Assessing achievement and maintenance of glycemic control by patients initiating basal insulin

Abstract

Objective:

Describe characteristics of diabetic patients who initiated basal insulin and assess their glycemic control.

Research design and methods:

Physician encounters in the General Electric EMR Database (2005–2010) were assessed for patients with type II diabetes (T2DM) who initiated basal insulin between February 2006 and August 2009, with initiation defined as no prescription record of insulin in prior 15 months. Patients were followed for an average 2.5 years after insulin initiation. The proportion and time to achieving HbA1c ≤ 7% (‘goal’) were assessed. Among patients who reached goal, the proportion and time to HbA1c increasing above 7% were analyzed. Cox proportional hazard models were estimated to identify predictors of HbA1c goal achievement and goal sustainability.

Results:

Basal insulin initiators with T2DM (n = 13,373) were on average 60 years old, 50.5% were females, and 59.5% had HbA1c > 8%; 5840 (44%) patients reached goal within one year and 7699 (58%) reached goal during the ∼2.5-year follow-up. Being older, white or male, lower baseline HbA1c values, and no OAD use before insulin initiation were associated with significantly higher rates of reaching goal. Among patients who reached goal, 57.6% could not sustain the goal. Being Hispanic, higher baseline HbA1c values, and baseline OAD use were associated with significantly lower rates of goal sustainment.

Conclusion:

A high proportion of T2DM patients did not have adequate glycemic control after initiating basal insulin. Various factors existing prior to insulin initiation were related to successful treatment of T2DM. Further research on how to improve glycemic control is encouraged.

Key words::

• Achievement of glycemic control
• Basal insulin initiation
• Non-sustained glycemic control
• Patient characteristics

Transparency

Declaration of funding

This study was funded by Novo Nordisk.

Declaration of financial/other interests

M.A. has disclosed that he is an employee and stock holder of Novo Nordisk. N.W., L.B., M.F., and K.W. have disclosed that they are employees of United BioSource Corporation, a company that received funding for their part in the conducting and publication of this study.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.