Initiation of insulin therapy in patients with type 2 diabetes mellitus according to the Federal Diabetes Register in Moscow

Background. Insulin therapy (IT) occupies an important place in the treatment of patients with type 2 diabetes mellitus (DM2). According to the Federal Diabetes Register (FDR) in Moscow on 05/01/2018, 66.2 thousand DM2 patients received glucose-lowering therapy using insulin preparations (21% of the total number of DM2 patients). According to the Russian part of the CREDIT study, in 2009, for initiation of insulin therapy in DM2 patients, basal insulin (BasalIns; 66.2%) was most often used; less often - basal-bolus IT (17.9%) and mixed insulin (MixIns; 4%) and very rarely (1.1%) - only bolus insulin (BolusIns). IT initiation was carried out at an average level of HbA1c of 9.7±1.8% [2]. Objective. To determine the most commonly used schemes for initiating IT in DM2 patients. Methods. Based on the FDR in Moscow, the analysis of the database of DM2 patients who were assigned to receive IT for the first time in 2017 was carried out. The structure of initial IT in these patients has been determined. Results. Analysis of FDR in Moscow has identified 7020 DM2 patients with initiation of IT in 2017. There were 2,780 men (39.6%) and 4,240 women (60.4%). The average age of patients was 63.9±11.8, the average disease duration was 8.5±6.8 years. BMI was 31.2±6.5 kg/m2, the average НЬА1с level was 8.4±1.8%. Most often IT initiation was carried out using BasalIns (51.6%) or basal-bolus IT (34.4%). The combination of 2 (46.3%) and 3 glucoselowering drugs (38.8%) was most often used. In 78.9% of cases, IT initiation was performed using insulin analogues. In patients with newly diagnosed DM2, basal-bolus IT (48.0%) and BasalIns (40.4%) for IT initiation are mainly used, with the combination of 2 (60.0%) and 3 (21.9 %) sugar-lowering drugs. Conclusion. There is a change in the structure of the newly prescribed IT in DM2 patients com pared with the results of the CREDIT study (2009). Thus, according to the FDR in 2017, IT initiation in DM2 patients was carried out 2 times more often using the basal-bolus scheme (34.4 /s. 17.9%), and less frequently using BasalIns (51.6 /s. 66.2%), MixIns (12.3 /s. 14.4%).

type 2diabetes mellitus, insulin therapy, basal-bolus insulin therapy, basal insulin, insulin initiation