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Association between Adherence to Basal Insulin and Hypoglycemia

Tim Casey

Philadelphia—Managing patients with type 2 diabetes remains a major challenge, particularly when it comes to medication adherence, according to findings from an online, cross-sectional survey of patients and healthcare professionals.

The GAPP2 (Global Attitude of Patients and Physicians 2) survey found that 22% of patients missed a basal insulin dose in the past 30 days, with a mean of 3 missed doses. During that period, 41% of people who missed a basal insulin dose had hypoglycemia compared with 34% who were adherent (P<.05).

Results were presented at the ADA meeting during a late-breaking poster session. The poster was titled GAPP2: Global Survey Finds in the Last Month One in Four Type 2 Diabetes Patients Do Not Take Basal Insulin as Prescribed and Over a Third Suffer Hypoglycaemia. The authors noted that hypoglycemia is a barrier to optimum glycemic control, contributing to significant impacts on diabetes management and patient functioning.

Meryl Brod, PhD, the study’s lead author, said healthcare professionals do not take hypoglycemia seriously even though patients are worried about this condition.

“[Hypoglycemia] is not uncommon [in these patients], even though [healthcare professionals] think it is,” Dr. Brod said.

The survey included 3042 patients from the United States (61% of participants), Canada (5%), Japan (12%), Germany (10%), the United Kingdom (11%), and Denmark (2%) who were recruited from online research panels consisting of >6.5 million members. The patients were ≥40 years of age and had type 2 diabetes diagnosed by a healthcare professional ≥40 years of age. Exclusion criteria included patients who were on bolus only or a premix of basal and bolus or used insulin pumps.

Mean age was 61 years, and mean number of years since being diagnosed with diabetes was 11 years. Of the patients, 48% took basal only and the rest took basal bolus. They took an average of 1.2 basal injections per day.

The 1653 healthcare professionals included hospital specialists, general practitioners, and diabetes nurses who were recruited from a panel of >600,000 participants; 28% were from the United States, 15% from Canada, 14% from Japan, 19% from Germany, 19% from the United Kingdom, and 5% from Denmark. On average, the clinicians saw 97 type 2 diabetes patients per month, and 64% of the patients were on insulin analogue.

The survey found that 48% of patients had never missed a basal insulin dose (22% in the past 30 days), 51% had never mistimed a basal insulin dose (24% in the past 30 days), 38% had never reduced a basal insulin dose (14% in the past 30 days), and 80% of patients said they had experienced hypoglycemia (36% in the past 30 days). Of the patients reporting hypoglycemia in the past 30 days, 16% said their last event was nocturnal and 74% said their last event was diurnal.

Of the healthcare professionals surveyed, only 37% said they always discussed self-treated hypoglycemia with their basal bolus patients and 27% said they always discussed self-treated hypoglycemia with their basal insulin patients.

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