Clinical outcomes after insulin initiation in patients with type 2 diabetes: 6-month data from the INSTIGATE observational study in five European countries

Liebl, Andreas; Jones, Stephen C.; Benroubi, Marian; Castell, Conxa; Goday, Albert; Munier, Charles; Smith, Helen; Nicolay, Claudia; Simpson, Alexander I. F.

doi:10.1185/03007995.2011.555755

Cited by 32 publications

(33 citation statements)

References 24 publications

(29 reference statements)

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“…The higher hypoglycaemia rate observed with the basalbolus regimen in this study may be a result of the low rate of blood glucose monitoring for patients on basal-bolus, which was the lowest rate of the three regimens and may in part reflect local guidelines or reimbursement systems, whereas insulin dose was the highest. In contrast, in the INSTIGATE observational study in Germany where prandial and basal-bolus regimens were most commonly used, the hypoglycaemia rate was intermediate (22% of patients at 6 months), and the HbA 1c level was the lowest of all countries studied, with a mean rate of blood glucose monitoring of 21 tests per week or four times higher than in this study 9,25 . ADA recommends blood glucose monitoring three or more times daily in patients using multiple insulin injections both to prevent hypoglycaemia and improve glycaemic control 6 .…”

Section: Discussioncontrasting

confidence: 76%

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Clinical outcomes after 24 months of insulin therapy in patients with type 2 diabetes in five countries: results from the TREAT study

Oğuz

Benroubi

Brismar

et al. 2013

Current Medical Research and Opinion

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Section: Discussioncontrasting

confidence: 76%

“…The recent ADA-EASD position statement recommends, in general, a basal insulin at insulin initiation or a premixed insulin, mainly in patients with HbA 1c !9% 5 . In this study, insulin regimens at initiation differed between countries, as also seen in the INSTIGATE study 9 .…”

Section: Discussionmentioning

confidence: 68%

Clinical outcomes after 24 months of insulin therapy in patients with type 2 diabetes in five countries: results from the TREAT study

Oğuz

Benroubi

Brismar

et al. 2013

Current Medical Research and Opinion

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“…Intensive insulin treatment has been shown to be the most effective therapy in lowering blood glucose levels which in turn helps prevent or delay the development of micro-and macrovascular complications of diabetes 5,6 . Despite guideline recommendations and demonstrated benefits of insulin therapy in people with T2DM, substantial proportions of people do not achieve adequate glycemic control following insulin initiation [7][8][9] . This may in part be due to suboptimal persistence with insulin treatment in the real world care setting.…”

Section: Introductionmentioning

confidence: 99%

Basal insulin persistence, associated factors, and outcomes after treatment initiation among people with type 2 diabetes mellitus in the US

Pérez-Nieves

Kabul

Desai

et al. 2016

Current Medical Research and Opinion

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Objective To assess basal insulin persistence, associated factors, and economic outcomes for insulin-na€ ıve people with type 2 diabetes mellitus (T2DM) in the US. Research design and methods People aged 18 years diagnosed with T2DM initiating basal insulin between April 2006 and March 2012 (index date), no prior insulin use, and continuous insurance coverage for 6 months before (baseline) and 24 months after index date (follow-up period) were selected using de-identified administrative claims data in the US. Based on whether there were 30 day gaps in basal insulin use in the first year post-index, patients were classified as continuers (no gap), interrupters (1 prescription after gap), and discontinuers (no prescription after gap). Main outcome measures Factors associated with persistence -assessed using multinomial logistic regression model; annual healthcare resource use and costs during follow-up period -compared separately between continuers and interrupters, and continuers and discontinuers. Results Of the 19,110 people included in the sample (mean age: 59 years, 60% male), 20% continued to use basal insulin, 62% had 1 interruption, and 18% discontinued therapy in the year after initiation. Older age, multiple antihyperglycemic drug use, and injectable antihyperglycemic use during baseline were associated with significantly higher likelihoods of continuing basal insulin. Relative to interrupters and discontinuers, continuers had fewer emergency department visits, shorter hospital stays, and lower medical costs (continuers: $10,890, interrupters: $13,674, discontinuers: $13,021), but higher pharmacy costs (continuers: $7449, interrupters: $5239, discontinuers: $4857) in the first year post-index (p < 0.05 for all comparisons). Total healthcare costs were similar across the three cohorts. Findings for the second year post-index were similar. Conclusions The majority of people in this study interrupted or discontinued basal insulin treatment in the year after initiation; and incurred higher medical resource use and costs than continuers. The findings are limited to the commercially insured population in the US. In addition, persistence patterns were assessed using administrative claims as opposed to actual medicationtaking behavior and did not account for measures of glycemic control. Further research is needed to understand the reasons behind basal insulin persistence and the implications thereof, to help clinicians manage care for T2DM more effectively. ARTICLE HISTORY

