Probability of Achieving Glycemic Control with Basal Insulin in Patients with Type 2 Diabetes in Real-World Practice in the USA

Lawrence Blonde (Lead / Corresponding author), Luigi Meneghini, Xuejun Victor Peng, Anders Boss, Kyu Rhee, Alka Shaunik, Supriya Kumar, Sidhartha Balodi, Claire Brulle-Wohlhueter, Rory J. McCrimmon

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Abstract

Introduction: Basal insulin (BI) plays an important role in treating type 2 diabetes (T2D), especially when oral anti-diabetic (OAD) medications are insufficient for glycemic control. We conducted a retrospective, observational study using electronic medical records (EMR) data from the IBM® Explorys database to evaluate the probability of achieving glycemic control over 24 months after BI initiation in patients with T2D in the US.

Methods: A cohort of 6597 patients with T2D who started BI following OAD(s) and had at least one valid glycated hemoglobin (HbA1c) result recorded both within 90 days before and 720 days after BI initiation were selected. We estimated the changes from baseline in HbA1c every 6 months, the quarterly conditional probabilities of reaching HbA1c <7% if a patient had not achieved glycemic control prior to each quarter (Q), and the cumulative probability of reaching glycemic control over 24 months.

Results: Our cohort was representative of patients with T2D who initiated BI from OADs in the US. The average HbA1c was 9.1% at BI initiation, and decreased robustly (1.5%) in the first 6 months after initiation with no further reductions thereafter. The conditional probability of reaching glycemic control decreased rapidly in the first year (26.6% in Q2; 17.6% in Q3; 8.6% in Q4), and then remained low (≤6.1%) for each quarter in the second year. Cumulatively, about 38% of patients reached HbA1c <7% in the first year; only approximately 8% more did so in the second year.

Conclusion: Our study of real-world data from a large US EMR database suggested that among patients with T2D who initiated BI after OADs, the likelihood of reaching glycemic control diminished over time, and remained low from 12 months onwards. Additional treatment options should be considered if patients do not reach glycemic control within 12 months of BI initiation.
Original languageEnglish
Pages (from-to)1347-1358
Number of pages12
JournalDiabetes Therapy
Volume9
Issue number3
Early online date29 Mar 2018
DOIs
Publication statusPublished - Jun 2018

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Type 2 Diabetes Mellitus
Insulin
Electronic Health Records
Databases
Patient Advocacy
Glycosylated Hemoglobin A
Observational Studies
Retrospective Studies

Keywords

  • Basal insulin
  • IBM Explorys database
  • Real-world evidence
  • Type 2 diabetes

Cite this

Blonde, Lawrence ; Meneghini, Luigi ; Peng, Xuejun Victor ; Boss, Anders ; Rhee, Kyu ; Shaunik, Alka ; Kumar, Supriya ; Balodi, Sidhartha ; Brulle-Wohlhueter, Claire ; McCrimmon, Rory J. / Probability of Achieving Glycemic Control with Basal Insulin in Patients with Type 2 Diabetes in Real-World Practice in the USA. In: Diabetes Therapy. 2018 ; Vol. 9, No. 3. pp. 1347-1358.
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title = "Probability of Achieving Glycemic Control with Basal Insulin in Patients with Type 2 Diabetes in Real-World Practice in the USA",
abstract = "Introduction: Basal insulin (BI) plays an important role in treating type 2 diabetes (T2D), especially when oral anti-diabetic (OAD) medications are insufficient for glycemic control. We conducted a retrospective, observational study using electronic medical records (EMR) data from the IBM{\circledR} Explorys database to evaluate the probability of achieving glycemic control over 24 months after BI initiation in patients with T2D in the US.Methods: A cohort of 6597 patients with T2D who started BI following OAD(s) and had at least one valid glycated hemoglobin (HbA1c) result recorded both within 90 days before and 720 days after BI initiation were selected. We estimated the changes from baseline in HbA1c every 6 months, the quarterly conditional probabilities of reaching HbA1c <7{\%} if a patient had not achieved glycemic control prior to each quarter (Q), and the cumulative probability of reaching glycemic control over 24 months.Results: Our cohort was representative of patients with T2D who initiated BI from OADs in the US. The average HbA1c was 9.1{\%} at BI initiation, and decreased robustly (1.5{\%}) in the first 6 months after initiation with no further reductions thereafter. The conditional probability of reaching glycemic control decreased rapidly in the first year (26.6{\%} in Q2; 17.6{\%} in Q3; 8.6{\%} in Q4), and then remained low (≤6.1{\%}) for each quarter in the second year. Cumulatively, about 38{\%} of patients reached HbA1c <7{\%} in the first year; only approximately 8{\%} more did so in the second year.Conclusion: Our study of real-world data from a large US EMR database suggested that among patients with T2D who initiated BI after OADs, the likelihood of reaching glycemic control diminished over time, and remained low from 12 months onwards. Additional treatment options should be considered if patients do not reach glycemic control within 12 months of BI initiation.",
keywords = "Basal insulin, IBM Explorys database, Real-world evidence, Type 2 diabetes",
author = "Lawrence Blonde and Luigi Meneghini and Peng, {Xuejun Victor} and Anders Boss and Kyu Rhee and Alka Shaunik and Supriya Kumar and Sidhartha Balodi and Claire Brulle-Wohlhueter and McCrimmon, {Rory J.}",
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Blonde, L, Meneghini, L, Peng, XV, Boss, A, Rhee, K, Shaunik, A, Kumar, S, Balodi, S, Brulle-Wohlhueter, C & McCrimmon, RJ 2018, 'Probability of Achieving Glycemic Control with Basal Insulin in Patients with Type 2 Diabetes in Real-World Practice in the USA', Diabetes Therapy, vol. 9, no. 3, pp. 1347-1358. https://doi.org/10.1007/s13300-018-0413-5

