Clinical Profile of Patients with Type 2 Diabetes Mellitus Initiated on Insulin Therapy: A Single-Center Experience

Abstract

Objective: The objectives of the present study was to describe the demographic and clinical characteristics of people with type 2 diabetes initiated on insulin therapy and to identify common comorbidities and complications present at insulin initiation.

Methodology: It was a retrospective observational study conducted at the Endocrinology clinics of the Shifa International Hospital, Islamabad. Adults (≥18 years) with a diagnosis of T2DM who are being started on insulin therapy for the first time were included in the study. Patients already on insulin or who have used insulin previously due to any reason were excluded. Patients with hyperglycemic emergencies, pregnancy, hospitalization were also excluded. Data was collected from Electronic Medical Records over a period of 3 years from 2022-2025.

Results: In the cohort of 270 patients, who were started on insulin for the first time, there were 150 males (55.6%) and 120 females (44.4%), with a mean age of 56.8 ± 10.1 years (range: 30–80 years). Their mean duration of diabetes was 11.07 ± 5.0 years (range: 2–25 years). The overall mean HbA1c was 10.73 ± 1.81 % (range: 7.3–15.2), while the mean fasting plasma glucose (FPG) was 208.8 ± 41.6 mg/dL (range: 145–400). Most patients (56.7%) were on triple-drug therapy, followed by four-drug therapy (23.3%), dual therapy (15.2%), monotherapy (3.3%), and five-drug therapy (1.5%). Most common microvascular complication was neuropathy (43%) while most common macrovascular complication was CAD (14.4%). The most frequent reason for insulin initiation was failure of oral drugs (81.9%). Basal insulin was the most commonly initiated insulin (67.8%), followed by premixed insulin (31.5%) and basal-bolus (0.7%). Mean HbA1c was significantly higher among those started on premixed insulin (12.19 ± 1.48 %) compared to basal insulin (10.05 ± 1.51 %).

Conclusions: Insulin therapy was most commonly initiated after failure of three or more oral glucose-lowering agents and at markedly elevated HbA1c levels, suggesting delayed treatment intensification. Longer duration of diabetes and poorer glycemic control were associated with a higher prevalence of diabetes-related complications, highlighting the need for earlier insulin initiation and timely optimization of glycemic management.