Endocrine Abstracts

JOINT3029

Introduction: Type 2 diabetes (T2D) is a progressive disorder that often necessitates insulin therapy when oral glucose-lowering agents fail to control hyperglycemia. Initiating insulin in T2D patients represents a critical therapeutic escalation, aimed not only at preventing acute and chronic complications but also at reducing cardiovascular risks. This study aimed to evaluate the metabolic profile of Tunisian T2D patients at the time of insulin initiation.

Patients and Methods: We conducted a retrospective descriptive study at the Endocrinology Department of Taher Sfar University Hospital, including 245 T2D patients who commenced long-term insulin therapy due to the failure of oral antidiabetic agents or the presence of signs of insulinopenia.

Results: The study included 245 patients with a mean age of 59.3 ± 9.18 years and a sex ratio (M/F) of 0.67. The median duration of T2D was 10 years [6–15]. Hypertension and dyslipidemia were present in 50.6% and 53.5% of patients, respectively. Most patients (87.7%) were on a combination of metformin and sulfonylureas. Even though 66.4% of patients reported significant weight loss, the median BMI was 27.6 kg/m² [25.1–30], with 76% of patients being overweight or obese. Waist circumference, a key indicator of insulin resistance, was 100 cm [91.5–108.7] in women and 102 cm [93.5–107] in men. Glycemic control was suboptimal, with median HbA1c and fasting plasma glucose (FPG) levels of 11.43% [10.5–12.85] and 2.9 g/l [2.3–3.3], respectively. Lipid profiles were also poor, with median levels of total cholesterol, triglycerides, HDL-C, and LDL-C at 1.62 g/l [1.46–2.05], 1.32 g/l [0.9–1.82], 0.44 g/l [0.35–0.5], and 0.96 g/l [0.69–1.23], respectively. Median uric acid levels were 312 µmol/l [243–391].

Conclusion: Our findings underscore the poor metabolic profile of T2D patients at insulin initiation, reflecting a significant delay in therapeutic escalation. The observed dyslipidemia may be attributed to insulinopenia and/or chronic hyperglycemia. Early intensification of treatment, whether through basal insulin or other agents with proven metabolic benefits, could mitigate further cardiovascular complications and improve outcomes.