One in Seven Insulin-Treated Patients in Developing Countries Reported Poor Persistence with Insulin Therapy: Real World Evidence from the Cross-Sectional International Diabetes Management Practices Study (IDMPS).
Clinical science and care
Healthcare delivery
Insulin therapy
Journal
Advances in therapy
ISSN: 1865-8652
Titre abrégé: Adv Ther
Pays: United States
ID NLM: 8611864
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
02
02
2021
accepted:
30
03
2021
pubmed:
13
5
2021
medline:
23
6
2021
entrez:
12
5
2021
Statut:
ppublish
Résumé
Although poor adherence to insulin is widely recognised, periodic discontinuation of insulin may cause more severe hyperglycaemia than poor adherence. We assessed persistence with insulin therapy in patients with type 1 (T1D) or type 2 diabetes (T2D) in developing countries and the reasons for insulin discontinuation. The International Diabetes Management Practices Study collected real-world data from developing countries in seven waves between 2005 and 2017. In Wave 7 (2016-2017), we asked adult patients with T1D and insulin-treated T2D to report whether they had ever discontinued insulin, the estimated duration of discontinuation and underlying reasons. Among 8303 patients recruited from 24 countries by 620 physicians, 4596 were insulin-treated (T1D: 2000; T2D: 2596). In patients with T1D, 14.0% (95% CI: 12.5-15.6) reported having self-discontinued insulin for a median duration of 1.0 month (IQR: 0.5, 3.5). The respective figures in patients with T2D were 13.7% (12.4-15.1) and 2.0 months (IQR: 1.0, 6.0). The main reasons for discontinuation were impact on social life (T1D: 41.0%; T2D: 30.5%), cost of medications and test strips (T1D: 34.4%; T2D: 24.5%), fear of hypoglycaemia (T1D: 26.7%; T2D: 28.0%) and lack of support (T1D: 26.4%; T2D: 25.9%). Other factors included age < 40 years, non-university education and short disease duration (T1D: ≤ 1 year; T2D: > 1-≤ 5 years). Patients with T1D who did not perform self-monitoring of blood glucose (SMBG) or self-adjust their insulin dosage, and patients with T1D or T2D without glucose meters were less likely to persist with insulin. Nearly 50% of patients who reported poor persistence had HbA In developing countries, poor persistence with insulin is common among insulin-treated patients, supporting calls for urgent actions to ensure easy access to insulin, tools for SMBG and education.
Identifiants
pubmed: 33978906
doi: 10.1007/s12325-021-01736-4
pii: 10.1007/s12325-021-01736-4
pmc: PMC8189989
doi:
Substances chimiques
Blood Glucose
0
Hypoglycemic Agents
0
Insulin
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Pagination
3281-3298Références
International Diabetes Federation. IDF Diabetes Atlas, 9th ed. 2019. https://diabetesatlas.org/en/resources/ . Cited 6 Oct 2020.
McCarthy MI. Genomics, type 2 diabetes, and obesity. N Engl J Med. 2010;363(24):2339–50.
doi: 10.1056/NEJMra0906948
Luk AOY, et al. Diabetes-related complications and mortality in patients with young-onset latent autoimmune diabetes: a 14-year analysis of the prospective Hong Kong diabetes register. Diabetes Care. 2019;42(6):1042–50.
doi: 10.2337/dc18-1796
Ahlqvist E, et al. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Diabetes Endocrinol. 2018;6(5):361–9.
doi: 10.1016/S2213-8587(18)30051-2
Fonseca VA. Defining and characterizing the progression of type 2 diabetes. Diabetes Care. 2009;32(Suppl 2):S151–6.
doi: 10.2337/dc09-S301
American Diabetes Association (ADA). 6. Glycemic targets: standards of medical care in diabetes—2020. Diabetes Care. 2020;43(Supplement 1):S66–76.
