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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
received 10 January 2017
revised 12 June 2017
accepted 11 July 2017
11 September 2017 (online)
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.
- 1 International Diabetes Federation. IDF Diabetes Atlas. 7th edition. 2015. Available online at: http://www.diabetesatlas.org/ Last accessed April 21, 2016
- 2 Bundesärztekammer, Kassenärztliche Bundesvereinigung, Arbeitsgemeinschaft der Wissenschaftlichen Fachgesellschaften (Herausgeber): Nationale Versorgungsleitlinie Therapie des Typ 2 Diabetes, Version 4, 2014. Available at http://www.leitlinien.de/nvl/diabetes/therapie Last accessed: May 21, 2015
- 3 American Diabetes Association (ADA). Standards of Medical Care in Diabetes - 2014. Diabetes Care 2014; 37 (Suppl. 01) S14-S80
- 4 Inzucchi SE, Bergenstal RM, Buse JB. et al. Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015; 38: 140-149
- 5 Wu N, Aagren M, Boulanger L. et al. Assessing achievement and maintenance of glycemic control by patients initiating basal insulin. Curr Med Res Opin 2012; 28: 1647-1656
- 6 Higgins V, Leith A, Siddall J. Adherence amongst type 2 diabetics: real-world physician and patients views and patient profiling. Abstract. Available at http://www.easdvirtualmeeting.org/resources/adherenceamongst-type-2-diabetics-real-world-physician-and-patients-viewsand-patient-profiling-2e1e643e-e302-4fcc-b26e-5ba3892a7be1 Last accessed December 12, 2016
- 7 Ayyagari R, Wei W, Cheng D. et al. Effect of adherence and insulin delivery system on clinical and economic outcomes among patients with type 2 diabetes initiating insulin treatment. Value Health 2015; 18: 198-205
- 8 Perez-Nieves M, Kabul S, Desai U. et al. Basal insulin persistence, associated factors, and outcomes after treatment initiation among people with type 2 diabetes mellitus in the US. Curr Med Res Opin 2016; 32: 669-680
- 9 Wei W, Pan C, Xie L. et al. Real-world insulin treatment persistence among patients with type 2 diabetes. Endocr Pract 2014; 20: 52-61
- 10 Ascher-Svanum H, Lage MJ, Perez-Nieves M. et al. Early discontinuation and restart of insulin in the treatment of type 2 diabetes mellitus. Diabetes Ther 2014; 5: 225-242
- 11 García-Pérez LE, Alvarez M, Dilla T. et al. Adherence to therapies in patients with type 2 diabetes. Diabetes Ther 2013; 4: 175-194
- 12 Davies MJ, Gagliardino JJ, Gray LJ. et al. Real-world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus: A systematic review. Diabet Med 2013; 30: 512-524
- 13 Breitscheidel L, Stamenitis S, Dippel FW. et al. Economic impact of compliance to treatment with antidiabetes medication in type 2 diabetes mellitus: A review paper. J Med Econ 2010; 13: 8-15
- 14 Hadjiyianni I, Desai U, Ivanova JI. et al. Basal insulin persistence, associated factors, and outcomes after treatment initiation among people with type 2 diabetes mellitus In Japan. Abstract. Value Health 2015; 18: A611-A612
- 15 Yavuz DG, Ozcan S, Deyneli O. Adherence to insulin treatment in insulin-naïve type 2 diabetic patients initiated on different insulin regimens. Patient Prefer Adherence 2015; 9: 1225-1231
- 16 Pscherer S, Chou E, Dippel FW. et al. Treatment persistence after initiating basal insulin in type 2 diabetes patients: A primary care database analysis. Prim Care Diabetes 2015; 9: 377-384
- 17 Cooke CE, Lee HY, Tong YP. et al. Persistence with injectable antidiabetic agents in members with type 2 diabetes in a commercial managed care organization. Curr Med Res Opin 2010; 26: 231-238
- 18 Wang L, Wei W, Miao R. et al. Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: A comparative retrospective database study. BMJ Open 2013; 3 DOI: 10.1136/bmjopen-2012-002348.
- 19 Peyrot M, Barnett AH, Meneghini LF. et al. Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study. Diabet Med 2012; 29: 682-689
- 20 Kostev K, Dippel FW, Rathmann W. Predictors of early discontinuation of basal insulin therapy in type 2 diabetes in primary care. Prim Care Diabetes 2016; 10: 142-147
- 21 Rathmann W, Czech M, Franek E. et al. Treatment persistence in the use of basal insulins in Poland and Germany. Int J. Clin Pharmacol Ther 2017; Feb 55: 119-125
- 22 Perez-Nieves M, Ivanova JI, Hadjiyianni I et al. Basal insulin initiation use and experience among people with type 2 diabetes mellitus with different patterns of persistence: Results from a multi-national survey. Curr Med Res Opinion. 2017 [e-pub ahead of print]
- 23 Polinski JM, Kim SC, Jiang D. et al. Geographic patterns in patient demographics and insulin use in 18 countries, a global perspective from the multinational observational study assessing insulin use: understanding the challenges associated with progression of therapy (MOSAIc). BMC Endocr Disord 2015; 15: 46
- 24 Moennig E, Hadjiyianni I, Otto T. et al. Factors associated with treatment persistence among people with Type 2 Diabetes Mellitus (T2DM) initiating basal insulin – real-world data from Germany. Abstract. Diabetologie und Stoffwechsel 2016; 1 Suppl 11-FV31 Available at https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0036-1580778
- 25 Peyrot M, Rubin RR, Lauritzen T. et al. International DAWN Advisory Panel. Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. Diabetes Care 2005; 28: 2673-2679
- 26 Liebl A, Jones S, Benroubi M. et al. Clinical outcomes after insulin initiation in patients with type 2 diabetes: 6-month data from the INSTIGATE observational study in five European countries. Curr Med Res Opin 2011; 27: 887-895
- 27 Ng CJ, Lai PS, Lee YK. et al. Barriers and facilitators to starting insulin in patients with type 2 diabetes: a systematic review. Int J Clin Pract 2015; 69: 1050-1070
- 28 American Diabetes Association. Strategies for Improving Care. Diabetes Care 2016; 39 (Suppl. 01) S6-S12
- 29 Kulzer B, Lüthgens B, Landgraf R. et al. Diabetesbezogene Belastungen, Wohlbefinden und Einstellung von Menschen mit Diabetes. Deutsche Ergebnisse der DAWN2-Studie. Diabetologie 2015; 11: 211-218