Time to first insulin use

The majority of type 2 diabetes cases can be initially managed through a combination of diet, exercise, and medication (RACGP 2016).

However, some people newly diagnosed with type 2 diabetes need insulin replacement from diagnosis. While insulin treatment in a newly diagnosed patient is less common, it might be used in patients with type 2 diabetes in hyperglycaemic emergencies.

When blood glucose levels can no longer be maintained at optimum levels through diet, exercise, and other medications, insulin replacement might be required (RACGP 2016). Eventually, many people with type 2 diabetes will need insulin as well as other treatments.

Between 2012 and 2018, the median time to first insulin use for people with insulin-treated type 2 diabetes remained relatively unchanged, at about 7–8 years after diagnosis.

The proportion of people with insulin-treated type 2 diabetes, who began using insulin immediately (that is, less than a year) after diagnosis remained relatively unchanged between 2012 and 2017 at around 18–19%, with a slight rise to 21% in 2018.

Between 2012 and 2018, the proportion of people with insulin-treated type 2 diabetes who began using insulin:

  • decreased from 23% to 19% for those who started insulin 1–5 years after diagnosis
  • decreased from 31% to 22% for those who started insulin 6–10 years after diagnosis
  • peaked in 2016 at 24% for those who started using insulin 11–15 years after diagnosis, before falling to 21% in 2018
  • increased from 3% to 13% for those who started insulin 16–20 years after diagnosis
  • remained similar at about 3%–4% for those who started insulin 21 years or more after diagnosis.

Data should be interpreted with caution. Many factors influence the timing of insulin initiation. They include the benefits of early effective glycaemic control, the number of non-insulin treatments available, glycaemic target used for individual patients, and the availability of insulin supplies and monitoring equipment (RACGP 2015).

Data presented for time to first insulin use might include people who are prescribed insulin treatment only once or for a short period of time, who might no longer be using insulin.

Age and sex

Between 2012 and 2018, the median time to first insulin use for people with insulin-treated type 2 diabetes was similar for males and females, at about 7–8 years.

In 2018, the median time to first insulin use increased with age, peaking among those aged 40–54 (10 years), and then decreasing. The median time among those aged 75 and over was 1 year.

Population groups

Between 2012 and 2018, the median time to first insulin use for people with insulin-treated type 2 diabetes was similar across remoteness and socioeconomic areas.

References

RACGP 2015. The introduction of insulin in type 2 diabetes mellitus. East Melbourne: RACGP.

RACGP 2016. General practice management of type 2 diabetes: 2016–18. East Melbourne: RACGP.