Initiation of Basal Insulin Analog Treatment for Type 2 Diabetes and Reasons Behind Patients’ Treatment Persistence Behavior: Real-World Data from Germany

Moennig, E; Pérez-Nieves, Magaly; Hadjiyianni, Irene; Cao, Dachuang; Ivanova, Jasmina; Klask, R

doi:10.1055/s-0043-116386

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…Compared with previous studies, we found that much lower proportions of discontinuers reported hypoglycaemia (6.7%) or weight gain (2.4%) as the reasons for discontinuation. In this study, general hypoglycaemia happened in 9.7% and 7.7% of discontinuers and continuers in the past month (weight gain >2 kg: 16.0%, 12.1%), respectively, whereas the proportion of severe hypoglycaemia after BI initiation was very low (0.6%).…”

Section: Discussioncontrasting

confidence: 98%

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: Discussioncontrasting

confidence: 98%

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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“…Laferton et al (15) also showed an injectable medication was expected to be more effective than an oral one. Reduction of glucose to a target level was the number one most expected benefit, 7 out of 10 insulin participants anticipated this result, higher than 42 and 61% reported by multinational studies (20,21). In contrast, 5 out of 10 metformin users expected this benefit, a result lower than that documented in primary care of 70% (18).…”

Section: Type Of Medicationmentioning

confidence: 72%

“…One study found that only one-fifth of persons with diabetes expected to take glucose-lowering agents for the rest of their lives ( 19 ). Moennig et al ( 20 ) found that 42% of insulin users expected an improvement in glucose, and fulfillment of this expectation was the main cause of uninterrupted use. Naegeli et al ( 21 ) documented a higher percentage of insulin users anticipate achieving optimal glucose levels (61%).…”

Section: Introductionmentioning

confidence: 99%

Idealistic, realistic, and unrealistic expectations of pharmacological treatment in persons with type 2 diabetes in primary care

Salinas-Martı́nez

Montes²,

Morado³

et al. 2023

Front. Public Health

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IntroductionInformation on treatment expectations in diabetes is scarce for Mexican and Latino populations. We determined idealistic, realistic, and unrealistic expectations for metformin, insulin, and glyburide in primary care. We also explored the association between sociodemographic attributes, time since diagnosis, and expectations.MethodsThis was a cross-sectional study conducted during 2020–2022 in governmental primary care centers. We consecutively included persons with type 2 diabetes aged 30–70 years under pharmacological medication (n = 907). Questions were developed using information relevant to expectation constructs. Data were collected by interview. We used descriptive statistics, a test of the difference between two proportions, and multivariate ordinal logistic regression.ResultsA high percentage of participants would like to have fewer daily pills/injections or the option of temporarily stopping their medication. Realistic expectations ranged from 47% to 70%, and unrealistic expectations from 31 to 65%. More insulin users wished they could take a temporary break (p < 0.05) or would like to be able to change the route of administration (p < 0.001) than metformin users. More persons with diabetes on insulin expected realistic expectations compared to those on metformin or glyburide (p ≤ 0.01). Being able to interrupt medication upon reaching the glucose goal was higher in combined therapy users (p < 0.001).ConclusionTime since diagnosis, place of residence, sex, and diabetes education were factors associated to expectations. Management of expectations must be reinforced in primary care persons with type 2 diabetes undergoing pharmacological medication.

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Reasons for discontinuing insulin and factors associated with insulin discontinuation in patients with type 2 diabetes mellitus: a real-world evidence study

Morrison

Zhao

et al. 2021

Clin Diabetes Endocrinol

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Background Evidence suggests that insulin therapy of patients with type 2 diabetes mellitus (T2DM) is frequently discontinued. However, the reasons for discontinuing insulin and factors associated with insulin discontinuation in this patient population are not well understood. Methods We conducted a retrospective cohort study of adults with T2DM prescribed insulin between 2010 and 2017 at Partners HealthCare. Reasons for discontinuing insulin and factors associated with insulin discontinuation were studied using electronic medical records (EMR) data. Natural language processing (NLP) was applied to identify reasons from unstructured clinical notes. Factors associated with insulin discontinuation were extracted from structured EMR data and evaluated using multivariable logistic regression. Results Among 7009 study patients, 2957 (42.2%) discontinued insulin within 12 months after study entry. Most patients who discontinued insulin (2121 / 71.7%) had reasons for discontinuation documented. The most common reasons were improving blood glucose control (33.2%), achieved weight loss (18.5%) and initiation of non-insulin diabetes medications (16.7%). In multivariable analysis adjusted for demographics and comorbidities, patients were more likely to discontinue either basal or bolus insulin if they were on a basal-bolus regimen (OR 1.6, 95% CI 1.3 to 1.8; p < 0.001) or were being seen by an endocrinologist (OR 2.6; 95% CI 2.2 to 3.0; p < 0.001). Conclusions In this large real-world evidence study conducted in an area with a high penetration of health insurance, insulin discontinuation countenanced by healthcare providers was common. In most cases it was linked to achievement of glycemic control, achieved weight loss and initiation of other diabetes medications. Factors associated with and stated reasons for insulin discontinuation were different from those previously described for non-adherence to insulin therapy, identifying it as a distinct clinical phenomenon.

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Initiation of Basal Insulin Analog Treatment for Type 2 Diabetes and Reasons Behind Patients’ Treatment Persistence Behavior: Real-World Data from Germany

Abstract: Quality interactions between physicians or other HCPs and their patients before and during the initiation of basal insulin may help to manage patient expectations and to improve persistence to insulin therapy.

Cited by 4 publications

References 25 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

Idealistic, realistic, and unrealistic expectations of pharmacological treatment in persons with type 2 diabetes in primary care

Reasons for discontinuing insulin and factors associated with insulin discontinuation in patients with type 2 diabetes mellitus: a real-world evidence study

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