Persistence with Insulin Therapy in Patients with Type 2 Diabetes in France: An Insurance Claims Study

AimsTo identify subgroups of patients with type 2 diabetes mellitus (T2DM) following distinct trajectories of HbA1c after insulin initiation and explore underlying differences in clinical characteristics.Materials and methodsA cohort study was conducted in patients with T2DM initiating insulin in 2007–2013 with a follow‐up of 2 to 4 years. Data were collected from the Groningen Initiative to Analyze Type 2 Diabetes Treatment (GIANTT) database. The primary outcome was subgroups with different trajectories of HbA1c patterns after insulin initiation, as identified by latent class growth modeling. Differences between subgroups were tested using one‐way ANOVA, Kruskal‐Wallis or chi‐square tests, where appropriate.ResultsFrom 1459 patients, three subgroups with distinct HbA1c patterns were identified. Group 1 (8%) initially showed a moderate decrease followed by an increase in HbA1c 2 years later, despite receiving more comedication. Group 2 (84%) showed a stable decrease. Group 3 (8%) had a high initial level of HbA1c and a rapid decline within the first year, followed by a slow increase thereafter. Group 1 patients were on average 6–7 years younger than patients in groups 2 and 3 and were more likely to receive sulfonylureas than Group 3 patients. Group 3 patients had a shorter diabetes duration and were less well‐controlled for HbA1c, systolic blood pressure and LDL‐cholesterol at insulin initiation.ConclusionsMost patients showed a stable HbA1c response, but one out of six patients showed either a poor response, or a rapid initial response only after insulin initiation. Response patterns were associated with age, diabetes duration and risk‐factor controls at the time of insulin initiation.

Section: Discussionsupporting

confidence: 81%

HbA1c response after insulin initiation in patients with type 2 diabetes mellitus in real life practice: Identifying distinct subgroups

Sidorenkov

Boven

Hoekstra

et al. 2018

“…Patients who had discontinued BI within the past 12 months were also eligible. While reports on the percentages of patients who discontinue BI vary, 19,20 based on an estimated total sample size of 120 patients per country and results of a French study indicating that approximately 25% of patients discontinued BI within 1 year of treatment initiation, 21 it was estimated that~30 patients per country who had discontinued BI would be included in the patient sample.…”

Section: Patientsmentioning

confidence: 99%

Insights into optimal basal insulin titration in type 2 diabetes: Results of a quantitative survey

Berard

Bonnemaire

Mical

et al. 2017

AimsBasal insulin (BI) treatment initiation and dose titration in type 2 diabetes (T2DM) are often delayed. Such “clinical inertia” results in poor glycaemic control and high risk of long‐term complications. This survey aimed to determine healthcare professional (HCP) and patient attitudes to BI initiation and titration.MethodsAn online survey (July–August 2015) including HCPs and patients with T2DM in the USA, France and Germany. Patients were ≥18 years old and had been on BI for 6 to 36 months, or discontinued BI within the previous 12 months.ResultsParticipants comprised 386 HCPs and 318 people with T2DM. While >75% of HCPs reported discussing titration at the initiation visit, only 16% to 28% of patients remembered such discussions, many (32%–42%) were unaware of the need to titrate BI, and only 28% to 39% recalled mention of the time needed to reach glycaemic goals. Most HCPs and patients agreed that more effective support tools to assist BI initiation/titration are needed; patients indicated that provision of such tools would increase confidence in self‐titration. HCPs identified fear of hypoglycaemia, failure to titrate in the absence of symptoms, and low patient motivation as important titration barriers. In contrast, patients identified weight gain, the perception that titration meant worsening disease, frustration over the time to reach HbA1c goals and fear of hypoglycaemia as major factors.ConclusionA disconnect exists between HCP‐ and patient‐perceived barriers to effective BI titration. To optimize titration, strategies should be targeted to improve HCP–patient communication, and provide support and educational tools.

“…Basal insulin discontinuation rates are high among patients with T2D . Low persistence with insulin therapy has important consequences, increasing the risk of hyperglycaemia and, consequently, diabetes‐related complications .…”

Section: Introductionmentioning

confidence: 99%

“…Basal insulin discontinuation rates are high among patients with T2D. [3][4][5][6] Low persistence with insulin therapy has important consequences, increasing the risk of hyperglycaemia and, consequently, diabetes-related complications. 7 Elevated A1C levels are strongly predictive of diabetes-related complications 8 and increased diabetesrelated health care costs.…”

Section: Introductionmentioning

confidence: 99%

Relationship between treatment persistence and A1C trends among patients with type 2 diabetes newly initiating basal insulin

Zhou

Xie

Pan

et al. 2018

This study examines the relationship between glycated haemoglobin (A1C) levels and treatment persistence with, or time to discontinuation of, basal insulin in patients with type 2 diabetes (T2D) newly initiating insulin. Claims data were extracted from the Optum Clinformatics database from January 2010 to June 2015. Adult patients with T2D initiating insulin glargine 100 U/mL (Gla‐100) or insulin detemir (DET) with ≥1 A1C measurement during 12‐month baseline and 18‐month follow‐up periods were included. Patients with a refill gap of >90 days were considered non‐persistent; otherwise, patients were considered persistent with insulin. The main outcome was A1C, measured closest to the end of each quarter during the follow‐up period. A total of 3993 of 109 934 patients met the inclusion criteria (43.0% persistent; 57.0% non‐persistent). Persistent patients were older (54.7 vs 52.7 years; P < .001), were more likely to be male (59.4% vs 54.4%; P = .002), and had significantly lower mean unadjusted A1C values at 18 months (8.26% vs 8.60%; P < .001) and quarterly. Only 43.0% of adults initiating basal insulin persisted with treatment for 18 months, with earlier discontinuation associated with higher A1C.