Initiating insulin earlier in the course of type 2 diabetes, when HbA1c levels are only modestly elevated, has been shown to have increased probability of achieving and sustaining target glycemic values. 1203 people with type 2 diabetes in the Hoorn Diabetes Care System with age ≥40 years; initiation of insulin during follow-up after failure to reach HbA1c levels ≤7% with oral glucose-lowering agents; and a follow up ≥2 years after initiating insulin were included in the study.

Four HbA1c trajectories were identified. Over an average 5.5 years, most people (88.7%) had stable HbA1c of about 7.4%. Only 24.4% were “on target” in response to insulin. Those in the “off-target” group were significantly younger, and had higher HbA1c and glucose levels at the time of insulin initiation. It was observed that low HbA1c levels and advanced age at the start of insulin therapy were associated with better response to insulin therapy.

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