Correlates of basal insulin persistence among insulin-naïve people with type 2 diabetes: results from a multinational survey

Abstract

Background and objective: People with T2DM who initiate basal insulin therapy often stop therapy temporarily or permanently soon after initiation. This study analyzes the reasons for and correlates of stopping and restarting basal insulin therapy among people with T2DM.

Methods: An online survey was completed by 942 insulin-naïve adults with self-reported T2DM from Brazil, France, Germany, Japan, Spain, UK, and US. Respondents had initiated basal insulin therapy within the 3–24 months before survey participation and met criteria for one of three persistence groups: continuers had no gaps of ≥7 days in basal insulin treatment; interrupters had at least one gap in insulin therapy of ≥7 days within the first 6 months after initiation and had since restarted basal insulin; and discontinuers stopped using basal insulin within the first 6 months after initiation and had not restarted.

Results: Physician recommendations and cost were strongly implicated in patients stopping and not resuming insulin therapy. Continuous persistence was lower for patients with more worries about insulin initiation, greater difficulties and weight gain while using insulin, and higher for those using pens and perceiving their diabetes as severe. Repeated interruption of insulin therapy was associated with hyperglycemia and treatment burden while using insulin. Resumption and perceived likelihood of resumption were associated with hyperglycemia upon insulin cessation. Perceived likelihood of resumption among discontinuers was associated with perceived benefits of insulin.

Conclusion: Better understanding of the risk factors for patient cessation and resumption of basal insulin therapy may help healthcare providers improve persistence with therapy.

Keywords:

• Insulin persistence
• physician recommendations
• patient perceptions
• type 2 diabetes

Transparency

Declaration of funding

Funding for this research was provided by Eli Lilly and Company and Boehringer Ingelheim. The sponsor reviewed and provided comments on this article.

Author contributions: M.P., M.P.-N., D.C., J.I., S.K. and I.H. were involved in the conception and design of this study. M.P. and L.S. were involved in the analysis of the data. All authors were involved in the interpretation of the data. M.P. developed the manuscript draft. All authors were involved in revising the manuscript critically for intellectual content, provided a final approval of the version to be published, and agreed to be accountable for all aspects of the work.

Declaration of financial/other relationships

M.P. has disclosed that he has received consultancy fees from Astra Zeneca, Calibra, Lilly, and Novo Nordisk, lecture fees from Lilly and Novo Nordisk, and has served on the Scientific Advisory Boards of Calibra, Lilly, and Novo Nordisk. M.P.-N., D.C., S.K. and I.H. have disclosed that they are employees of Eli Lilly and Company. J.I. and L.S. have disclosed that they are employees of Analysis Group Inc., which has received research funding from Eli Lilly and Company. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

Previous presentation: A synopsis for part of the current research was presented in poster format: Peyrot M, Ivanova JI, Zhao C, et al. Reasons for different patterns of basal insulin persistence after initiation among people with type 2 diabetes mellitus (T2DM). Poster presented at the American Diabetes Association meeting, New Orleans, LA, USA, 10–14 June 2016.