Insulin initiation in type 2 diabetic patients admitted in hospital in France and follow-up at 1 year - The "IDAHO 2" study

Objectives and methods: The IDAHO 2 epidemiological survey was conducted in departments of diabetology in insulin-naive type 2 diabetics for whom insulin was initiated. The objective was to assess the patients' profil, the treatments proposed during hospital stay and after one year. Results: 797 patients were analysed. Their characteristics were: age 64 +/- 12 years, 49% males, weight: 78 +/- 17 kg, BMI: 29 +/- 6 kg/m(2), diabetes duration 11 years, prevalence of complications: 68%, fasting blood glucose 13 +/- 6 mmol/l, HbA(1c): 10 +/- 2.2%; treatment prior to insulin comprised: at least 2 OHA: 71% of cases, one: 21%, no OAD: 8%. At hospital discharge, 54% of the patients used basal insulin. After 1 year, 670 continued on insulin. The insulin initiation was accompanied by a decrease in the FBG level (baseline: 13 6 mmol/l, final: 8.5 +/- 2.75 mmol/l; P < 0.0001) and a HbA(1c) improvement (baseline: 10 2.2%; final: 7.9 +/- 1.4%; P < 0.0001). This was observed during the first 6 months (HbA(1c): 7.8%, P < 0.0001 versus baseline). 80% of the patients remained on the same insulin regimen after 1 year: 35% had 1 injection/day, 44% had 2, 12% had 3 and 9% had a complexe regimen. The weight gain, the final daily dose and hypoglycaemias increased with the number of injections. The mean daily insulin dose was 33 U/day (24 U with 1 injection/day). Conclusion: The IDAHO study shows that insulin is effective in type 2 diabetics however, management is inadequate with insulin therapy being initiated too late and at doses which are low after one year.