Diabetes Patients With Multiple Daily Injections Have Low Persistence, High Medical Costs

An award-winning poster at the AMCP 2018 Annual Meeting found that type 2 diabetes patients who need multiple daily injections of basal-bosul insulin have low 1-year persistence and higher medial costs

“Persistency among type 2 diabetes patients who progress to multiple daily injections of insulin is critical for glycemic control,” Anastasia Ermakova, PharmD, postdoctoral fellow in Health Economics and Outcomes Research at Becton Dickinson, and colleagues wrote. “Information on the impact of persistency on glycemic control, medical costs and health resource utilization for type 2 diabetes patients with multiple daily injections patients is limited.”

To determine persistence among type 2 diabetes patients with multiple daily injections of basal-bosul insulin, and how these factors impact health care utilization and costs, the researchers conducted a retrospective cohort study of 12.882 patients aged 18 to 64. Cohort patients included those with at least 18 months of continuous health care coverage. The researcher measured persistence as continuous use of insulins without a gap of 90 days.

Study results showed that persistence was 22.4% among patients for continuous use of both basal and bolus insulins without a gap of 90 days and 21.1% among patients with presence of one claim for both basal and bolus insulins on a quarterly basis for 4 consecutive quarters.

The researchers found that patients with higher persistence experienced a greater average reduction in HbA_1c after 1 year of treatment. These patients also achieved treatment success more often compared to nonpersistence patients.

Additionally, nonpersistent patients had higher overall health care costs at 17,703, compared with $13,107 in persistent patients. Also, diabetes related costs were higher among nonpersistent patients at approximately $8000 vs approximately $6000 in persistent patients. Health resource utilization and emergency department visits were also higher in nonpersistent patients. 

“One year persistence rates for type 2 diabetes patients with multiple daily injections patients were low,” Dr Ermakova and colleagues concluded. “Nonpersistent patients exhibited higher medical costs, greater health resource utilization, and poorer glycemic control compared to persistent patients.”

—David Costill