Aschner P, et al. Persistent poor glycaemic control in individuals with type 2 diabetes in developing countries: 12 years of real-world evidence of the International Diabetes Management Practices Study (IDMPS). Diabetologia. 2020;63(4):711–21.
doi: 10.1007/s00125-019-05078-3
Gagliardino JJ, et al. Type 2 diabetes: prescription patterns and treatment outcomes of IDMPS survey in Argentina. Diabetes Res Clin Pract. 2019;153:86–92.
doi: 10.1016/j.diabres.2019.05.008
Khunti K, et al. Clinical inertia with regard to intensifying therapy in people with type 2 diabetes treated with basal insulin. Diabetes Obes Metab. 2016;18(4):401–9.
doi: 10.1111/dom.12626
Mauricio D, et al. Glycaemic control and hypoglycaemia burden in patients with type 2 diabetes initiating basal insulin in Europe and the USA. Diabetes Obes Metab. 2017;19(8):1155–64.
doi: 10.1111/dom.12927
Russell-Jones D, Pouwer F, Khunti K. Identification of barriers to insulin therapy and approaches to overcoming them. Diabetes Obes Metab. 2018;20(3):488–96.
doi: 10.1111/dom.13132
Donnelly LA, et al. Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes. QJM. 2007;100(6):345–50.
doi: 10.1093/qjmed/hcm031
Sarbacker GB, Urteaga EM. Adherence to insulin therapy. Diabetes Spectr. 2016;29(3):166–70.
doi: 10.2337/diaspect.29.3.166
Pastakia SD, et al. Diabetes in sub-Saharan Africa—from policy to practice to progress: targeting the existing gaps for future care for diabetes. Diabetes Metab Syndr Obes. 2017;10:247–63.
doi: 10.2147/DMSO.S126314
Chan JCN, et al. Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS). Diabetes Care. 2009;32(2):227–33.
doi: 10.2337/dc08-0435
Ringborg A, et al. Resource use associated with type 2 diabetes in Asia, Latin America, the Middle East and Africa: results from the International Diabetes Management Practices Study (IDMPS). Int J Clin Pract. 2009;63(7):997–1007.
doi: 10.1111/j.1742-1241.2009.02098.x
Gagliardino JJ, et al. Patients’ education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS). Diabetes Metab. 2012;38(2):128–34.
doi: 10.1016/j.diabet.2011.09.002
Casciano R, et al. A quantitative assessment of patient barriers to insulin. Int J Clin Pract. 2011;65(4):408–14.
doi: 10.1111/j.1742-1241.2010.02590.x
Gagliardino JJ, et al. Resource use associated with type 2 diabetes in Africa, the Middle East, South Asia, Eurasia and Turkey: results from the International Diabetes Management Practice Study (IDMPS). BMJ Open Diabetes Res Care. 2017;5(1):e000297.
doi: 10.1136/bmjdrc-2016-000297
Aschner, P, et al., High prevalence of depressive symptoms in patients with type 1 and type 2 diabetes in developing countries: results from the International Diabetes Management Practices Study. Manuscript submitted to diabetes care, 2021.
Cramer JA, et al. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44–7.
doi: 10.1111/j.1524-4733.2007.00213.x
Brown RJ, Rother KI. Effects of beta-cell rest on beta-cell function: a review of clinical and preclinical data. Pediatr Diabetes. 2008;9(3 Pt 2):14–22.
doi: 10.1111/j.1399-5448.2007.00272.x
Skovlund SE, Peyrot M. The Diabetes Attitudes, Wishes, and Needs (DAWN) Program: a new approach to improving outcomes of diabetes care. Diabetes Spectr. 2005;18(3):136–42.
doi: 10.2337/diaspect.18.3.136
Perez-Nieves M, et al. Adherence to basal insulin therapy among people with type 2 diabetes: a retrospective cohort study of costs and patient outcomes. Diabetes Ther. 2018;9(3):1099–111.
doi: 10.1007/s13300-018-0421-5
Anderten H, Dippel F-W, Kostev K. Early discontinuation and related treatment costs after initiation of Basal insulin in type 2 diabetes patients: a German primary care database analysis. J Diabetes Sci Technol. 2015;9(3):644–50.
