Persistence Patterns Post Insulin Initiation in Diabetes

The number of patients who have from diabetes is expected to almost double from 285 million to 438 million people by 2030 due to obesity trends. Currently, 85-95% of cases are type 2 diabetes.

Microvascular and macrovascular complications increase diabetes mortality and are especially common in poorly controlled patients. Antihyperglycemic therapy can restore glycemic control and prevent future complications.

Insulin has the highest efficacy among all glucose lowering agents. It is recommended as initial therapy for symptomatic diabetes, elevated blood glucose levels, and patients who fail to achieve/maintain their glycemic target with non-insulin monotherapy.

The journal Current Medical Research and Opinion published a study in July 2017 evaluating experiences during and after basal insulin initiation among type 2 diabetes patients with different treatment persistence patterns.

Researchers surveyed 942 patients who initiated basal insulin within the past 3-24 months and classified them as continuers (no therapy gaps of > 7 days), interrupters (first therapy gap > 7 days within 6 months of initiation and restarted therapy), or discontinuers (stopped therapy for > 7 days within 6 months of initiation without restarting).

Insulin continuers report fewer concerns before and after therapy initiation, fewer challenges during the first week of use, and fewer adverse effects. Continuers reported insulin had a positive effect on glycemic control, physical well-being, and emotional well-being.

Discontinuers were more likely to initiate insulin therapy after other antihyperglycemic therapies failed and thought providers did not considered their views when deciding to start insulin. The researchers concluded that the likelihood of continuing insulin is different for patients prescribed insulin as a necessary regimen versus patients who have treatment options.

Medication adherence is essential for managing diabetes and preventing complications. Providers must understand patient challenges, address concerns, and continually provide patient support to ensure therapy persistence.

Reference

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. Current Med Res Opinion. 2017. doi; 10.1080/03007995.2017.1341403.