Clinical predictors of progression to insulin use among Chinese patients with Type 2 Diabetes - The Hong Kong Diabetes Registry
Refereed conference paper presented and published in conference proceedings


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AbstractObjective- Factors that affect disease progression and glycaemic deterioration in type 2 diabetes are poorly understood, but may facilitate precision medicine in diabetes. In this study, we aim to identify factors predicting earlier need for insulin treatment among Chinese patients with type 2 diabetes (T2D).

Methods- We included 10,129 consecutive Chinese patients with diabetes who were enrolled into our registry between 1995-2007. We excluded patients with type 1 diabetes, those already on insulin treatment at baseline, or patients who required insulin within 1 year of follow-up. We identified all subjects who progressed to continuous insulin treatment during the follow-up period. We calculated time-to-insulin use for each patient. We performed Cox regression analysis to identify clinical predictors of progression to insulin use.

Results- Among 7,570 patients with T2D in our registry not requiring insulin at baseline, 2882 (38%) progressed to insulin treatment during a median follow-up period of 9.3 years (IQR 5.4-13.6). Subjects who progressed to insulin use during follow-up period were younger, had earlier onset of diabetes, longer duration of diabetes at time of recruitment and shorter duration of follow-up. Incident insulin-users had higher HbA1c, TG, LDL- cholesterol and lower HDL cholesterol at baseline, and were more likely to have sensory neuropathy, retinopathy, albuminuria, or CKD at baseline. On multivariate analysis, independent predictors of progression to insulin use included: age at diagnosis (HR 0.97 [CI 0.97-0.98]), smoking status, higher baseline HbA1c (HR 1.3 [1.30-1.35]), lower eGFR, presence of diabetic retinopathy (HR 1.68 [1.54-1.83]) and low BMI (<18.5kg/m2) (HR 1.71 [1.36-2.17]).

Discussion- In this large cohort of patients with T2D representative of real-life clinical practice, a significant proportion progressed to insulin use during follow-up. In addition to poor glycaemic control, young-onset diabetes was identified as an important predictor for disease progression to insulin use. Low BMI should alert clinicians regarding the earlier need for insulin. Limitations of the current study include clinical inertia and delay in commencement of insulin treatment. Additional analyses to define glycaemic deterioration and need for insulin using serial A1c and prescription data on oral medications are currently underway. Genome-wide association analyses to identify genetic factors associated with need for insulin is also being conducted.

Conclusions: Asian T2D patients with low baseline BMI, higher baseline HbA1c, younger age of diagnosis and impaired renal function are at increased risk of progression to insulin use.
All Author(s) ListRonald C.W. Ma, Guozhi Jiang, Claudia H.T. Tam, Andrea O. Luk, Risa Ozaki, Elaine Chow, Alice P.S. Kong, Chun Chung Chow, Wing Yee So, Juliana C.N. Chan
Name of ConferenceThe American Association of Clinical Endocrinologist 26th Annual Scientific and Clinical Congress
Start Date of Conference03/05/2017
End Date of Conference07/05/2017
Place of ConferenceAustin, Texas
Country/Region of ConferenceUnited States of America
Year2017
LanguagesEnglish-United States

Last updated on 2018-14-05 at 12:06