Are patients on basal insulin attaining glycemic targets? Characteristics and goal achievement of patients with type 2 diabetes mellitus treated with basal insulin and physician-perceived barriers to achieving glycemic targets

- In this real-world retrospective analysis 27% of insulin treated T2D patients reached HbA1c < 7%.
- Through survey, physicians identified practice philosophy regarding patients on insulin.
- Costs, patient's lifestyle and adherence were the main barriers to intensification by physicians.
- Fear of hypoglycemia and weight changes were considered to be less important by physicians.

AimsTo investigate treatment patterns and achievement of glycemic targets in patients with type 2 diabetes mellitus treated with basal insulin in a real-world setting, and to determine physicians' beliefs and practices regarding these patients.MethodsThis study had two components; a retrospective analysis using a US claims database of patient and treatment data, and a survey of physicians' beliefs and practices.ResultsA total of 39,074 patients treated with basal insulin were included in this analysis. The proportion of patients achieving HbA1c < 7.0% (53 mmol/mol) was similar in ongoing basal insulin users at baseline (26%) and at 3 months follow-up (27%). The number of new initiators achieving HbA1c < 7.0% (53 mmol/mol) increased from baseline (11%) to 3 months (27%). In the physician survey component, the majority of physicians indicated they would continue to increase basal insulin dose as long as was needed to reach HbA1c/fasting blood glucose goals (85% of physicians treating 'not on-goal' patients, 78% of physicians treating 'on-goal' patients). Physician-perceived barriers to insulin intensification included patient's lifestyle, non-adherence, and concerns about out-of-pocket costs.ConclusionsA large proportion of patients on insulin-based therapy fail to reach glycemic goals. More education of clinicians may improve insulin intensification rates and increase the proportion of patients reaching glycemic targets.