New Study Details PWT2D Experiences with Basal Insulin Titration

Stewart Harris, MD, MPH

A new multi-national study presented at The Metabolic Institute of America (TMIOA) 2021 World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC) Meeting, suggested novel tools and strategies be implemented in clinical settings to empower patients with type 2 diabetes (T2D) and enable effective basal insulin (BI) titration.

This suggestion was in response to only 1/3 of the patients with T2D having reached the fasting blood glucose (FBG) after initiating BI in the study.

For T2D patients undergoing BI treatment, optimal titration of their dose can aid in achieving glycemic control. However, many of them remain uncontrolled for reasons related to a lack of understanding of BI titration.

As such, investigators led by Stewart Harris, MD, MPH, Schulich School of Medicine & Dentistry, The University of Western Ontario, Canada, evaluated the perspectives and experiences of BI titration in people with T2D initiating dosing.

The Methods

Stewart and investigators identified recent BI initiators through enrollment, medical, and pharmacy records from the Optum Research Database.

Inclusion criteria including 2 years or more of medical claims with a diagnosis for T2D ≥30 days apart in the 12-month sample identification period, which ended in March 2021 for wave 1 and April 2021 for wave 2.

Additionally, ≥1 pharmacy claim for BI (insulin glargine 100 U/mL, insulin glargine 300 U/mL, insulin degludec or insulin detemir) in the most recent month of pharmacy data was also required, as was being 18 years and older as of the index date and 12 months of continuous enrollment with medical and pharmacy benefits prior to index date.

From there, all identified BI initiators were tasked with completing a survey, which included questions on experience with BI titration involving titration resources, healthcare provider (HCP) interactions, self-management of titration, clinical information, titration status, and goal attainment.

A total of 416 BI initiators were included in the study.

Of those 416 survey responders, 51% were male, 71% were white, the mean age was 70 years, and mean BMI kg/m2. The mean age at diagnosis was 51 years, and 72% of responders had T2D for more than a decade.

The Findings

Harris and colleagues reported that most responders (74%) had BI titration explained to them by their provider, and the majority (67%) were very/extremely satisfied with the support received. Only 5% were not at all satisfied.

Regarding glycemic control and hypoglycemia, most responders documented BI dose (89%) and fasting blood glucose (FBG; 80%) daily

Aside from the 35% of responders reached FBG targets, 58% had not reached FGB and were still titrating while 7% had stopped using BI.

Only half (204, 49%) of partcipants experienced hypoglycemia during titration.

Mean Diabetes Treatment Satisfaction Questionnaire (DTSQ) total score was 28 (range 0–36; higher score indicates greater satisfaction), while mean Patient Activation Measure (PAM) total score was 65.

The score from PAM measured patient’s knowledge, ability, and confidence in managing their own health, on a 100-point scale, with higher scores indicating greater activation levels.

Patients were categorized into 1 of 4 activation levels according to their overall PAM score, and only 6% were categorized as “disengaged and overwhelmed”.

Investigators felt that the study had addressed the lack of understanding about the patient experience with BI titration.

“While many people with T2D initiating BI had received titration education/support, only one-third reached the FBG target, suggesting novel tools and strategies to empower patients and enable effective BI titration are needed,” the team wrote.