The Trend of High-Dose Insulin Usage Among Patients with Diabetes in the UK: A Retrospective Study

Abstract

IntroductionMany patients with diabetes may require high-dose insulin treatment to achieve target HbA1c level, but the prevalence, disease burden, and patient characteristics of the population remain unclear. We therefore investigated people with insulin-treated diabetes in the UK from 2009 to 2013, who were prescribed high daily doses (> 200 units/day).MethodsA retrospective analysis was conducted using the UK primary care electronic dataset from the Clinical Practice Research Datalink (CPRD). Trends of demographics, insulin dose, clinical characteristics, and annualized incidence rate of the insulin initiators were analyzed. Patients with type 1 (T1D) or type 2 diabetes (T2D) and who were prescribed insulin between 2009 and 2013 were categorized into either a low- or high-dose insulin user group. Two-sample t test and chi-square test were used for comparison of continuous variables and categorical variables, respectively. A multivariable negative binomial regression analysis with (log) person time as an offset was used to assess the impact of different covariates on incidence of high-dose insulin initiation.ResultsBetween 2009 and 2013, 19,631 patients with diabetes were treated with insulin (T1DM, 7620; T2DM, 12,011). In 2013, 415 high-dose insulin initiators were identified (T1DM, N = 170; T2DM, N = 245). More than half were male (T1DM/T2DM, 62.4%/56.3%) and 94.1%/83.7% of T1DM/T2DM patients were prescribed an insulin analogue at high-dose insulin initiation. At 6 months, 43.6% of T1DM and 42.6% of T2DM remained to have suboptimal HbA1c level of ≥ 8% (64 mmol/mol). Overall, 15.9%/63.3% of high-dose insulin initiators (HDII) with T1DM/T2DM took oral antidiabetics. From 2009 to 2013, the estimated glomerular filtration rate worsened in both T1DM and T2DM HDII.ConclusionDespite a number of patients requiring high doses of insulin in the UK, achievement of optimal HbA1c levels remains poor. Early identification of HDII is important in order to plan for alternative/adjuvant antidiabetic and lifestyle strategies to achieve optimal glycemic targets in this patient group.FundingEli Lilly and Company.

Harnessing the Biologics and Biosimilars Collective Intelligence Consortium to Evaluate Patterns of Care

“…We have reported baseline characteristics that are similar to those reported in some retrospective observational studies. [17][18][19] Our population was much younger and had fewer women than a study using the U.S. HMO Research Network; however, that study combined the results of patients with T1DM or type 2 diabetes mellitus. 19 A recent systematic review and network meta-analysis found no significant difference between LAIs and neutral protamine Hagedorn (NPH) insulins with respect to severe hypoglycemic events among patients with T1DM, which echo our findings.…”

Concentrated insulins: History and critical reappraisal

“…The resulting complex insulin injection regimen may result in reduced adherence, which may lead to poorer glucose control. Concentrated insulins can help overcome pitfalls patients encounter when administering large single‐injection insulin doses, such as increased pain, low adherence, need for multiple injections, and more frequent pen changes …”

“…Concentrated insulins can help overcome pitfalls patients encounter when administering large single-injection insulin doses, such as increased pain, low adherence, need for multiple injections, and more frequent pen changes. [63][64][65][66] Each concentrated insulin provides its own benefits to patients, and so the needs of the patient should drive the selection of the appropriate insulin. Patients of any weight for whom smaller insulin volumes are desirable could benefit from concentrated insulins.…”

Missed and Mistimed Insulin Doses in People with Diabetes: A Systematic Literature Review

“…[2][3][4] Furthermore, evidence suggests that many insulin-treated people with diabetes (PwD) are still failing to reach glycemic targets. [5][6][7][8][9] This trend of inadequate glycemic control is already having a detrimental impact, with national statistics and epidemiological studies demonstrating that rates of diabetes-related complications have increased in recent years. 10 Failure to achieve glycemic control at a population level has been linked with the inherent complexities of medication taking.…”