Open AccessFactors and outcomes associated with discontinuation of basal insulin therapy in patients with type 2 diabetes mellitus
Author(s) -
Zhang Puhong,
Zhang Heng,
Li Xian,
Chen Minyuan,
Wang Du,
Ji Lig
Publication year - 2020
Publication title -
endocrinology, diabetes and metabolism
Language(s) - English
Resource type - Journals
ISSN - 2398-9238
DOI - 10.1002/edm2.122
Subject(s) - discontinuation , medicine , insulin , diabetes mellitus , basal (medicine) , type 2 diabetes mellitus , type 2 diabetes , pediatrics , endocrinology
Objectives To assess treatment discontinuation, associated factors and outcomes after initiating basal insulin (BI) among Chinese insulin‐naïve patients with type 2 diabetes mellitus (T2DM) who had previously uncontrolled hyperglycaemia on OADs. Patients Insulin‐naïve patients with T2DM who had uncontrolled hyperglycaemia (HbA1c ≥7%) by OADs and were willing to initiate BI treatment were enrolled from 209 secondary and tertiary hospitals in eight geographical regions in China. Design Each participant was interviewed at baseline, 3 and 6 months to collect study information. Patients with at least one visit during follow‐up were included in the analyses. BI discontinuation was defined by a question asking whether the patient discontinued BI therapy at 3 or 6 months. Analyses were conducted to identify baseline factors associated with BI discontinuation and to estimate the association between insulin treatment discontinuation and patients' clinical outcomes at 6 months. Results Of 17 858 patients, 25.8% discontinued basal insulin therapy within 6 months after initiation, and nearly two‐thirds doing so within the first 3 months. Among patients discontinued basal insulin, 70.2% stopped all insulin therapy; 25.9% switched to premixed insulin and 3.8% switched to bolus only. Three most common reasons for BI discontinuation reported by patients were being unwilling to persist basal insulin without specific reasons (46.8%), reducing the frequency of daily injection (23.5%) and medical affordability (15.1%). Factors significantly associated with BI discontinuation were hospital level, patient recruitment setting, age, education level, out‐of‐pocket ratio, BMI, diabetes duration, self‐monitoring of blood glucose (SMBG), numbers of OADs, BI type and insulin regimen. Compared with discontinuers, patients continued BI therapy had higher FPG (46.4% vs 28.8%) and HbA1c (42.3% vs 36.5%) control rate. Conclusion Among patients with T2DM who initiated BI therapy due to uncontrolled hyperglycaemia by OADs, the proportion of insulin discontinuation was high within 6 months. Further study is needed to understand the reason behind the BI discontinuation.