Probability of Achieving Glycemic Control with Basal Insulin in Patients with Type 2 Diabetes in Real-World Practice in the USA

This multicenter, longitudinal, descriptive, observational study of T2DM adults in Thailand aimed to assess real-world outcomes of basal insulin (BI) dose titration on glycemic control. Three-hundred and twenty-four patients were recruited and followed up over 24 weeks. Basal insulin titration was physician-driven in 58.2% of patients and patient-driven in the rest. During the 24-week study period, the total daily BI dose moved from 20.9 to 25.6 in the physician-driven group, while in the patient-driven group, it increased from 25.3 to 29.7. Thirty-five patients (11.2%) achieved their individualized HbA1c targets, with 18 patients (5.8%) achieving HbA1c ⩽ 7% without documented hypoglycemia. In summary, this study highlights that BI titration is suboptimal in the real world, and patients are unable to achieve their glycemic targets.

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Initiation of Basal Insulin Analog Treatment for Type 2 Diabetes and Reasons Behind Patients’ Treatment Persistence Behavior: Real-World Data from Germany

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0043-116386 ◽

2017 ◽

Vol 126 (05) ◽

pp. 287-297 ◽

Cited By ~ 1

Author(s):

Elisabeth Moennig ◽

Magaly Perez-Nieves ◽

Irene Hadjiyianni ◽

Dachuang Cao ◽

Jasmina Ivanova ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Insulin Therapy ◽

Real World ◽

Basal Insulin ◽

Well Being ◽

Insulin Initiation ◽

Treatment Persistence ◽

Persistence Behavior

Abstract Background Poor treatment persistence can affect the real-world effectiveness of insulin therapy. A cross-sectional online survey in 942 patients with type 2 diabetes from 7 different countries evaluated patient experience when initiating basal insulin and the reasons behind insulin persistence patterns. Here, we report the quantitative results for the subset of patients from Germany. Methods Adults with type 2 diabetes who had initiated basal insulin during the last 3–24 months, identified from market-research panels, participated in the survey. Patients were asked if they had ≥7-day gaps in basal insulin treatment, and were then classified as “continuers” (no gap since starting insulin), “interrupters” (≥1 gap within the first 6 months after starting insulin and subsequently restarted insulin), or “discontinuers” (stopped insulin within the first 6 months after starting and had not restarted at the time of the survey). For each country, 50 participants were planned per persistence category. Enrollment ended if the target quota was reached or enrollment plateaued. Data were analyzed overall and separately for each persistence cohort. Results The 131 participants from Germany included 55 (42.0%) continuers, 50 (38.2%) interrupters and 26 (19.9%) discontinuers. The most common motivations to initiate basal insulin therapy were encouragement by physician or other healthcare provider (HCP; 54.2%) and expectation to improve glycemic control (42.0%). More than 95% of participants received training before and during insulin initiation (considered as helpful by 81.7%); most (67.2%) preferred in-person training. Continuers more frequently felt that insulin would help to manage diabetes and that their own views were considered when initiating insulin, they reported less concerns and challenges before and during insulin initiation than interrupters or discontinuers. The most common motivations to continue basal insulin were improved glycemic control (72.7%), improved physical well-being (49.1%), and instruction by physician or other HCP (45.5%). The most common reasons contributing to interruption/discontinuation were perceived weight gain (52.0%/50.0%), hypoglycemia (22.0%/38.5%), and potential adverse effects (30.0%/26.9%). Conclusions Quality interactions between physicians or other HCPs and their patients before and during the initiation of basal insulin may help to manage patient expectations and to improve persistence to insulin therapy.

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Evaluation of the long-term cost-effectiveness of IDegLira versus liraglutide added to basal insulin for patients with type 2 diabetes failing to achieve glycemic control on basal insulin in the USA

Journal of Medical Economics ◽

10.1080/13696998.2017.1301943 ◽

2017 ◽

Vol 20 (7) ◽

pp. 663-670 ◽

Cited By ~ 13

Author(s):

B. Hunt ◽

M. Mocarski ◽

W. J. Valentine ◽

J. Langer

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Glycemic Control ◽

Basal Insulin ◽

The Usa

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A Real-World Observational Study Evaluating the Probability of Glycemic Control with Basal Insulin or Glucagon-Like Peptide-1 Receptor Agonist in Japanese Patients with Type 2 Diabetes

Diabetes Therapy ◽

10.1007/s13300-020-00836-8 ◽

2020 ◽

Vol 11 (7) ◽

pp. 1481-1496 ◽

Cited By ~ 1

Author(s):

Mike Baxter ◽

Yukiko Morimoto ◽

Masami Tamiwa ◽

Masakatsu Hattori ◽

Xuejun Victor Peng ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Observational Study ◽

Real World ◽

Basal Insulin ◽

Receptor Agonist ◽

Japanese Patients ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1

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De-Intensification of Antidiabetic Treatment Using Canagliflozin in Patients with Heart Failure and Type 2 Diabetes: Cana-Switch-HF Study

Journal of Clinical Medicine ◽

10.3390/jcm10092013 ◽

2021 ◽

Vol 10 (9) ◽

pp. 2013

Author(s):

Luis M. Pérez-Belmonte ◽

Michele Ricci ◽

Jaime Sanz-Cánovas ◽

Lidia Cobos-Palacios ◽

María D. López-Carmona ◽

...

Keyword(s):

Heart Failure ◽

Type 2 Diabetes ◽

Glycemic Control ◽

Real World ◽

Basal Insulin ◽

Emergency Department Visits ◽

Antidiabetic Agents ◽

Antidiabetic Treatment ◽

Patients With Heart Failure

Canagliflozin is a sodium-glucose co-transporter 2 inhibitor that reduces glycemia as well as the risk of cardiovascular events. Our main objective was to analyze antidiabetic treatment de-intensification and the glycemic efficacy of replacing antidiabetic agents (excluding metformin) with canagliflozin in patients with heart failure and type 2 diabetes with poor glycemic control. In this observational, retrospective, real-world study, we selected patients treated with metformin in combination with ≥2 non-insulin antidiabetic agents or metformin in combination with basal insulin plus ≥1 non-insulin antidiabetic agent. Non-insulin antidiabetic agents were replaced with canagliflozin. Patients were followed-up on at three, six, and 12 months after the switch and a wide range of clinical variables were recorded. A total of 121 patients were included. From baseline to 12 months, the number of antidiabetic agents (3.1 ± 1.0 vs. 2.1 ± 0.8, p < 0.05), basal insulin dose (20.1 ± 9.8 vs. 10.1 ± 6.5 units, p < 0.01), and percentage of patients who used basal insulin (47.9% vs. 31.3%, p < 0.01) decreased. The proportion of patients who used diuretics also declined significantly. In addition, we observed improvement in glycemic control, with an increase in the proportion of patients with glycated hemoglobin <7% from 16.8% at three months to 63.5% at 12 (p < 0.001). Canagliflozin use was also beneficial in terms of body weight, blood pressure, heart failure status, functional class, and cardiovascular-renal risk. There were also reductions in the number of emergency department visits and hospitalizations for heart failure. Moreover, canagliflozin was well-tolerated, with a low rate of drug-related discontinuation. Mounting evidence from randomized controlled trials and real-world studies point to the beneficial profile of sodium-glucose co-transporter type 2 inhibitors such as canagliflozin in patients with heart failure.

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