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Lifestyle adjustments can offset HbA1c effects of insulin therapy refusal
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Among a cohort of patients with type 2 diabetes who decided not to take insulin, the odds of achieving lower HbA1c measures were eight times higher for those who made adjustments to their lifestyle practices compared with those who did not, according to findings published in the Journal of Diabetes and its Complications.
In addition, having elevated HbA1c prior to starting noninsulin therapy also increased the odds of reducing HbA1c while inconsistent medication use decreased them.
“Many patients with type 2 diabetes who decline insulin therapy, counterintuitively, see an improvement in their blood glucose levels,” Alexander Turchin, MD, MS, of the division of endocrinology at Brigham and Women’s Hospital in Boston, told Endocrine Today. “Provider[s] should be aware of treatment approaches, such as lifestyle changes or initiation of non-insulin diabetes medications, that appear to be effective in this patient population.”
Turchin and colleagues used electronic medical records to assess HbA1c outcomes in 300 adults aged at least 18 years with type 2 diabetes. Insulin therapy was refused by all participants, who were treated at Brigham and Women’s Hospital or Massachusetts General Hospital in Boston from 1993 to 2014. Among the total cohort, HbA1c rose in 150 patients (mean age, 62.5 years; 54% women), and HbA1c fell in the other 150 (mean age, 62 years; 52.6% women).
More than one-quarter of patients who experienced a drop in HbA1c reported making adjustments to their lifestyle (27.3%) while 7.3% of those who experienced an increase made such adjustments (P < .001). Noninsulin diabetes medications were taken by 47.3% of those who lowered HbA1c and by 31.3% of those who increased HbA1c (P = .006). Among those who had experienced lowered HbA1c measures, 1.3% did not take their medications consistently compared with 26.7% of those who experienced heightened measures (P < .001). In addition, 8% of those who presented with lower HbA1c during the study stopped taking their medications altogether while the rate was higher (16%) for those who presented with elevated HbA1c (P = .049).
Patients with higher HbA1c prior to treatment had greater odds of achieving lower HbA1c than those with lower initial levels (OR = 1.83; 95% CI, 1.4-2.39). Those who made adjustments to their lifestyle practices had eightfold higher odds of lowering their HbA1c compared with those who did not (OR = 8.39; 95% CI, 3.26-21.55). Conversely, the odds of achieving lower HbA1c were reduced for those who did not consistently take their medications as prescribed (OR = 0.014; 95% CI, 0.0025-0.085) and those who stopped taking them altogether (OR = 0.3; 95% CI, 0.11-0.8).
“There are many medications available to treat diabetes, and insulin is not the best treatment for everyone. But there are patients for whom insulin is the best approach — providers should make a convincing argument for why it is better than the alternatives,” Turchin said. “Clinicians need to keep in mind that there are many effective ways of treating diabetes. There is no single, one-size-fits-all approach, and finding the best treatment for every patient is our most important task.” – by Phil Neuffer
For more information:
Alexander Turchin, MD, MS, can be reached at aturchin@bwh.harvard.edu.
Disclosures: Turchin reports he has received funding from Eli Lilly, Novo Nordisk and Sanofi, equity in Brio Systems and personal fees from Monarch Medical Technologies and MonARC Bionetworks. The other authors report no relevant financial disclosures.
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