title: Challenges associated with insulin therapy progression among patients with type 2 diabetes: Latin American MOSAIc study baseline data.
abstract: BACKGROUND
  Poor glycemic control in patients with type 2 diabetes is commonly recorded worldwide; Latin America (LA) is not an exception. Barriers to intensifying insulin therapy and which barriers are most likely to negatively impact outcomes are not completely known. The objective was to identify barriers to insulin progression in individuals with type 2 diabetes mellitus (T2DM) in LA countries (Mexico, Brazil, and Argentina).
  
  
  METHODS
  MOSAIc is a multinational, non-interventional, prospective, observational study aiming to identify the patient-, physician-, and healthcare-based factors affecting insulin intensification. Eligible patients were ≥18 years, had T2DM, and were treated with insulin for ≥3 months with/without oral antidiabetic drugs (OADs). Demographic, clinical, and psychosocial data were collected at baseline and regular intervals during the 24-month follow-up period. This paper however, focuses on baseline data analysis. The association between glycated hemoglobin (HbA1c) and selected covariates was assessed.
  
  
  RESULTS
  A trend toward a higher level of HbA1c was observed in the LA versus non-LA population (8.40 ± 2.79 versus 8.18 ± 2.28; p ≤ 0.069). Significant differences were observed in clinical parameters, treatment patterns, and patient-reported outcomes in LA compared with the rest of the cohorts and between Mexico, Brazil, and Argentina. Higher number of insulin injections and lower number of OADs were used, whereas a lower level of knowledge and a higher level of diabetes-related distress were reported in LA. Covariates associated with HbA1c levels included age (-0.0129; p < 0.0001), number of OADs (0.0835; p = 0.0264), higher education level (-0.2261; p = 0.0101), healthy diet (-0.0555; p = 0.0083), self-monitoring blood glucose (-0.0512; p = 0.0033), hurried communication style in the process of care (0.1295; p = 0.0208), number of insulin injections (0.1616; p = 0.0088), adherence (-0.1939; p ≤ 0.0104), and not filling insulin prescription due to associated cost (0.2651; p = 0.0198).
  
  
  CONCLUSIONS
  MOSAIc baseline data showed that insulin intensification in LA is not optimal and identified several conditions that significantly affect attaining appropriate HbA1c values. Tailored public health strategies, including education, should be developed to overcome such barriers. Trial Registration NCT01400971.
authors.affiliation: Eli Lilly and Company, Tronador 4890, Piso 12, CABA, C1430DNN Buenos Aires, Argentina.
authors.forename: Bruno
authors.initials: B
authors.lastname: Linetzky
authors.affiliation: Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA.
authors.forename: Brad
authors.initials: B
authors.lastname: Curtis
authors.affiliation: Servicio de Nutrición y Diabetes, Hospital Sirio Libanes, Campana 4658, C1419HN Buenos Aires, Argentina.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Frechtel
authors.affiliation: School of Medicine of the Federal University of Ceará, Rua Capitao Francisco Pedro, 1290 Fortaleza, Ceara, 60430-370 Brazil.
authors.forename: Renan
authors.initials: R
authors.lastname: Montenegro
authors.affiliation: Hospital de Especialidades del Centro Médico de Occidente IMSS, Belisario Domínguez 1000, piso 2., Col. Independencia Guadalajara, Jalisco, Mexico.
authors.forename: Miguel
authors.initials: M
authors.lastname: Escalante Pulido
authors.affiliation: Eli Lilly and Company, Barranca del Muerto 329-1, Col. San José Insurgentes, Delegación Benito Juárez, Mexico, 03900 Distrito Federal Mexico.
authors.forename: Oded
authors.initials: O
authors.lastname: Stempa
authors.affiliation: Eli Lilly and Company, Av. Morumbi 8.264, São Paulo, Brazil.
authors.forename: Janaina Martins
authors.initials: JM
authors.lastname: de Lana
authors.affiliation: CENEXA, Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET La Plata), Calle 60 y 120, La Plata, Argentina.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Gagliardino
keywords: Diabetes education; Diabetes knowledge; Diabetes self-care management; Insulin treatment; Latin America; Observational study; Psychological impact; Quality of care; Type 2 diabetes