title: Patterns and trends in insulin intensification among patients with type 2 diabetes: a systematic review.
abstract: Type 2 diabetes (T2DM) diagnoses are skyrocketing, making treatment of this disease an increasing focus of primary care visits. Guidelines recommend insulin intensification over time to achieve HbA1c targets. We conducted a systematic review regarding patterns and trends of insulin intensification and barriers to intensification. Providers across primary and specialty care settings often did not intensify insulin regimens despite patients' clinical status. Even among progressed patients, HbA1c values remained high. The paucity of available studies prevented a comprehensive understanding of patterns and trends in insulin intensification. Such information is needed to assess the quality of pharmacologic care for patients with T2DM.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States. Electronic address: jpolinski@partners.org.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Polinski
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: John G
authors.initials: JG
authors.lastname: Connolly
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, United States.
authors.forename: Bradley H
authors.initials: BH
authors.lastname: Curtis
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: John D
authors.initials: JD
authors.lastname: Seeger
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, United States.
authors.forename: Kimela
authors.initials: K
authors.lastname: Gaskins
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, United States.
authors.forename: Magaly
authors.initials: M
authors.lastname: Perez
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Smith
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
mesh_terms: D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence / Q000639:trends; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011320:Primary Health Care / Q000639:trends; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Insulin intensification; Patterns and trends; Type 2 diabetes