Are patients on basal insulin attaining glycemic targets? Characteristics and goal achievement of patients with type 2 diabetes mellitus treated with basal insulin and physician-perceived barriers to achieving glycemic targets.
OBJECTIVE
To investigate treatment patterns and achievement of glycemic targets in patients with type 2 diabetes mellitus treated with basal insulin in a real-world setting, and to determine physicians' beliefs and practices regarding these patients.


METHODS
This study had two components; a retrospective analysis using a US claims database of patient and treatment data, and a survey of physicians' beliefs and practices.


RESULTS
A total of 39,074 patients treated with basal insulin were included in this analysis. The proportion of patients achieving HbA1c<7.0% (53mmol/mol) was similar in ongoing basal insulin users at baseline (26%) and at 3months follow-up (27%). The number of new initiators achieving HbA1c<7.0% (53mmol/mol) increased from baseline (11%) to 3months (27%). In the physician survey component, the majority of physicians indicated they would continue to increase basal insulin dose as long as was needed to reach HbA1c/fasting blood glucose goals (85% of physicians treating 'not on-goal' patients, 78% of physicians treating 'on-goal' patients). Physician-perceived barriers to insulin intensification included patient's lifestyle, non-adherence, and concerns about out-of-pocket costs.


CONCLUSIONS
A large proportion of patients on insulin-based therapy fail to reach glycemic goals. More education of clinicians may improve insulin intensification rates and increase the proportion of patients reaching glycemic targets.
Millennium Pharmaceuticals, a wholly-owned subsidiary of Takeda Pharmaceuticals Inc., Cambridge, MA, USA. Electronic address: Mehul.dalal@Takeda.com.
Mehul R
MR
Dalal
Healthcore Inc., Wilmington, DE, USA.
Michael
M
Grabner
OptumRx, Irvine, CA, USA.
Nicole
N
Bonine
Healthcore Inc., Wilmington, DE, USA.
Judith J
JJ
Stephenson
Akcea Therapeutics, Cambridge, MA, USA.
Andres
A
DiGenio
Sanofi US, Inc., Bridgewater, NJ, USA.
Nella
N
Bieszk
D000124:Achievement; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D038321:Glycemic Index; D006040:Goals; D005102:Health Expenditures; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
Basal insulin; Glycemic targets; Goal achievements; Physician survey; Real-world evidence; Type 2 diabetes