ESTIMATED BASAL INSULIN COVERAGE AND CLINICAL OUTCOMES IN TYPE 2 DIABETES: A QUESTIONNAIRE LINKED REAL WORLD COHORT STUDY
Author(s)
Ariel Israel, MD PhD1, Eugene Merzon, MD1, alona aharonovich, Pharm D2, Evgeny Youzefpolsky, Pharm D2, Roy Eldor, MD PhD1.
1Leumit Health Care Services, Tel Aviv, Israel, 2Novo Nordisk, Kefar Saba, Israel.
1Leumit Health Care Services, Tel Aviv, Israel, 2Novo Nordisk, Kefar Saba, Israel.
OBJECTIVES: To evaluate associations between estimated basal insulin coverage and clinical outcomes in adults with type 2 diabetes (T2D)
METHODS: Retrospective cohort study linking Leumit Health Services electronic records with structured questionnaires from 400 adults with T2D using daily basal insulin (degludec, glargine, detemir) initiated 2019-2024. Estimated coverage was calculated as total insulin units purchased during 12 months before data extraction divided by self-reported daily dose, yielding estimated days of supply (EDS). Participants were stratified above/below the median EDS. Between-group unadjusted comparisons used t-tests (continuous variables) and chi-square (categorical variables). Baseline characteristics were captured at insulin initiation, outcomes at data extraction.
RESULTS: Median EDS was 500 days (211 participants below, 189 above). Groups differed at baseline. Lower-coverage participants were younger (mean [SD]) (54.3 [11.3] vs 56.8 [10.7] years, p=0.023), had higher HbA1c (10.0 [2.1] vs 9.5 [1.9] %, p=0.008), fasting glucose (228.9 [78.8] vs 210.1 [71.6] mg/dL, p=0.014), reported higher basal insulin requirements (34 [15] vs 29 [16] units, p<0.001), lower adherence (73.0% vs 88.4% never-skippers, p<0.001), and lower insulin confidence (3.6 [1.22] vs 4.0 [1.1] on scale 1-5, p<0.001). At follow-up, higher coverage was associated with better glycaemic control: lower HbA1c (7.3 [1.2] vs 8.1 [1.9] %, p<0.001), fasting glucose (124.6 [40.0] vs 149.2 [62.7] mg/dL, p<0.001); more participants achieving HbA1c ≤8% (76.2% vs 55.0%, p<0.001), fasting glucose ≤126 mg/dL (59.3% vs 42.2%, p<0.001); fewer with HbA1c ≥10% (3.2% vs 14.2%, p=0.0001). Higher coverage was associated with fewer emergency department (0.25 vs 0.52 visits/year, p=0.004) and primary physician visits (18.2 vs 21.0 visits/year, p=0.008).
CONCLUSIONS: In these unadjusted comparisons, higher EDS was associated with better glycaemic control and reduced healthcare utilization. Lower-coverage participants reported more frequent missed injections and lower insulin confidence; these factors co-occur with suboptimal outcomes and may represent intervention targets. Further research exploring strategies to improve insulin adherence is warranted.
METHODS: Retrospective cohort study linking Leumit Health Services electronic records with structured questionnaires from 400 adults with T2D using daily basal insulin (degludec, glargine, detemir) initiated 2019-2024. Estimated coverage was calculated as total insulin units purchased during 12 months before data extraction divided by self-reported daily dose, yielding estimated days of supply (EDS). Participants were stratified above/below the median EDS. Between-group unadjusted comparisons used t-tests (continuous variables) and chi-square (categorical variables). Baseline characteristics were captured at insulin initiation, outcomes at data extraction.
RESULTS: Median EDS was 500 days (211 participants below, 189 above). Groups differed at baseline. Lower-coverage participants were younger (mean [SD]) (54.3 [11.3] vs 56.8 [10.7] years, p=0.023), had higher HbA1c (10.0 [2.1] vs 9.5 [1.9] %, p=0.008), fasting glucose (228.9 [78.8] vs 210.1 [71.6] mg/dL, p=0.014), reported higher basal insulin requirements (34 [15] vs 29 [16] units, p<0.001), lower adherence (73.0% vs 88.4% never-skippers, p<0.001), and lower insulin confidence (3.6 [1.22] vs 4.0 [1.1] on scale 1-5, p<0.001). At follow-up, higher coverage was associated with better glycaemic control: lower HbA1c (7.3 [1.2] vs 8.1 [1.9] %, p<0.001), fasting glucose (124.6 [40.0] vs 149.2 [62.7] mg/dL, p<0.001); more participants achieving HbA1c ≤8% (76.2% vs 55.0%, p<0.001), fasting glucose ≤126 mg/dL (59.3% vs 42.2%, p<0.001); fewer with HbA1c ≥10% (3.2% vs 14.2%, p=0.0001). Higher coverage was associated with fewer emergency department (0.25 vs 0.52 visits/year, p=0.004) and primary physician visits (18.2 vs 21.0 visits/year, p=0.008).
CONCLUSIONS: In these unadjusted comparisons, higher EDS was associated with better glycaemic control and reduced healthcare utilization. Lower-coverage participants reported more frequent missed injections and lower insulin confidence; these factors co-occur with suboptimal outcomes and may represent intervention targets. Further research exploring strategies to improve insulin adherence is warranted.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD6
Topic
Clinical Outcomes, Patient-Centered Research, Real World Data & Information Systems
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas