INS and diabetes mellitus: However, the poor level of glycemic control prior to insulin initiation is consistent with other studies, such as the Diabetes Attitudes Wishes and Needs (DAWN) Japan study, which also reported a mean HbA1c of 9.4% (79.2 mmol/mol) prior to insulin initiation [19], and the global SOLVE study, where pre-insulin HbA1c was 8.9% (73.8 mmol/mol) [20].