Persistence to Basal Insulin: Association With Health Outcomes in a Population With Type 2 Diabetes

Abstract

This study examined the association between persistence to basal insulin and clinical and economic health outcomes. The question of whether a persistence measure for basal insulin could be leveraged in quality measurement was also explored. Using the IBM-Truven MarketScan Commercial and Medicare Supplemental Databases from 1 January 2011 to 31 December 2015, a total of 14,126 subjects were included in the analyses, wherein 9,898 (70.1%) were categorized as persistent with basal insulin therapy. Basal insulin persistence was associated with lower A1C, fewer hospitalizations and emergency department visits, and lower health care expenditures. Quality measures based on prescription drug claims for basal insulin are feasible and should be considered for guiding quality improvement efforts.

Figure 1

Cohort flowchart diagram. ^aThe study period is from 1 January 2011 to 21 December 2015. ^bThe identification period is from 1 July 2011 to 31 December 2014.

Figure 2

Insulin persistence regression model results. All models adjusted for variables including age, sex, type of insurance (commercial vs. Medicare), insulin type (pen vs. vial), prescription drug class, and DCCI score. **A1C values were available for 4,121 subjects. *P <0.05.