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“…3,13,14 In some European countries, prandial insulin is also frequently used within initial insulin regimens. 15 Insulin regimens can therefore be complex, requiring patients to administer multiple daily injections and health care providers (HCPs) to provide appropriate training and support. 16 Furthermore, patients' fears regarding insulin treatment often concern handling problems, hypoglycemia, 17 and insulin self-injection, [18][19][20] as well as the perception that insulin therapy is an indication that self-management (and therefore the patient) has "failed."…”

Section: Perceptions Of Usability and Design For Prefilled Insulin Dementioning

confidence: 99%

Perceptions of Usability and Design for Prefilled Insulin Delivery Devices for Patients With Type 2 Diabetes

Heron¹,

Reaney²,

Hermanns³

et al. 2013

Diabetes Spectrum

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Although many patients with type 2 diabetes are initially managed through lifestyle modification, most eventually require insulin therapy. However, insulin initiation is often delayed because of factors such as patients' resistance to insulin therapy and worries about injections. Such delays affect glycemic control, have a direct effect on patient encounters, and may affect medication adherence. Insulin pen delivery systems may address some of these concerns. This study had two phases. First, semi-structured qualitative interviews were conducted to identify the most important features of insulin delivery devices for prandial use from the perspective of patients (n = 8) and health care professionals (HCPs; n = 10). From phase 1, a 26-item questionnaire was developed. In phase 2, patients (n = 33 insulin naive, n = 78 pen users) and HCPs (n = 151) were asked to indicate the most important features to them in insulin delivery devices. Patients then simulated injection using three different pens (SoloSTAR, KwikPen, and FlexPen) and ranked them based on the same features. The most important features were knowing that the entire dose has been injected, ease of reading the dose correctly, and ease of correcting if the dose is over-dialed. In the simulation study, KwikPen and SoloSTAR scored significantly higher (paired t test, P < 0.05) than FlexPen on “knowing if you have injected the entire dose” (mean score out of 10: KwikPen, 8.9; SoloSTAR, 8.6; and FlexPen, 8.4). No other significant differences among the pens were noted in usability or design, and the mean ranking (from 1 to 3) of the pens was similar (KwikPen, 2.0; FlexPen, 2.1; and SoloSTAR, 1.9). By identifying which insulin delivery pens offer these features, HCPs can choose the most appropriate delivery device for patients, which may lead to earlier insulin initiation, greater patient adherence, and better clinical outcomes.

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Clinical outcomes after insulin initiation in patients with type 2 diabetes: 6-month data from the INSTIGATE observational study in five European countries

Abstract: Differences in insulin regimen were observed between countries, and appeared to reflect the guidelines and treatment regimens used.

Cited by 32 publications

References 24 publications

Clinical outcomes after 24 months of insulin therapy in patients with type 2 diabetes in five countries: results from the TREAT study

Clinical outcomes after 24 months of insulin therapy in patients with type 2 diabetes in five countries: results from the TREAT study

Basal insulin persistence, associated factors, and outcomes after treatment initiation among people with type 2 diabetes mellitus in the US

Perceptions of Usability and Design for Prefilled Insulin Delivery Devices for Patients With Type 2 Diabetes

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