Barriers to the initiation of, and persistence with, insulin therapy

Oliveria, Susan A.; Menditto, Laura; Yood, Marianne Ulcickas; Koo, Yuri H.; Wells, Karen; McCarthy, Bruce D.

doi:10.1185/030079907x242638

Cited by 40 publications

(41 citation statements)

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“…Although treatment with an oral anti-diabetic drug (OAD), usually metformin, in combination with lifestyle changes is recommended as the initial therapy for most patients, worsening β-cell function typically requires intensification of therapy with basal or intermediate-acting insulin (e.g., insulin glargine, insulin detemir, or neutral protamine Hagedorn) or glucagon-like peptide-1 (GLP-1) receptor agonists (such as liraglutide) [1]. Initiating injectable therapy may be delayed by negative perceptions from patients and health care professionals, including fear of injection pain, misconceptions about insulin risks (e.g., hypoglycemia and weight gain), attributing the need for insulin to personal failure, and the perceived negative impact on the patient’s social life and job [2–4]. …”

Section: Introductionmentioning

confidence: 99%

The INITIATOR Study: Pilot Data on Real-World Clinical and Economic Outcomes in US Patients with Type 2 Diabetes Initiating Injectable Therapy

et al. 2013

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IntroductionType 2 diabetes mellitus (T2DM) progression often results in treatment intensification with injectable therapy to maintain glycemic control. Using pilot data from the Initiation of New Injectable Treatment Introduced after Anti-diabetic Therapy with Oral-only Regimens study, real-world treatment patterns among T2DM patients initiating injectable therapy with insulin glargine or liraglutide were assessed.MethodsThis was a retrospective analysis of claims from the OptumInsight™ (OI; January 1, 2010 to July 30, 2010) and HealthCore® (HC; January 1, 2010 to June 1, 2010) health insurance databases. Baseline characteristics, health care resource utilization, and costs were compared between adults with T2DM initiating injectable therapy with insulin glargine pen versus liraglutide. Follow-up outcomes, including glycated hemoglobin A1c (A1C), hypoglycemia, health care utilization, and costs, were assessed.ResultsAt baseline, almost one in three liraglutide patients (OI, n = 363; HC, n = 521) had A1C <7.0%, while insulin glargine patients (OI, n = 498; HC, n = 1,188) had poorer health status, higher A1C (insulin glargine: 9.8% and 9.1% versus liraglutide: 7.9% and 7.7%, OI and HC, respectively, both P < 0.001), and were less likely to be obese (insulin glargine: 10.8% and 9.2% versus liraglutide: 17.4% and 18.8%, OI and HC, respectively, both P < 0.01). The percentage of patients experiencing a hypoglycemic event was numerically higher for insulin pen use for both cohorts (OI 4.4% versus 3.0%; HC 6.2% versus 2.3%). During follow-up, in the insulin glargine cohort, annualized diabetes-related costs remained unchanged ($8,344 versus $7,749 OI, and $7,094 versus $7,731 HC), despite a significant increase in pharmacy costs, due to non-significant decreases in medical costs, while the liraglutide cohort had a significant increase in annualized diabetes-related costs ($4,510 versus $7,731 OI, and $4,136 versus $7,111 HC; both P < 0.001) due to a non-significant increase in medical costs coupled with a significant increase in pharmacy costs.ConclusionThese descriptive data identified differences in demographic and baseline clinical characteristics among patients initiating injectable therapies. The different health care utilization and cost patterns warrant further cost-effectiveness analysis.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-013-0074-8) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

The INITIATOR Study: Pilot Data on Real-World Clinical and Economic Outcomes in US Patients with Type 2 Diabetes Initiating Injectable Therapy

et al. 2013

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“…5 Several barriers to adherence to insulin regimens have been identified, including issues related to insulin injection, such as dislike of performing the injections, difficulties adhering to an injection schedule, and pain associated with injection. 6 Downloaded by [New York University] at 22:48 05 August 2015…”

Section: Discussionmentioning

confidence: 99%

Outcomes Associated with Post-Discharge Insulin Continuity in US Patients with Type 2 Diabetes Mellitus Initiating Insulin in the Hospital

Zhou

et al. 2012

Hospital Practice

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“…16 Ary ve ark.nın 208 tip 1 ve tip 2 diyabetik hastada yapmış olduğu bir başka uyum çalışmasında, tip 2 diyabetik hastaların insülin tedavisine uyumunu sosyal faktörlerin yaygın olarak etkilediğini göstermişlerdir. 17 Ross ve ark.nın yapmış oldukları derlemede hipoglisemi korkusu ve enjeksiyon zorluğu insülin tedavisine başlamada bir engel olarak bulunmuştur.…”

