Geographic patterns in patient demographics and insulin use in 18 countries, a global perspective from the multinational observational study assessing insulin use: understanding the challenges associated with progression of therapy (MOSAIc).
BACKGROUND
Among patients with type 2 diabetes, insulin intensification to achieve glycemic targets occurs less often than clinically indicated. Barriers to intensification are not well understood. We present patients' baseline characteristics from MOSAIc, a study investigating patient-, physician-, and healthcare environment-based factors affecting insulin intensification and subsequent health outcomes.


METHODS
MOSAIc is a longitudinal, observational study following patients' diabetes care in 18 countries: United Arab Emirates (UAE), Argentina, Brazil, Canada, China, Germany, India, Israel, Italy, Japan, Mexico, Russia, Saudi Arabia, South Korea, Spain, Turkey, United Kingdom, United States. Eligible patients are age ≥ 18, have type 2 diabetes, and have used insulin for ≥ 3 months with/without other antidiabetic medications. Extensive baseline demographic, clinical, and psychosocial data are collected at baseline and regular intervals during the 24-month follow-up. We conducted descriptive analyses of baseline data.


RESULTS
Four thousand three hundred forty one patients met eligibility criteria. Patients received their type 2 diabetes diagnosis 12 ± 8 years prior to baseline visit, yet patients in developing countries were younger than in developed countries (e.g., UAE, 55 ± 10; Germany = 70 ± 10). Saudi Arabians had the highest HbA1c values (9.0 ± 2.2) and Germany (7.5 ± 1.4) among the lowest. Most patients in 5 (28%) of the 18 countries did not use an oral antidiabetic drug. Over half of patients in fourteen (78 %) countries exclusively used basal insulin; most Indian and Chinese patients exclusively used mixed insulin.


CONCLUSIONS
MOSAIc's baseline data highlight differences in patient characteristics across countries. These patterns, along with physician and healthcare environment differences, may contribute to the likelihood of insulin intensification and subsequent clinical outcomes.
CVS Health, Woonsocket, RI, USA. Jennifer.Polinski@CVSCaremark.com.|Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA, 02120, USA. Jennifer.Polinski@CVSCaremark.com.|Harvard Medical School, Boston, MA, USA. Jennifer.Polinski@CVSCaremark.com.
Jennifer M
JM
Polinski
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA, 02120, USA. skim62@partners.org.|Harvard Medical School, Boston, MA, USA. skim62@partners.org.
Seoyoung C
SC
Kim
Eli Lilly and Company, Indianapolis, IN, USA. jiang_dingfeng@lilly.com.
Dingfeng
D
Jiang
Dubai Diabetes Center, Dubai, UAE. aakhass@yahoo.com.
Ahmed
A
Hassoun
CVS Health, Woonsocket, RI, USA. william.shrank@cvscaremark.com.
William H
WH
Shrank
CAP Sant Marti de Provencals, Catalan Institute of Health, Barcelona, Spain. xcos.claramunt@gmail.com.
Xavier
X
Cos
Center for Diabetes Control, Inc, Carolina, PR, ᅟ. efrodrig@gmail.com.
Efraín
E
Rodríguez-Vigil
Eli Lilly Japan K.K., Kobe, Japan. suzuki_shuichi@lilly.com.
Shuichi
S
Suzuki
Kanagawa Physicians Association, Kanagawa, Japan. ikuro@matsuba-web.com.
Ikuro
I
Matsuba
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA, 02120, USA. jdseeger@partners.org.|Harvard Medical School, Boston, MA, USA. jdseeger@partners.org.|Harvard School of Public Health, Boston, MA, USA. jdseeger@partners.org.
John D
JD
Seeger
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA, 02120, USA. weddings@partners.org.|Harvard Medical School, Boston, MA, USA. weddings@partners.org.
Wesley
W
Eddings
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA, 02120, USA. gbrill@partners.org.|Harvard Medical School, Boston, MA, USA. gbrill@partners.org.
Gregory
G
Brill
Eli Lilly and Company, Indianapolis, IN, USA. curtis_bradley_h@lilly.com.
Bradley H
BH
Curtis
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001118:Argentina / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007194:India / Q000453:epidemiology; D007328:Insulin / Q000627:therapeutic use*; D007557:Israel / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D012426:Russia / Q000453:epidemiology; D012529:Saudi Arabia / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D014421:Turkey / Q000453:epidemiology; D014479:United Arab Emirates / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human