Blonde L, Lew E, Raccah D, Meyers J, Ajmera M, Davis K, Bertolini M, Guerci B. Impact of time to basal insulin initiation on glycemic control and health care costs in T2DM patients:  an analysis of US commercial claims data. Poster presented at the American Diabetes Association 77th Scientific Sessions; June 10, 2017. San Diego, CA.

OBJECTIVE: Many patients who would benefit from insulin therapy do not receive it in a timely manner. This study assessed HbA1c control and health care costs in a real world setting using a retrospective commercial claims database.

METHODS:  Patients with a T2DM diagnosis (ICD-9-CM codes 250.x0 or 250.x2) from 1/1/2007 to 12/31/2014, were identified in the MarketScan database. Patients initiating basal insulin (BI) and with an HbA1c test >7% in the 6 months pre-BI initiation were identified. Patients were required to have 24 months pre- and 12 months post-BI initiation health plan enrollment and were stratified by time with uncontrolled HbA1c (>7%) before BI initiation (i.e, <6, 6-12, 12-18, 18-24 months). Study measures included pre- and post-BI initiation HbA1c and health care costs.

RESULTS: A total of 5,422 patients met the inclusion criteria. Before BI initiation, mean (SD) HbA1c was 9.8% (2.0), with 50.3% of patients uncontrolled <6, 18.3% 6-12, 13.7% 12-18, and 17.8% 18-24 months. There was little variation in baseline HbA1c by duration of time uncontrolled. Mean (SD) reduction in HbA1c was 1.4 (2.4) and 48.1% of patients had HbA1c > 8% during follow-up. Patients with uncontrolled HbA1c <6 months had the largest reduction in HbA1c (mean [SD] change of 1.8% [2.7], 58.4% HbA1c < 8%), while patients with uncontrolled HbA1c 18-24 months had the smallest change in HbA1c (mean [SD] change of 1.0% [2.0], 38.4% HbA1c < 8%). Costs ranged from mean (SD) $14,621 ($22,654) among patients uncontrolled for 12-18 months to $18,816 ($40,793) <6 months.

CONCLUSIONS: Despite improvements in HbA1c following BI initiation, almost half of patients had HbA1c >8% during follow-up, with patients with the longest period of uncontrolled Hba1c during baseline least likely to achieve HbA1c <8%. This study suggests there would be benefit from earlier introduction of BI or alternative therapeutic options to assist patients in achieving HbA1c targets. 

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