{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T04:47:22Z","timestamp":1773290842722,"version":"3.50.1"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,5,8]],"date-time":"2015-05-08T00:00:00Z","timestamp":1431043200000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Sanofi US, Inc."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      To compare clinical and economic outcomes of early insulin initiation with those of delayed initiation in older adults with type 2 diabetes mellitus (T2\n                      <jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Humana Medicare Advantage health insurance plan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      Older (\u226565) Medicare beneficiaries with T2\n                      <jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>\n                      Subjects were grouped according to number of classes of oral antidiabetes drugs (\n                      <jats:styled-content style=\"fixed-case\">OAD<\/jats:styled-content>\n                      s) they had taken before initiation of insulin: one (early insulin initiators), two, or three or more (delayed insulin initiators). One\u2010year follow\u2010up outcomes included change in glycosylated hemoglobin (HbA1c), percentage of older adults with HbA1c less than 8.0%, hypoglycemic events, and total healthcare costs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 14,669 individuals were included in the analysis. Baseline and 1\u2010year follow\u2010up HbA1c levels were available for 4,028 (27.5%) individuals. Insulin was initiated early in 32% and delayed in 20%. At follow\u2010up, unadjusted reduction in HbA1c was 0.9\u00a0\u00b1\u00a03.7% for the group with one\n                      <jats:styled-content style=\"fixed-case\">OAD<\/jats:styled-content>\n                      , 0.7\u00a0\u00b1\u00a02.4% for those with two, and 0.5\u00a0\u00b1\u00a03.6% for those with three or more. Early insulin initiation was associated with significantly greater reduction in HbA1c (0.4%; adjusted\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;.001), 30% greater likelihood of achieving HbA1c less than 8.0% (adjusted odds ratio\u00a0=\u00a01.30, 95% confidence interval\u00a0=\u00a01.18\u20131.43), and no significant differences in total costs or hypoglycemia events (11.5% of early initiators vs 10.2% of delayed initiators;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.32).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This study suggests beneficial effects of early insulin initiation in older adults with T2\n                      <jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content>\n                      who do not have adequate glycemic control, without increasing the risk of hypoglycemia or greater total direct healthcare costs.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.13388","type":"journal-article","created":{"date-parts":[[2015,5,8]],"date-time":"2015-05-08T08:05:02Z","timestamp":1431072302000},"page":"893-901","source":"Crossref","is-referenced-by-count":25,"title":["A Real\u2010World Study of the Effect of Timing of Insulin Initiation on Outcomes in Older Medicare Beneficiaries with Type 2 Diabetes Mellitus"],"prefix":"10.1111","volume":"63","author":[{"given":"Rituparna","family":"Bhattacharya","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Systems and Policy School of Pharmacy West Virginia University Morgantown West Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve","family":"Zhou","sequence":"additional","affiliation":[{"name":"Sanofi US, Inc. 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Bridgewater New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mayank","family":"Ajmera","sequence":"additional","affiliation":[{"name":"RTI International Research Triangle Park North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Usha","family":"Sambamoorthi","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Systems and Policy School of Pharmacy West Virginia University Morgantown West Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,5,8]]},"reference":[{"issue":"1","key":"e_1_2_6_2_1","first-page":"S11","article-title":"Standards of medical care in diabetes\u20142012","volume":"35","author":"American Diabetes Association","year":"2012","journal-title":"Diabetes Care"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200565030-00005"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmm008"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0806470"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-012-0451-9"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60762-X"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2013.0081"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1326.2011.01487.x"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2007.02279.x"},{"key":"e_1_2_6_11_1","volume-title":"National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011","year":"2011"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.2147\/ciia.2006.1.2.107"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2389.2003.51256.x"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-1801"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.11.2673"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-1184"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc06-9912"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-0413"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.2165\/11537890-000000000-00000"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/46.6.717"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.08m04301"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(06)00588-X"},{"key":"e_1_2_6_23_1","first-page":"721","article-title":"Validating the adapted Diabetes Complications Severity Index in claims data","volume":"18","author":"Chang HY","year":"2012","journal-title":"Am J Manag Care"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.29.03.06.dc05-2078"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2012.04079.x"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6823-8-4"},{"key":"e_1_2_6_27_1","unstructured":"U.S. Department of Labor. 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