doi: 10.1177/1932296814566232
Ascher-Svanum H, et al. Early discontinuation and restart of insulin in the treatment of type 2 diabetes mellitus. Diabetes Ther. 2014;5(1):225–42.
doi: 10.1007/s13300-014-0065-z
Del Degan S, et al. Risk factors for recurrent diabetic ketoacidosis in adults with type 1 diabetes. Can J Diabetes. 2019;43(7):472–6 ((e1)).
doi: 10.1016/j.jcjd.2019.01.008
Genuth S, et al. Implications of the United kingdom prospective diabetes study. Diabetes Care. 2003;26(Suppl 1):S28-32.
pubmed: 12502617
King P, Peacock I, Donnelly R. The UK prospective diabetes study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol. 1999;48(5):643–8.
doi: 10.1046/j.1365-2125.1999.00092.x
Polonsky WH, et al. Identifying solutions to psychological insulin resistance: an international study. J Diabetes Complicat. 2019;33(4):307–14.
doi: 10.1016/j.jdiacomp.2019.01.001
McGill M, et al. The interdisciplinary team in type 2 diabetes management: challenges and best practice solutions from real-world scenarios. J Clin Transl Endocrinol. 2016;7:21–7.
pubmed: 29067246
pmcid: 5651292
Mbanya JC, et al. Self-monitoring of blood glucose (SMBG) and glycaemic control in Cameroon: results of the International Diabetes Management Practices Study (IDMPS). Diabetes Res Clin Pract. 2017;126:198–201.
doi: 10.1016/j.diabres.2016.11.029
Alsayed K, Ghoraba M. Assessment of diabetic patients’ adherence to insulin injections on basal-bolus regimen in diabetic care center in Saudi Arabia 2018: Cross sectional survey. J Family Med Prim Care. 2019;8(6):1964–70.
doi: 10.4103/jfmpc.jfmpc_276_19
Aminde LN, et al. Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon. BMC Endocr Disord. 2019;19(1):35.
doi: 10.1186/s12902-019-0360-9
Wu H, et al. Association between educational level and cardiovascular disease and all-cause mortality in patients with type 2 diabetes: a prospective study in the Joint Asia Diabetes Evaluation Program. Clinical Epidemiol. 2018;10:1561–71.
doi: 10.2147/CLEP.S177437
Saydah S, Lochner K. Socioeconomic status and risk of diabetes-related mortality in the U.S. Public health reports (Washington, D.C.: 1974). 2010;125(3):377–88.
Chan JCN, et al. Lancet commission on diabetes: using data to transform diabetes care and patient lives. Lancet. 2020;396(10267):2019–82.
doi: 10.1016/S0140-6736(20)32374-6
Norris SL, et al. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002;25(7):1159–71.
doi: 10.2337/diacare.25.7.1159
Lim LL, et al. Aspects of multicomponent integrated care promote sustained improvement in surrogate clinical outcomes: a systematic review and meta-analysis. Diabetes Care. 2018;41(6):1312–20.
doi: 10.2337/dc17-2010
Gagliardino JJ, et al. Clinical, metabolic and psychological outcomes and treatment costs of a prospective randomized trial based on different educational strategies to improve diabetes care (PRODIACOR). Diabet Med. 2013;30(9):1102–11.
doi: 10.1111/dme.12230
Krass I, Schieback P, Dhippayom T. Adherence to diabetes medication: a systematic review. Diabet Med. 2015;32(6):725–37.
doi: 10.1111/dme.12651
World Health Organization. WHO model list of essential medicines. 2017. https://apps.who.int/iris/bitstream/handle/10665/273826/EML-20-eng.pdf?ua=1 . cited 8 July 2019.
Baumgartner PC, et al. A systematic review of medication adherence thresholds dependent of clinical outcomes. Front Pharmacol. 2018;9:1290.
doi: 10.3389/fphar.2018.01290
Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86(4):304–14.
doi: 10.4065/mcp.2010.0575