Abstract: FR-PO0359
Insulin in Type 2 Diabetes: Therapeutic Failure or Marker of Disease Severity?
Session Information
- Diabetic Kidney Disease: Progression, Predictive Tools, Therapeutics, and Outcomes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Duran Martinez, Carlos, Florida Kidney Physicians, Delray Beach, Florida, United States
- Diaz Martinez, Janet, Florida International University, Miami, Florida, United States
- Hospital, Michelle M, Florida International University, Miami, Florida, United States
- Mancilla, Jessica Janelly, Caridad Center, Boynton Beach, Florida, United States
- Hernandez-Fuentes, Gustavo A., Universidad de Colima - Campus Villa de Alvare, Villa de Álvarez, Col., Mexico
- Delgado-Enciso, Ivan, Universidad de Colima - Campus Villa de Alvare, Villa de Álvarez, Col., Mexico
Background
Patients with type 2 diabetes (T2D) treated with insulin commonly exhibit poorer clinical outcomes, including impaired renal function. Clarifying insulin's role as a marker of clinical complexity could guide kidney care strategies.
Methods
We conducted a cross-sectional analysis of EMR from 1,397 T2D patients at a community-based clinic. Clinical characteristics, glycemic control (HbA1c ≤7%), renal outcomes (glomerular filtration rate [eGFR], urine albumin-to-creatinine ratio [UACR]), medication patterns, and healthcare utilization (primary care, specialist, case management, mental health, diabetes education) were compared between insulin-treated patients and those receiving other pharmacological therapies (non-insulin-treated group). Statistical analyses included descriptive statistics, t-tests, chi-squared tests, and multivariate logistic regression
Results
Insulin-treated patients exhibited significantly poorer glycemic control (33.3% achieving HbA1c ≤7%) compared to thoses on other pharmacologic therapies, including SGLT2 inhibitors (90.9%) and GLP-1 receptor agonists (85.7%; both p<0.001). Renal outcomes were significantly worse among insulin-treated patients compared to all non-insulin-treated patients, evidenced by lower mean eGFR (67.7±43.4 vs. 101.1±19.0 mL/min/1.73 m2; p<0.001) and higher albuminuria (mean UACR 148.6±324.6 vs. 47.3±71.6 mg/g; p<0.001). Additionally, insulin-treated patients had higher healthcare utilization (visits): specialist (28.2±21.5 vs. 13.4±12.0; p<0.001), primary care (2.51±4.53 vs. 1.14±2.97; p<0.001), case management (6.61±5.45 vs. 2.76±3.15; p<0.001), mental health (4.93±13.29 vs. 2.48±10.03; p=0.005), and diabetes education sessions (1.61±2.12 vs. 0.56±1.26; p<0.001). Logistic regression analysis confirmed insulin was strongly associated with poorer glycemic control (aOR=0.018; 95% CI: 0.005–0.060; p<0.001)
Conclusion
Our findings support that insulin-treated T2D patients exhibit significantly poorer glycemic control, worse renal outcomes, and greater healthcare utilization compared to those receiving other therapies. These clinical differences highlight receiving insulin therapy as a marker of patients who may require intensified, multidisciplinary management, particularly with a focus on proactive kidney care strategies.