Clinical outcomes of insulin deintensification in a real-world primary care setting: A retrospective observational study

ABSTRACT

Introduction: This study evaluated the outcomes of a structured insulin deintensification clinic for patients with type 2 diabetes mellitus (T2DM) in a Malaysian public primary care clinic during a national insulin supply shortage.
Methods: This retrospective observational study analysed 61 patients with T2DM (≥1-year diagnosis) on insulin (≥6 months). Patients who were pregnant, had type 1 diabetes mellitus, experienced recent diabetic emergencies or had severe target organ damage were excluded. A multidisciplinary team implemented personalised strategies including insulin dose reduction, regimen simplification and lifestyle counselling. The primary outcome was glycated haemoglobin (HbA1c) changes at 3 months (n=58), while the secondary outcomes included changes in the total daily insulin dosage, injection frequency, body weight and prevalence of adverse events.
Results: Participants (mean age: 63.2±12.0 years) had high baseline complexity: 80.3% were on four-times-daily regimens, and 44.3% had HbA1c levels of >10%. Deintensification significantly reduced the mean daily insulin dosage by 0.41 unit/kg (95% CI: –0.49 to –0.33; P<0.001) and injection frequency (P<0.001). While the overall HbA1c level remained stable, patients with baseline HbA1c level of >10% significantly improved (–1.3%; P=0.004). Weight decreased by 2.0% (95% CI: –2.8% to –1.2%; P<0.001). The prevalence of hypoglycaemia and hunger pangs dropped from 16.4% to 3.3% (P=0.008) and from 42.6% to 4.9% (P<0.001). No severe hyperglycaemic emergencies occurred.
Conclusion: Structured insulin deintensification is a feasible strategy in primary care settings. In patients with T2DM, it reduces treatment burden, hypoglycaemic events and body weight while maintaining glycaemic stability.