Section: Discussionunclassified

The Rate of Insulin Nonpersistence Among Patients with Type II Diabetes Who Were First Started on Insulin Treatment

Karabayraktar¹,

Tekin²,

Tekin³

et al. 2017

Turkiye Klinikleri J Med Sci

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Ö ÖZ ZE ET T A Am ma aç ç: : Çalışmamızın amacı ilk kez insülin tedavisi başlanan standart insülin tedavi eğitimi alan diyabetik hastaların insülin bırakma oranlarını ve tedavi uyumsuzluğunun sebeplerini saptamaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya 1 Ocak 2012-1 Ocak 2013 tarihleri arasında Dr.Lütfi Kır-dar Kartal Eğitim ve Araştırma Hastanesi polikliniklerinde ilk kez insülin tedavisi başlanan ve diyabet eğitim odasında aynı iki diyabet hemşiresi tarafından verilen standart insülin tedavi eğitimi alan 700 tip 2 diyabetik hasta alındı. Hastalar telefon ile aranarak sosyodemografik verilerini, ek hastalıklarını, insülin tedavisini başlayan klinik, insülin kullanımlarını içeren anket uygulandı. Toplam 462 hasta/hasta yakınına ulaşıldı, 14 hastanın vefat ettiği öğrenildi. Hekim tarafından insülin tedavisi kesilen 23 hasta çalışma dışı bırakılarak, 425 hasta çalışmaya dahil edildi. B Bu ul lg gu ul la ar r: : Çalış-mamızda dahil edilen 425 hastanın %50,8'i erkekti. Yaş ortalaması 57,7±11,6 yıl, diyabet süresi 6,6±6,2 yıl olarak saptandı. Diyabetik hastaların %57,6'sı bazal, %17,9'u hazır karışım, %24,5'i bazal bolus tedavisi kullanmakta idi. İnsülin tedavisini bırakma oranı %6,2 olarak bulundu. Nonparametrik korelasyon testleri ile değerlendirildiğinde diyabet yaşı arttıkça tedaviye devam oranının arttığı görüldü (p=0,01, r=0,12). Tedaviyi bırakma sebepleri sorgulandığında hipoglisemi, halsizlik (%26,9), iyileştiklerini düşünme (%23), enjeksiyon zorluğu (%15,3), allerji (%11,5), çevresel faktör-ler (%7,6) ve bağımlılık korkusu (%7,6) saptandı. S So on nu uç ç: : Diyabetli hastalara insülin tedavisi başlanan merkezlerin, hastalarının insülin bırakma oranlarını ve nedenlerini saptaması ve elde edilen sonuç-lara göre tedaviye uyumsuzluk nedenlerine yönelik olarak standart eğitim programlarının güncel-lenmesi daha çok hastanın glisemik hedeflere yaklaştırılması konusunda önemli bir adım olacaktır.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Tedavi uyumu; diabetes mellitus; insülin A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Our aim in this study is to assess the rate and possible causes of nonpersistence among patients with diabetes who have received standard insulin education for their insulin treatment. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : 700 patients with type II diabetes, who were started on insulin treatment by outpatient clinics of Dr. Lütfi Kırdar Kartal Training and Research Hospital between 1/1/2012-1/1/2013, and who had received the same standard insulin education given by diabetes nurses, were enrolled in this study. Patients were called by the phone and a questionnaire was filled regarding patients' socio-demographic characteristics, comorbidities and patients' insulin use. We have reached 462 patients/relatives. Total of 14 patients died, and 23 patients, whose insulin treatment was nonpersistent by a physician, were excluded. 425 patients were included in the final analysis. R Re es su ul lt ts s: : Among 425 patients, 50.8% w...

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Barriers to the initiation of, and persistence with, insulin therapy

Cited by 40 publications

References 13 publications

The INITIATOR Study: Pilot Data on Real-World Clinical and Economic Outcomes in US Patients with Type 2 Diabetes Initiating Injectable Therapy

The INITIATOR Study: Pilot Data on Real-World Clinical and Economic Outcomes in US Patients with Type 2 Diabetes Initiating Injectable Therapy

Outcomes Associated with Post-Discharge Insulin Continuity in US Patients with Type 2 Diabetes Mellitus Initiating Insulin in the Hospital

The Rate of Insulin Nonpersistence Among Patients with Type II Diabetes Who Were First Started on Insulin Treatment

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