Reasons for discontinuing insulin and factors associated with insulin discontinuation in patients with type 2 diabetes mellitus: a real-world evidence study
Tóm tắt
Evidence suggests that insulin therapy of patients with type 2 diabetes mellitus (T2DM) is frequently discontinued. However, the reasons for discontinuing insulin and factors associated with insulin discontinuation in this patient population are not well understood. We conducted a retrospective cohort study of adults with T2DM prescribed insulin between 2010 and 2017 at Partners HealthCare. Reasons for discontinuing insulin and factors associated with insulin discontinuation were studied using electronic medical records (EMR) data. Natural language processing (NLP) was applied to identify reasons from unstructured clinical notes. Factors associated with insulin discontinuation were extracted from structured EMR data and evaluated using multivariable logistic regression. Among 7009 study patients, 2957 (42.2%) discontinued insulin within 12 months after study entry. Most patients who discontinued insulin (2121 / 71.7%) had reasons for discontinuation documented. The most common reasons were improving blood glucose control (33.2%), achieved weight loss (18.5%) and initiation of non-insulin diabetes medications (16.7%). In multivariable analysis adjusted for demographics and comorbidities, patients were more likely to discontinue either basal or bolus insulin if they were on a basal-bolus regimen (OR 1.6, 95% CI 1.3 to 1.8; p < 0.001) or were being seen by an endocrinologist (OR 2.6; 95% CI 2.2 to 3.0; p < 0.001). In this large real-world evidence study conducted in an area with a high penetration of health insurance, insulin discontinuation countenanced by healthcare providers was common. In most cases it was linked to achievement of glycemic control, achieved weight loss and initiation of other diabetes medications. Factors associated with and stated reasons for insulin discontinuation were different from those previously described for non-adherence to insulin therapy, identifying it as a distinct clinical phenomenon.
Tài liệu tham khảo
Selvin E, Parrinello CM, Sacks DB, Coresh J. Trends in prevalence and control of diabetes in the United States, 1988-1994 and 1999-2010. Ann Intern Med. 2014;160(8):517–25.
Diabetes Fact Sheet 2018. https://www.who.int/news-room/fact-sheets/detail/diabetes. Accessed 15 Oct 2019.
Dall TM, Yang W, Gillespie K, Mocarski M, Byrne E, Cintina I, Beronja K, Semilla AP, Iacobucci W, Hogan PF. The economic burden of elevated blood glucose levels in 2017: diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes. Diabetes Care. 2019;42(9):1661–8.
ADA. Standards of medical care in diabetes - 2019. Diabetes Care. 2019;42(Suppl 1):S1–S193.
Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA. 1999;281(21):2005–12.
Owens DR. Clinical evidence for the earlier initiation of insulin therapy in type 2 diabetes. Diabetes Technol Ther. 2013;15(9):776–85.
Sapkota S, Brien JA, Greenfield JR, Aslani P. A systematic review of interventions addressing adherence to anti-diabetic medications in patients with type 2 diabetes--components of interventions. PLoS One. 2015;10(6):e0128581.
Sorli C, Heile MK. Identifying and meeting the challenges of insulin therapy in type 2 diabetes. J Multidiscip Healthc. 2014;7:267–82.
Garcia-Perez LE, Alvarez M, Dilla T, Gil-Guillen V, Orozco-Beltran D. Adherence to therapies in patients with type 2 diabetes. Diabetes Ther. 2013;4(2):175–94.
Slabaugh SL, Bouchard JR, Li Y, Baltz JC, Meah YA, Moretz DC. Characteristics relating to adherence and persistence to basal insulin regimens among elderly insulin-naive patients with type 2 diabetes: pre-filled pens versus vials/syringes. Adv Ther. 2015;32(12):1206–21.
Xie L, Zhou S, Wei W, Gill J, Pan C, Baser O. Does pen help? A real-world outcomes study of switching from vial to disposable pen among insulin glargine-treated patients with type 2 diabetes mellitus. Diabetes Technol Ther. 2013;15(3):230–6.
Bonafede MM, Kalsekar A, Pawaskar M, Ruiz KM, Torres AM, Kelly KR, Curkendall SM. Insulin use and persistence in patients with type 2 diabetes adding mealtime insulin to a basal regimen: a retrospective database analysis. BMC Endocr Disord. 2011;11:3.
Perez-Nieves M, Kabul S, Desai U, Ivanova JI, Kirson NY, Cummings AK, Birnbaum HG, Duan R, Cao D, Hadjiyianni I. Basal insulin persistence, associated factors, and outcomes after treatment initiation among people with type 2 diabetes mellitus in the US. Curr Med Res Opin. 2016;32(4):669–80.
Moennig E, Perez-Nieves M, Hadjiyianni I, Cao D, Ivanova J, Klask R. Initiation of basal insulin analog treatment for type 2 diabetes and reasons behind patients’ treatment persistence behavior: real-world data from Germany. Exp Clin Endocrinol Diabetes. 2018;126(5):287–97.
Peyrot M, Perez-Nieves M, Ivanova J, Cao D, Schmerold L, Kalirai S, Hadjiyianni I. Correlates of basal insulin persistence among insulin-naive people with type 2 diabetes: results from a multinational survey. Curr Med Res Opin. 2017;33(10):1843–51.
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613–9.
Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004;57(12):1288–94.
Malmasi S, Sandor NL, Hosomura N, Goldberg M, Skentzos S, Turchin A. Canary: an NLP platform for clinicians and researchers. Appl Clin Inform. 2017;8:447–53.
Kopp H, Krzyzanowska K, Möhlig M, Spranger J, Pfeiffer A, Schernthaner G. Effects of marked weight loss on plasma levels of adiponectin, markers of chronic subclinical inflammation and insulin resistance in morbidly obese women. Int J Obes. 2005;29(7):766.
Peyrot M, Barnett AH, Meneghini LF, Schumm-Draeger PM. Factors associated with injection omission/non-adherence in the global attitudes of patients and physicians in insulin therapy study. Diabetes Obes Metab. 2012;14(12):1081–7.
Davies MJ, Gagliardino JJ, Gray LJ, Khunti K, Mohan V, Hughes R. Real-world factors affecting adherence to insulin therapy in patients with type 1 or type 2 diabetes mellitus: a systematic review. Diabet Med. 2013;30(5):512–24.
Yavuz DG, Ozcan S, Deyneli O. Adherence to insulin treatment in insulin-naive type 2 diabetic patients initiated on different insulin regimens. Patient Prefer Adherence. 2015;9:1225–31.
Peyrot M, Barnett AH, Meneghini LF, Schumm-Draeger PM. Insulin adherence behaviours and barriers in the multinational global attitudes of patients and physicians in insulin therapy study. Diabet Med. 2012;29(5):682–9.
Wilson J, Bock A. The benefit of using both claims data and electronic medical record data in health care analysis. Optum Insight. 2012;1:1–4.
Ohno-Machado L. Realizing the full potential of electronic health records: the role of natural language processing. J Am Med Inform Assoc. 2011;18(5):539.
Turchin A, Hosomura N, Zhang H, Malmasi S, Shubina M. Predictors and consequences of declining insulin therapy by individuals with type 2 diabetes. Diabet Med. 2020;37(5):814–21.
Zhang H, Plutzky J, Shubina M, Turchin A. Continued statin prescriptions after adverse reactions and patient outcomes: a cohort study. Ann Intern Med. 2017;167(4):221–7.