Health care providers play a major role in whether type 2 diabetes patients initiating basal insulin persist with the therapy or discontinue it, a new survey suggests.

Another recent report indicates how successful persistence with basal insulin can be.

Results of the survey of U.S. adults with type 2 diabetes mellitus, which was conducted to better understand patients' insulin initiation experiences and treatment persistence behaviors, were published in the Diabetes, Metabolic Syndrome and Obesity journal.

Researchers from industry and the University of California San Francisco recruited participants from consumer panels and grouped them by basal insulin treatment pattern: 

• continuers (no gap of ≥7 days within 6 months of initiation);

• interrupters (gap ≥7 days, resumed treatment); 

• discontinuers (stopped for ≥7 days, not resumed). 

The study team set a quota of approximately 50 respondents per persistence category. The survey was completed by 154 respondents -- 52 continuers, 52 interrupters, 50 discontinuers, Respondents had a mean age of 51.4 years and were 51.9% male. 

Researchers note that continuers were more likely to report their views being considered during initiation, and less likely to report a sense of failure. Among the concerns were insulin dependence (64.3% agree/strongly agree), frequent blood glucose monitoring (55.2%), costs/ability to pay (53.9%), fears of or mistakes during self-injection (52.6%), and weight gain (52.6%). 

Continuers also were motivated by benefits of insulin therapy, according to the results, although experienced or potential side effects were strong factors in interruption/discontinuation. “Healthcare provider instruction was indicated as a reason for continuing, stopping, and restarting therapy,” the researchers emphasize.

“Benefits of basal insulin therapy motivated continuers while side effects impacted interruption/discontinuation. Persistence on basal insulin is often influenced by provider actions,” the authors write. “Earlier provider intervention upon signs of treatment discontinuation may promote persistence.”

A German study published in the Journal of Clinical Medicine, meanwhile, sought to track results of patients who had bedtime basal insulin (NPH insulin) added to their metformin regimen. Researchers report that the therapy was initiated due to failure to achieve a glycemic goal with metformin alone.

Until July 2019, 272 patients (95.4%) were followed-up. Participants averaged 59.5 years old, 92.6 kg weight with diabetes duration of 6.6 years and hemoglobin A1c of 8.4%/68.6 mmol/mol.

Results indicate that, after a duration of 31.7 ± 29.1 (range 2-133) months), HbA1c decreased by -1.2% and bodyweight by -1.7 kg.

The authors point out that severe hypoglycemia did not occur, but that in 144 out of 272 patients (52.9%), the therapeutic goal for HbA1c was achieved over 32.7 months. 

In 69 of 272 patients (25.4%), the HbA1c target was achieved over 25.0 months, with basal insulin therapy discontinued afterwards because HbA1c was under target.

In another 36 patients (13.2%), the HbA1c goal was achieved until the submission of this manuscript (mean duration of treatment 57.4 ± 28.2 (range 13-121) months). 

“Over 90% of patients with type 2 diabetes and failure of metformin reached their HbA1c goal with additional basal insulin at bedtime over several years in association with a reduction of bodyweight and without any event of severe hypoglycemia,” the authors conclude.