulin as a first‐line therapy and the factors associated with this. Methods: This retrospective study was based on data from the Disease Analyzer database and included 10 497 people with type 2 diabetes with an initial prescription of anti‐hyperglycaemic therapy from 859 general and diabetologist practices in Germany between January 2014 and December 2018. The main outcome of the study was the prevalence of insulin as a first‐line therapy. A multivariable logistic regression model was performed to investigate the association between predefined variables and the probability of receiving insulin as a first‐line therapy. Results: A total of 7.1% of participants received insulin as a first‐line therapy. Diabetologist practice [odds ratio (OR) 2.71, 95% confidence interval (CI) 1.81–4.06], age > 80 years (OR 2.35, 95% CI 1.20–4.61) compared with age ≤ 40 years, HbA1c ≥ 86 mmol/mol (10%) (OR 2.99, 95% CI 1.81–4.95) compared with HbA1c < 48 mmol/mol (6.5%), renal complications (OR 1.91, 95% CI 1.29–2.81), peripheral artery disease (OR 1.94, 95% CI 1.30–2.81), neurological complications (OR 1.45, 95% CI 1.00–2.09), Charlson Comorbidity Index (OR 1.16, 95% CI 1.08–1.25) and higher number of different drugs prescribed within 12 months prior–the index date (OR 1.09, 95% CI 1.05–1.12) were significantly associated with the probability of receiving insulin as a first‐line therapy. Conclusion: Insulin is rarely used as a first‐line therapy in people with type 2 diabetes. Furthermore, a person's likelihood of receiving insulin as a first‐line therapy is significantly influenced by diabetologist practice, age, HbA1c ≥ 86 mmol/mol (10%), renal, neurological and vascular complications, higher multimorbidity, and polypharmacy. What's new?: In this study, we used a nationwide real‐world database, allowing unbiased estimation of prescription prevalence in German primary care practices.Some 7.1% of participants with type 2 diabetes received insulin as a first‐line therapy.Factors that significantly impact the probability of receiving insulin as a first‐line therapy include diabetologist practice, age > 80 years, HbA1c ≥ 85.8 mmol/mol (10%), as well as renal, neurological and vascular complications, a higher Charlson Comorbidity Index, and polypharmacy. [ABSTRACT FROM AUTHOR]