Diabetes Management and Healthcare Resource Use When Intensifying from Basal Insulin to Basal-Bolus: A Survey of Type 2 Diabetes Patients

Kathryn M. Pfeiffer, Amaury Basse, Xin Ying Lee, Laura Tesler Waldman

Currently, there is limited knowledge about the experiences and challenges type 2 diabetes (T2D) patients face when intensifying from basal insulin to more complex regimens. The purpose of this study was to examine the experiences of adults with T2D who have been intensified to a basal-bolus insulin regimen, including challenges related to intensification, medication adherence issues, non-persistence, and healthcare resource use related to intensification. A web-based survey of adults diagnosed with T2D and currently treated with basal insulin was conducted in the UK and the USA. The analysis sample was restricted to respondents with current/recent basal-bolus treatment (n = 398) and divided into three analysis groups: (1) "basal-bolus adherent" (current basal-bolus treatment with at least 90% adherence); (2) "basal-bolus non-adherent" (current basal-bolus treatment with less than 80% adherence); and (3) "stopped bolus" (discontinued bolus in past 12 months). Basal-bolus non-adherent respondents reported fewer discussions with their healthcare providers (HCPs) before starting bolus and more frequent difficulties with and worries about taking bolus insulin compared to basal-bolus adherent and stopped bolus groups. The most frequently reported reasons for discontinuing bolus were related to the complicated nature of regimen, including too complicated to calculate bolus doses (25.7%), too complicated to regulate food in relation to bolus (20.7%), and too complicated to keep track of taking two different insulins (18.6%). Respondents who stopped bolus reported more frequent HCP visits related to diabetes compared to the basal-bolus adherent and basal-bolus non-adherent groups. Results suggest that the complicated nature of basal-bolus therapy contributes to the difficulties that T2D patients have with the regimen and to non-persistence. Physician and patient education may help patients address these treatment challenges to improve basal-bolus adherence and persistence, which could reduce healthcare resource use and costs. Less complex regimens may be appropriate for patients with persistent treatment difficulties. Novo Nordisk A/S.