title: Insulin use and persistence in patients with type 2 diabetes adding mealtime insulin to a basal regimen: a retrospective database analysis.
abstract: BACKGROUND
  The objective of this study was to characterize insulin use and examine factors associated with persistence to mealtime insulin among patients with type 2 diabetes (T2D) on stable basal insulin therapy initiating mealtime insulin therapy.
  
  
  METHODS
  Insulin use among patients with T2D initiating mealtime insulin was investigated using Thomson Reuters MarketScan® research databases from July 2001 through September 2006. The first mealtime insulin claim preceded by 6 months with 2 claims for basal insulin was used as the index event. A total of 21 months of continuous health plan enrollment was required. Patients were required to have a second mealtime insulin claim during the 12-month follow-up period. Persistence measure 1 defined non-persistence as the presence of a 90-day gap in mealtime insulin claims, effective the date of the last claim prior to the gap. Persistence measure 2 required 1 claim per quarter to be persistent. Risk factors for non-persistence were assessed using logistic regression.
  
  
  RESULTS
  Patients initiating mealtime insulin (n = 4752; 51% male, mean age = 60.3 years) primarily used vial/syringe (87%) and insulin analogs (60%). Patients filled a median of 2, 3, and 4 mealtime insulin claims at 3, 6, and 12 months, respectively, with a median time of 76 days between refills. According to measure 1, persistence to mealtime insulin was 40.7%, 30.2%, and 19.1% at 3, 6, and 12 months, respectively. Results for measure 2 were considerably higher: 74.3%, 55.3%, and 42.2% of patients were persistent at 3, 6, and 12 months, respectively. Initiating mealtime insulin with human insulin was a risk factor for non-persistence by both measures (OR < 0.80, p < 0.01). Additional predictors of non-persistence at 12 months included elderly age, increased insulin copayment, mental health comorbidity, and polypharmacy (p < 0.05 for all).
  
  
  CONCLUSIONS
  Mealtime insulin use and persistence were both considerably lower than expected, and were significantly lower for human insulin compared to analogs.
authors.affiliation: Outcomes Research, Thomson Reuters Inc, 37 Lowell Street, Andover MA 01810, USA. machaon.bonafede@thomsonreuters.com.
authors.forename: Machaon M
authors.initials: MM
authors.lastname: Bonafede
authors.forename: Anupama
authors.initials: A
authors.lastname: Kalsekar
authors.forename: Manjiri
authors.initials: M
authors.lastname: Pawaskar
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Ruiz
authors.forename: Amelito M
authors.initials: AM
authors.lastname: Torres
authors.forename: Karen R
authors.initials: KR
authors.lastname: Kelly
authors.forename: Suellen M
authors.initials: SM
authors.lastname: Curkendall