220-OR: Characteristics Associated with Adding Insulin in Type 2 Diabetes in the Glycemia Reduction Approaches in Diabetes (GRADE) Study

Delaying insulin when indicated in type 2 diabetes (T2D) prolongs exposure to hyperglycemia. In the GRADE study, adults (N=5047) with T2D (duration 7.5%. Written consent included acceptance of injectable medications, including insulin, and to add or intensify insulin therapy after outcome confirmation. Among 2387 participants with confirmed A1c>7.5%, 834 (35.0%) added insulin within 6 weeks, 698 (29.1%) after 6 weeks, and 855 (35.8%) never. When we did a comparison by time of initiation, there were differences by age, racial group, outcome A1c and assigned treatment group. Participants never adding insulin were more likely to be older, Black/African American, or assigned to glargine. Those who added insulin were more likely to have higher confirmation A1cs or be assigned to sitagliptin. Analyses to explore investigator and participant factors influencing decisions to delay or not add insulin despite suboptimal glucose control are underway.