title: Rapid Acting Insulin Use and Persistence among Elderly Type 2 Diabetes Patients Adding RAI to Oral Antidiabetes Drug Regimens.
abstract: We examined the real-world utilization and persistence of rapid acting insulin (RAI) in elderly patients with type 2 diabetes who added RAI to their drug (OAD) regimen. Insulin-naïve patients aged ≥65 years, with ≥1 OAD prescription during the baseline period, who were continuously enrolled in the US Humana Medicare Advantage insurance plan for 18 months and initiated RAI were included. Among patients with ≥2 RAI prescriptions (RAIp), persistence during the 12-month follow-up was assessed. Multivariate logistic regression analyses identified factors affecting RAI use and persistence. Of 3734 patients adding RAI to their OAD regimen, 2334 (62.5%) had a RAIp during follow-up. Factors associated with RAIp included using ≤2 OADs; cognitive impairment, basal insulin use during follow-up; and higher RAI out-of-pocket costs ($36 to <$56 versus $0 to $6.30). Patients were less likely to persist with RAI when on ≤2 OADs versus ≥3 OADs and when having higher RAI out-of-pocket costs ($36 to <$56 versus $0 to $6.30) and more likely to persist when they had cognitive impairment and basal insulin use during follow-up. Real-world persistence of RAI in insulin-naïve elderly patients with type 2 diabetes was very poor when RAI was added to an OAD regimen.
authors.affiliation: School of Pharmacy, West Virginia University, Morgantown, WV, USA.
authors.forename: Usha
authors.identifier: 0000-0001-8311-1360
authors.initials: U
authors.lastname: Sambamoorthi
authors.affiliation: School of Pharmacy, West Virginia University, Morgantown, WV, USA.
authors.forename: Arijita
authors.identifier: 0000-0002-4570-0364
authors.initials: A
authors.lastname: Deb
authors.affiliation: Sanofi US, Inc., Bridgewater, NJ, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Zhou
authors.affiliation: School of Pharmacy, West Virginia University, Morgantown, WV, USA.
authors.forename: Rahul
authors.identifier: 0000-0002-0236-7370
authors.initials: R
authors.lastname: Garg
authors.affiliation: Sanofi US, Inc., Bridgewater, NJ, USA.
authors.forename: Tao
authors.initials: T
authors.lastname: Fan
authors.affiliation: Sanofi US, Inc., Bridgewater, NJ, USA.
authors.forename: Anders
authors.identifier: 0000-0002-8575-5175
authors.initials: A
authors.lastname: Boss
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D017047:Cost Sharing; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism; D016527:Drug Costs; D004359:Drug Therapy, Combination; D006442:Glycated Hemoglobin / Q000378:metabolism; D005102:Health Expenditures; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007279:Injections, Subcutaneous; D061266:Insulin, Short-Acting / Q000627:therapeutic use*; D016015:Logistic Models; D055118:Medication Adherence; D015999:Multivariate Analysis; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D061266:Insulin, Short-Acting; C517652:hemoglobin A1c protein, human