Probability of Achieving Glycemic Control with Basal Insulin in Patients with Type 2 Diabetes in Real-World Practice in the USA. / Blonde, Lawrence (Lead / Corresponding author); Meneghini, Luigi; Peng, Xuejun Victor; Boss, Anders; Rhee, Kyu; Shaunik, Alka; Kumar, Supriya; Balodi, Sidhartha; Brulle-Wohlhueter, Claire; McCrimmon, Rory J.

In: Diabetes Therapy, Vol. 9, No. 3, 06.2018, p. 1347-1358.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Probability of Achieving Glycemic Control with Basal Insulin in Patients with Type 2 Diabetes in Real-World Practice in the USA

AU - Blonde, Lawrence

AU - Meneghini, Luigi

AU - Peng, Xuejun Victor

AU - Boss, Anders

AU - Rhee, Kyu

AU - Shaunik, Alka

AU - Kumar, Supriya

AU - Balodi, Sidhartha

AU - Brulle-Wohlhueter, Claire

AU - McCrimmon, Rory J.

N1 - Funding: Sanofi Corporation.

PY - 2018/6

Y1 - 2018/6

N2 - Introduction: Basal insulin (BI) plays an important role in treating type 2 diabetes (T2D), especially when oral anti-diabetic (OAD) medications are insufficient for glycemic control. We conducted a retrospective, observational study using electronic medical records (EMR) data from the IBM® Explorys database to evaluate the probability of achieving glycemic control over 24 months after BI initiation in patients with T2D in the US.Methods: A cohort of 6597 patients with T2D who started BI following OAD(s) and had at least one valid glycated hemoglobin (HbA1c) result recorded both within 90 days before and 720 days after BI initiation were selected. We estimated the changes from baseline in HbA1c every 6 months, the quarterly conditional probabilities of reaching HbA1c <7% if a patient had not achieved glycemic control prior to each quarter (Q), and the cumulative probability of reaching glycemic control over 24 months.Results: Our cohort was representative of patients with T2D who initiated BI from OADs in the US. The average HbA1c was 9.1% at BI initiation, and decreased robustly (1.5%) in the first 6 months after initiation with no further reductions thereafter. The conditional probability of reaching glycemic control decreased rapidly in the first year (26.6% in Q2; 17.6% in Q3; 8.6% in Q4), and then remained low (≤6.1%) for each quarter in the second year. Cumulatively, about 38% of patients reached HbA1c <7% in the first year; only approximately 8% more did so in the second year.Conclusion: Our study of real-world data from a large US EMR database suggested that among patients with T2D who initiated BI after OADs, the likelihood of reaching glycemic control diminished over time, and remained low from 12 months onwards. Additional treatment options should be considered if patients do not reach glycemic control within 12 months of BI initiation.

AB - Introduction: Basal insulin (BI) plays an important role in treating type 2 diabetes (T2D), especially when oral anti-diabetic (OAD) medications are insufficient for glycemic control. We conducted a retrospective, observational study using electronic medical records (EMR) data from the IBM® Explorys database to evaluate the probability of achieving glycemic control over 24 months after BI initiation in patients with T2D in the US.Methods: A cohort of 6597 patients with T2D who started BI following OAD(s) and had at least one valid glycated hemoglobin (HbA1c) result recorded both within 90 days before and 720 days after BI initiation were selected. We estimated the changes from baseline in HbA1c every 6 months, the quarterly conditional probabilities of reaching HbA1c <7% if a patient had not achieved glycemic control prior to each quarter (Q), and the cumulative probability of reaching glycemic control over 24 months.Results: Our cohort was representative of patients with T2D who initiated BI from OADs in the US. The average HbA1c was 9.1% at BI initiation, and decreased robustly (1.5%) in the first 6 months after initiation with no further reductions thereafter. The conditional probability of reaching glycemic control decreased rapidly in the first year (26.6% in Q2; 17.6% in Q3; 8.6% in Q4), and then remained low (≤6.1%) for each quarter in the second year. Cumulatively, about 38% of patients reached HbA1c <7% in the first year; only approximately 8% more did so in the second year.Conclusion: Our study of real-world data from a large US EMR database suggested that among patients with T2D who initiated BI after OADs, the likelihood of reaching glycemic control diminished over time, and remained low from 12 months onwards. Additional treatment options should be considered if patients do not reach glycemic control within 12 months of BI initiation.

KW - Basal insulin

KW - IBM Explorys database

KW - Real-world evidence

KW - Type 2 diabetes

U2 - 10.1007/s13300-018-0413-5

DO - 10.1007/s13300-018-0413-5

M3 - Article

VL - 9

SP - 1347

EP - 1358

JO - Diabetes Therapy

JF - Diabetes Therapy

SN - 1869-6953

IS - 3

ER -