PMID- 26703951
OWN - NLM
STAT- MEDLINE
DCOM- 20161213
LR  - 20220409
IS  - 1473-4877 (Electronic)
IS  - 0300-7995 (Linking)
VI  - 32
IP  - 4
DP  - 2016
TI  - Basal insulin persistence, associated factors, and outcomes after treatment 
      initiation among people with type 2 diabetes mellitus in the US.
PG  - 669-80
LID - 10.1185/03007995.2015.1135789 [doi]
AB  - OBJECTIVE: To assess basal insulin persistence, associated factors, and economic 
      outcomes for insulin-naive 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,  approximately 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 medication-taking 
      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.
FAU - Perez-Nieves, Magaly
AU  - Perez-Nieves M
AD  - a Eli Lilly and Company , Indianapolis , IN , USA ;
FAU - Kabul, Samaneh
AU  - Kabul S
AD  - a Eli Lilly and Company , Indianapolis , IN , USA ;
FAU - Desai, Urvi
AU  - Desai U
AD  - b Analysis Group Inc. , Boston , MA , USA ;
FAU - Ivanova, Jasmina I
AU  - Ivanova JI
AD  - c Analysis Group Inc. , New York , NY , USA ;
FAU - Kirson, Noam Y
AU  - Kirson NY
AD  - b Analysis Group Inc. , Boston , MA , USA ;
FAU - Cummings, Alice Kate
AU  - Cummings AK
AD  - b Analysis Group Inc. , Boston , MA , USA ;
FAU - Birnbaum, Howard G
AU  - Birnbaum HG
AD  - b Analysis Group Inc. , Boston , MA , USA ;
FAU - Duan, Ran
AU  - Duan R
AD  - a Eli Lilly and Company , Indianapolis , IN , USA ;
FAU - Cao, Dachuang
AU  - Cao D
AD  - a Eli Lilly and Company , Indianapolis , IN , USA ;
FAU - Hadjiyianni, Irene
AU  - Hadjiyianni I
AD  - d Lilly Deutschland GmbH , Bad Homburg , Germany.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20160113
PL  - England
TA  - Curr Med Res Opin
JT  - Current medical research and opinion
JID - 0351014
RN  - 0 (Blood Glucose)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Blood Glucose/drug effects
MH  - Diabetes Mellitus, Type 2/*drug therapy/economics/*epidemiology
MH  - Drug Costs
MH  - Female
MH  - Follow-Up Studies
MH  - Health Care Costs
MH  - Humans
MH  - Hyperglycemia/drug therapy
MH  - Hypoglycemic Agents/*administration & dosage/economics
MH  - Insulin/economics/*therapeutic use
MH  - Insurance, Health
MH  - Kaplan-Meier Estimate
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Retrospective Studies
MH  - Time Factors
MH  - Treatment Outcome
MH  - United States
MH  - Young Adult
OTO - NOTNLM
OT  - Basal insulin
OT  - Costs
OT  - Diabetes
OT  - Factors
OT  - Persistence
OT  - Resource use
EDAT- 2015/12/26 06:00
MHDA- 2016/12/15 06:00
CRDT- 2015/12/26 06:00
PHST- 2015/12/26 06:00 [entrez]
PHST- 2015/12/26 06:00 [pubmed]
PHST- 2016/12/15 06:00 [medline]
AID - 10.1185/03007995.2015.1135789 [doi]
PST - ppublish
SO  - Curr Med Res Opin. 2016;32(4):669-80. doi: 10.1185/03007995.2015.1135789. Epub 
      2016 Jan 13.