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BackgroundDespite the availability of a variety of treatments, many patients with type 2 diabetes mellitus (T2DM) are not achieving glucose control. We analyzed successive waves of the Adelphi Real World Diabetes Disease Specific Programmes (DSPs) to assess treatment patterns reported by primary care physicians (PCPs) and specialists and the effect of treatment on levels of glucose control.MethodsData were collected between 2000 and 2015 in the US and EU5 (France, Germany, Italy, Spain, and the UK). Physicians completed patient record forms for the next 10 patients consulting with T2DM. Key aspects captured were change over time in therapy usage, time to insulin introduction, and glycated hemoglobin (HbA1c) levels.ResultsOver 12 DSP waves, 3,555 specialists and 5,109 PCPs completed questionnaires for 70,657 patients. Treatment patterns changed considerably over time as new agents were introduced. The number of agents prescribed per patient increased over time, as did HbA1c levels at which physicians stated they would introduce insulin. The greatest improvements in HbA1c levels occurred during 2000–2008, with little improvement since 2008.ConclusionIn this real-world setting, the proportion of patients with T2DM achieving good glucose control has not increased greatly since 2008. A better understanding of how to individualize treatment pathways may be required to improve control in these patients.

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OBJECTIVES: Non-adherence to insulin therapy in patients with type 2 diabetes presents a serious challenge. Potential explanations for non adherence may include aversion to insulin self-injection and fear of hypoglycemic events. In clinical trails, insulin analogs have shown to reduce the risk of hypoglycemic events versus human insulins, and a recent review suggests that insulin delivered via a pen device may result in greater adherence versus vial and syringe. This study was conducted to compare the adherence rates of patients initiating basal insulin therapy with insulin detemir (IDet) FlexPen® versus those initiating basal insulin therapy with NPH via vial and syringe. METHODS: Data were gathered from a large US national payer retrospective claims database, and included only patients with type 2 diabetes that initiated basal insulin therapy with either IDet FlexPen® or NPH in vials. Patients with claims for any other type of insulin, other than the index insulin formulations during the 12-month observation period were excluded. Patients were defined as being adherent to therapy if they had a medication possession ration (MPR) of at least 0.80 in the 12-month follow up period. RESULTS: The IDet FlexPen® cohort (nϭ1082) and the NPH vial cohort (nϭ794) were of similar age (54.06 vs. 53.13, pϭ0.134); however, the IDet FlexPen® cohort had a lower proportion of female patients (44% vs. 55%, pϽ0.001) and fewer patients without a history of pre-index OADs (9% vs 45%, pϽ0.001), than the NPH vial cohort. After controlling for important confounders, patients initiating insulin therapy with IDet FlexPen® were 39% more likely to achieve an MPR of 0.80 or greater versus patients initiating insulin therapy with NPH vial (95% CI: 1.04-1.85). CONCLUSIONS: These results suggest that adherence may be improved for patients initiating basal insulin therapy with IDet in the FlexPen® versus NPH in a vial.