Five-Year Predictors of Insulin Initiation in People with Type 2 Diabetes under Real-Life Conditions

Absract

We performed a real-life analysis of clinical and laboratory parameters, in orally treated T2DM patients aiming at identifying predictors of insulin treatment initiation. Overall, 366955 patients (55.8% males, age 65 ± 11 years, diabetes duration 7 ± 8 years) were followed up between 2004 and 2011. Each patient was analyzed step-by-step until either eventually starting insulin treatment or getting to the end of the follow-up period. Patients switching to insulin showed a worse global risk profile, longer disease duration (10 ± 9 years vs. 6 ± 7 years, respectively; ), higher HbA1c (8.0 ± 1.6% vs. 7.2 ± 1.5%, respectively; ), higher triglycerides, a greater prevalence of arterial hypertension, antihypertensive, lipid-lowering and aspirin treatment, a higher rate of nonproliferative/proliferative retinopathy, and a nearly 4 times lower prevalence of the “diet alone.” They also showed a higher prevalence of subjects with eGFR < 60 ml/min/1.73 m2 (24.0% vs. 16.2%, respectively; ). Multivariate analysis identified diabetes duration, HbA1c, triglyceride and low HDL-C values, presence of retinopathy or renal dysfunction, and sulphonylurea utilization (the risk being approximately 3 times greater in the latter case) as independent predictors of insulin treatment initiation. LDL-C, lipid-lowering treatment, and overweight/obese seem to be protective. Results of tree analysis showed that patients on sulphonylurea, with high HbA1c, eGFR below 50 ml/min/1.73 m2, and at least 5-year disease duration, are at very high risk to start insulin treatment. We have to stick to this real-life picture, of course, until enough data are collected on patients treated with innovative medications which are expected to improve beta cell survival and further delay treatment-related insulin requirement.

https://www.hindawi.com/journals/jdr/2018/7153087/   full text

So unnecessary  when there is an easy answer by ignoring official guidelines and using a fad low carb diet

I lost count of the number of people who were told on diagnosis "you'll be on insulin in five/ten years" and of course none of them are.

"By now we would have expected you to be on at least two or three diabetes medications" - my doctor a couple of years ago. She's finally starting to see the point, I directed her to David Unwin's Twitter feed but I haven't seen her for ages to see what she's learned.

No medication can produce normal glucose and insulin levels without reducing carbs intake. They don't normalize either then wonder how the diabetes progress and how complications ensue. They are Clueless!

From Chris's post-

""you'll be on insulin in five/ten years""

Yes, Eddie (Type 2 diabetic)  was told this … But, (and I'm sure regular readers know), with LCHF he reduced his HbA1c from in the 12’s (at diagnosis) to the 5’s. By living this lifestyle, his blood sugar levels remain constant, and his only diabetic medication is metformin...

We still need to spread the good news about LCHF and what can be achieved by living this lifestyle  

All the best Jan

Did you spot this from the paper

"Among measured biochemical factors, higher triglyceride levels were found to be associated with long-term oral hyperglycemic agent failure, and in our hands, Cox regression confirmed triglycerides to be a strong predictor for future insulin requirement. This is a major point, because hypertriglyceridemia may serve as a marker of reduced insulin production or activity and may indicate the presence of lipotoxicity, which can lead to beta cell loss [28], especially in the presence of hyperglycemia "

Well there's an easy way to reduce trigs isn't there?

chris c wrote:
Well there's an easy way to reduce trigs isn't there?

Yes I know how as do many other low carbers but the method is mainly ignored by mainstream providers of diabetic dietary advice cos it involves a fad diet   as Yoly said they are clueless

Yes the fad diet we ate for millennia until low fat was invented a few decades ago.