Factors associated with injection omission/non‐adherence in the Global Attitudes of Patients and Physicians in Insulin Therapy study

Peyrot, Mark; Barnett, Anthony; Meneghini, Luigi; Schumm–Draeger, Petra–Maria

doi:10.1111/j.1463-1326.2012.01636.x

Cited by 124 publications

(110 citation statements)

References 21 publications

(41 reference statements)

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“…Among patients unwilling to initiate insulin therapy, approximately half cited problematic hypoglycemia as a reason 21 , while >10% of insulin-treated patients reported dissatisfaction with their insulin treatment associated with safety concerns regarding hypoglycemia -as did >30% of physicians 22 . Barriers to insulin therapy mean that approximately 25% of patients with T2D are reluctant to initiate insulin therapy 21 , and even when patients have initiated insulin, insulin omission/nonadherence is common 23 .…”

Section: Discussionmentioning

confidence: 99%

Hypoglycemia in patients with type 2 diabetes newly initiated on basal insulin in the US in a community setting: impact on treatment discontinuation and hospitalization

Dalal

Kazemi

Ye³

2016

Current Medical Research and Opinion

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Objective: To evaluate the impact of 6 month hypoglycemia on treatment discontinuation and hospitalization of patients initiating basal insulin for type 2 diabetes (T2D) in real-world practice. Methods: This was a retrospective cohort study of patient-level data using electronic medical records (EMRs) in the Predictive Health Intelligence diabetes dataset. Data from adult patients with T2D initiating basal insulin glargine, insulin detemir, or Neutral Protamine Hagedorn insulin between January 2008 and March 2014 was analyzed. The date of first basal insulin prescription in an outpatient setting was the index date. A 12 month baseline prior to the index date was established; follow-up was 6-24 months from the index date. Patients were assigned to cohorts by experience of hypoglycemia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code or blood glucose test) in the first 6 months following the index date; with hypoglycemia and without hypoglycemia cohorts were compared for basal insulin treatment discontinuation and hospitalization. Results: Overall, 49,062 patients were included; 5159 (10.5%) experienced hypoglycemia in the 6 months following basal insulin initiation. In the first 12 months, 68.1% of patients in the with hypoglycemia cohort discontinued basal insulin versus 53.9% in the without hypoglycemia cohort (p < .0001); more patients in the with hypoglycemia cohort had at least one hospitalization in the first year of follow-up (50.1% vs. 14.6%; p < .0001). Conclusion: Patients with hypoglycemia soon after initiating basal insulin are at greater risk of discontinuation of their basal insulin therapy and hospitalization versus those who did not have hypoglycemic events within the first 6 months of basal insulin initiation. A limitation of this study is that it was a retrospective analysis of EMR data and the study may not be representative of all US patients with T2D on basal insulin and it cannot be assumed that every hypoglycemic event was recorded.ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

Hypoglycemia in patients with type 2 diabetes newly initiated on basal insulin in the US in a community setting: impact on treatment discontinuation and hospitalization

Dalal

Kazemi

Ye³

2016

Current Medical Research and Opinion

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“…Diabetes mellitus patients inject insulin in different regions of the body according to personal preference and activity pattern [1][2][3]. However, differences can exist in the pharmacokinetic and pharmacodynamic properties of insulin following subcutaneous (SC) administration in different regions [4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Glucose-lowering Effect of Insulin Degludec is Independent of Subcutaneous Injection Region

Nosek¹,

Coester²,

Thomsen³

et al. 2012

Canadian Journal of Diabetes

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“…At best, this is acutely unpleasant for the patient; at worst, it can have serious neurological sequelae, occasionally fatal. Fear of hypoglycaemia can be a major barrier to treatment adherence that undermines attempts to improve patient prognosis [4][5][6]. The challenge of lowering glucose towards euglycaemia while simultaneously avoiding hypoglycaemia is further compounded when blood glucose concentration is erratic and unpredictable because glucose variability underlies episodes of both hyper-and hypoglycaemia.…”

Section: Introduction: the Elusive Goal Of Euglycaemia And The Confoumentioning

confidence: 99%

Variability of glucose‐lowering effect as a limiting factor in optimizing basal insulin therapy: a review

Vora

Heise

2013

Diabetes Obesity Metabolism

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Lowering blood glucose with insulin therapy towards beneficial target levels while also avoiding hypoglycaemia is a challenging task. An important confounding factor, which might be under-appreciated in this scenario, is that of variable glucose readings causing difficulties with dose adjustment. Furthermore, this glucose variability is, to some extent, a reflection of variability in the glucose-lowering action of the insulin therapy itself. Not only is glucose variability a major confounding factor in disease management but it is possibly also of direct prognostic consequence and is increasingly recognized as an informative measurement in diabetes management. The scope for insulin-induced glucose variability is particularly great with basal insulins because of their prolonged absorption from high-dose depots. Pharmacodynamic (PD) variability manifests as both fluctuations in the level of glucose-lowering effect over time, and as inconsistencies in the response from one injection to another. Well-controlled pharmacokinetic (PK)/PD studies using repeated isoglycaemic clamp methodology clearly how that many injected basal insulin products have high variable absorption with correspondingly variable action. Incomplete resuspension and precipitation appear to be important issues with regard to unpredictability in this action, while an inadequate duration of action relative to the dosing interval results in a fluctuating action profile. There are some ultra-long-acting basal insulins with novel protraction mechanisms currently in clinical development for which clamp studies show markedly improved PK/PD profiles. Keywords: basal insulin, diabetes mellitus, glucose fluctuation, glucose variability, insulin absorption, insulin degludec, insulin variability, PEGylated lispro Date submitted 26 October 2012; date of first decision 21 January 2013; date of final acceptance 25 February 2013 Introduction: The Elusive Goal of Euglycaemia and the Confounding Issue of Glucose VariabilitySuccessful management of blood glucose remains a major ongoing challenge for patients with type 1 (T1D) and type 2 (T2D) diabetes and their carers. While it is vital to limit chronic overexposure to hyperglycaemia, which increases the incidence and progression of diabetic complications [1][2][3], overzealous reduction of blood glucose can precipitate hypoglycaemia. At best, this is acutely unpleasant for the patient; at worst, it can have serious neurological sequelae, occasionally fatal. Fear of hypoglycaemia can be a major barrier to treatment adherence that undermines attempts to improve patient prognosis [4][5][6]. The challenge of lowering glucose towards euglycaemia while simultaneously avoiding hypoglycaemia is further compounded when blood glucose concentration is erratic and unpredictable because glucose variability underlies episodes of both hyper-and hypoglycaemia. Underpinning the success (or otherwise) of diabetes therapy in general, and insulin therapy in particular, are the pharmacokinetic/dynamic (PK/PD) properties of the regimens ...

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Factors associated with injection omission/non‐adherence in the Global Attitudes of Patients and Physicians in Insulin Therapy study

Cited by 124 publications

References 21 publications

Hypoglycemia in patients with type 2 diabetes newly initiated on basal insulin in the US in a community setting: impact on treatment discontinuation and hospitalization

Hypoglycemia in patients with type 2 diabetes newly initiated on basal insulin in the US in a community setting: impact on treatment discontinuation and hospitalization

Glucose-lowering Effect of Insulin Degludec is Independent of Subcutaneous Injection Region

Variability of glucose‐lowering effect as a limiting factor in optimizing basal insulin therapy: a review

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