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首页> 外文期刊>BMC Endocrine Disorders >The consequences of delaying insulin initiation in UK type 2 diabetes patients failing oral hyperglycaemic agents: a modelling study
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The consequences of delaying insulin initiation in UK type 2 diabetes patients failing oral hyperglycaemic agents: a modelling study

机译：未能通过口服高血糖药治疗的英国2型糖尿病患者延迟胰岛素启动的后果：一项模型研究

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Background Recent data have shown that type 2 diabetes patients in the UK delay initiating insulin on average for over 11 years after first being prescribed an oral medication. Using a published computer simulation model of diabetes we used UK-specific data to estimate the clinical consequences of immediately initiating insulin versus delaying initiation for periods in line with published estimates. Methods In the base case scenario simulated patients, with characteristics based on published UK data, were modelled as either initiating insulin immediately or delaying for 8 years. Clinical outcomes in terms of both life expectancy and quality-adjusted life expectancy and also diabetes-related complications (cumulative incidence and time to onset) were projected over a 35 year time horizon. Treatment effects associated with insulin use were taken from published studies and sensitivity analyses were performed around time to initiation of insulin, insulin efficacies and hypoglycaemia utilities. Results For patients immediately initiating insulin there were increases in (undiscounted) life expectancy of 0.61 years and quality-adjusted life expectancy of 0.34 quality-adjusted life years versus delaying initiation for 8 years. There were also substantial reductions in cumulative incidence and time to onset of all diabetes-related complications with immediate versus delayed insulin initiation. Sensitivity analyses showed that a reduced delay in insulin initiation or change in insulin efficacy still demonstrated clinical benefits for immediate versus delayed initiation. Conclusion UK type 2 diabetes patients are at increased risk of a large number of diabetes-related complications due to an unnecessary delay in insulin initiation. Despite clear guidelines recommending tight glycaemic control this failure to begin insulin therapy promptly is likely to result in needlessly reduced life expectancy and compromised quality of life.
机译：背景技术最近的数据表明，英国的2型糖尿病患者在首次开具口服药物后，平均延迟启动胰岛素超过11年。使用已发布的糖尿病计算机模拟模型，我们使用了英国特定的数据来评估立即开始胰岛素治疗与延迟开始胰岛素治疗的临床后果，其结果与公布的估计一致。方法在基本情况下，模拟患者具有根据已公开的英国数据特征，被建模为立即开始胰岛素或延迟8年。预计在35年的时间范围内，就预期寿命和质量调整的预期寿命以及与糖尿病相关的并发症（累积发生率和发病时间）而言，临床结果。与胰岛素使用相关的治疗效果来自已发表的研究，并在开始胰岛素治疗，胰岛素功效和低血糖效用前后进行了敏感性分析。结果对于立即开始胰岛素治疗的患者，延长寿命（不加统计）为0.61年，而质量校正后的预期寿命为0.34质量校正后的寿命（延迟开始使用8年）。立即和延迟开始胰岛素治疗，所有与糖尿病相关的并发症的累积发生率和发病时间也大大减少。敏感性分析表明，减少的胰岛素启动延迟或胰岛素功效的改变仍然证明了立即启动和延迟启动的临床益处。结论英国2型糖尿病患者由于不必要的胰岛素启动延迟而增加了与糖尿病相关的大量并发症的风险。尽管有明确的指南建议严格控制血糖，但未能立即开始胰岛素治疗可能会导致不必要的预期寿命缩短和生活质量下降。

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