Correlates of basal insulin persistence among insulin-naïve people with type 2 diabetes: results from a multinational survey

Peyrot, Mark; Pérez-Nieves, Magaly; Ivanova, Jasmina I.; Cao, Dachuang; Schmerold, Luke; Kalirai, Samaneh; Hadjiyianni, Irene

doi:10.1080/03007995.2017.1341868

Cited by 20 publications

(20 citation statements)

References 22 publications

(31 reference statements)

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“…Affordability of insulin therapy was the third most common reason for BI discontinuation, accounting for 15.1%. In line with our finding, a previous multinational survey also showed 9.8% and 17.2% of patients reported cost of therapy as a reason for interruption and discontinuation, respectively . And multivariate Cox regression analysis also indicated that ≥80% out‐of‐pocket ratio was associated with higher likelihood of discontinuation compared with <20% out‐of‐pocket ratio.…”

Section: Discussionsupporting

confidence: 90%

“…In this study, 9% of discontinuers self‐reported unsatisfied glycaemic control as the reason for their discontinuation. Another study reported 11.4% and 10.1% interrupted and discontinued insulin therapy due to insufficient glycaemic control, respectively . Those patients might perceive insulin therapy as lack of short‐term clinical efficacy, therefore, be unwilling to persist in it.…”

Section: Discussionmentioning

confidence: 99%

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Factors and outcomes associated with discontinuation of basal insulin therapy in patients with type 2 diabetes mellitus

Zhang

et al. 2020

Endocrino Diabet & Metabol

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Objectives:To assess treatment discontinuation, associated factors and outcomes after initiating basal insulin (BI) among Chinese insulin-naïve patients with type 2 diabetes mellitus (T2DM) who had previously uncontrolled hyperglycaemia on OADs. Patients:Insulin-naïve patients with T2DM who had uncontrolled hyperglycaemia (HbA1c ≥7%) by OADs and were willing to initiate BI treatment were enrolled from 209 secondary and tertiary hospitals in eight geographical regions in China.Design: Each participant was interviewed at baseline, 3 and 6 months to collect study information. Patients with at least one visit during follow-up were included in the analyses. BI discontinuation was defined by a question asking whether the patient discontinued BI therapy at 3 or 6 months. Analyses were conducted to identify baseline factors associated with BI discontinuation and to estimate the association between insulin treatment discontinuation and patients' clinical outcomes at 6 months. Results:Of 17 858 patients, 25.8% discontinued basal insulin therapy within 6 months after initiation, and nearly two-thirds doing so within the first 3 months.Among patients discontinued basal insulin, 70.2% stopped all insulin therapy; 25.9% switched to premixed insulin and 3.8% switched to bolus only. Three most common reasons for BI discontinuation reported by patients were being unwilling to persist basal insulin without specific reasons (46.8%), reducing the frequency of daily injection (23.5%) and medical affordability (15.1%). Factors significantly associated with BI discontinuation were hospital level, patient recruitment setting, age, education level, out-of-pocket ratio, BMI, diabetes duration, self-monitoring of blood glucose (SMBG), numbers of OADs, BI type and insulin regimen. Compared with discontinuers, patients continued BI therapy had higher FPG (46.4% vs 28.8%) and HbA1c (42.3% vs 36.5%) control rate. Conclusion:Among patients with T2DM who initiated BI therapy due to uncontrolled hyperglycaemia by OADs, the proportion of insulin discontinuation was high within 6 months. Further study is needed to understand the reason behind the BI discontinuation.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Factors and outcomes associated with discontinuation of basal insulin therapy in patients with type 2 diabetes mellitus

Zhang

et al. 2020

Endocrino Diabet & Metabol

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Therefore, in real-world practice, early and recurrent hypoglycaemia after insulin initiation might have a significant negative impact on mid-and long-term glycaemic control as fear of (and experienced) hypoglycaemia events is often associated with insufficient insulin titration, reduced adherence and compliance to insulin treatment, and higher rates of discontinuation of insulin treatment than those observed in randomized controlled trials. [10][11][12][13] A limitation of this post-hoc analysis is that it describes observations associated with retrospectively defined hypoglycaemia subgroups and, by necessity, has used a descriptive analysis and, therefore, cannot demonstrate any causality of these associations.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] A limitation of this post-hoc analysis is that it describes observations associated with retrospectively defined hypoglycaemia subgroups and, by necessity, has used a descriptive analysis and, therefore, cannot demonstrate any causality of these associations.Confounding factors other than BMI, weight or fasting C-peptide level may also have contributed to the difference in hypoglycaemia risk during Gla-100 titration.In summary, the present retrospective analysis of hypoglycaemia risk in a large sample of individuals with T2DM who are initiating Gla-100 after inadequate glycaemic control with oral therapy has identified individuals who required or received different insulin doses to reach a similar level of glycaemic control, but who also differed considerably in characteristics associated with hypoglycaemia risk during titration. Changes in glycaemia, body weight and insulin dose from baseline to Weeks 12 and 24 were analysed.…”

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confidence: 99%

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Hypoglycaemia risk in the first 8 weeks of titration with insulin glargine 100 U/mL in previously insulin‐naive individuals with type 2 diabetes mellitus

Frier

Landgraf

Zhang

et al. 2018

Diabetes Obesity Metabolism

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Patient characteristics associated with hypoglycaemia frequency during insulin glargine 100 U/mL (Gla-100) titration and clinical outcomes at Week 24 were examined using participant-level data from 16 treat-to-target trials involving individuals with type 2 diabetes mellitus who were inadequately controlled with oral antidiabetes drugs and were initiating Gla-100 (n = 3549). Hypoglycaemia (plasma glucose <3.9 mmol/L or severe) during the first 8 weeks of titration was stratified by number of events (0, 1-3 and ≥4), resulting in 72.5%, 20.6% and 6.9% of participants in each group, respectively. Changes in glycaemia, body weight and insulin dose from baseline to Weeks 12 and 24 were analysed. Hypoglycaemia was more common in participants with lower BMI and fasting C-peptide, and in those undergoing sulfonylurea treatment. Glycaemic outcomes at Week 24 were similar in each hypoglycaemia group, despite the fact that the Week 24 mean daily dose and dose increase for Gla-100 were highest in participants without hypoglycaemia and were lowest in those experiencing ≥4 events. The risk of hypoglycaemia during Gla-100 titration depends mainly on patient characteristics and on sulfonylurea use and may delay dose titration, which apparently has little effect on short-term glycaemic control in a clinical trial setting.

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Validation of an instrument to measure adherence to type 2 diabetes management

et al. 2020

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Correlates of basal insulin persistence among insulin-naïve people with type 2 diabetes: results from a multinational survey

Abstract: Better understanding of the risk factors for patient cessation and resumption of basal insulin therapy may help healthcare providers improve persistence with therapy.

Cited by 20 publications

References 22 publications

Factors and outcomes associated with discontinuation of basal insulin therapy in patients with type 2 diabetes mellitus

Factors and outcomes associated with discontinuation of basal insulin therapy in patients with type 2 diabetes mellitus

Hypoglycaemia risk in the first 8 weeks of titration with insulin glargine 100 U/mL in previously insulin‐naive individuals with type 2 diabetes mellitus

Validation of an instrument to measure adherence to type 2 diabetes management

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