OBJECTIVES: Hypoglycemia and poor medication adherence in patients with type 2 diabetes (T2D) have been shown to cause high glycemic variability leading to increased disease burden. This retrospective study aimed to examine the temporal trends in hypoglycemia events and medication adherence in patients with T2D initiating first-generation basal insulins who show different long-term A1C profiles.

METHODS: Adults (≥18 years) with a T2D diagnosis were identified from the Clinformatics Data Mart between 01/01/2010-30/06/2018. The date of the first basal insulin prescription was the index date. Inclusion criteria: continuous health plan enrolment 12 months pre- (baseline) and 18 months post-index (follow-up), ≥1 OAD/GLP-1 RA prescription during the baseline period, ≥1 baseline A1C record and no missing A1C in two consecutive quarters during follow-up. Quarterly hypoglycemia events and proportion of days covered (PDC) were examined for patients in different A1C cohorts: consistently below target (<7%), consistently above target (⩾7%), and fluctuating.

RESULTS: There were 5,785 patients included in the analysis. During follow-up, the below target cohort had more hypoglycemia events in Q1 (0.14 vs. 0.08) and Q2 (0.12 vs. 0.06) than the above target (p<0.05), and lower PDC for basal insulin after Q1 than above target or fluctuating cohort (all p<0.05). Decreasing number of hypoglycemia events (0.10-0.05) and PDC (0.74-0.49) were observed between Q1-Q6 for the overall population. Among patients with basal insulin on hand in each quarter, below target cohort also had more hypoglycemia events in Q1 (0.14 vs. 0.08, p<0.05). A decreasing trend from Q1-Q6 (0.10-0.04) was also observed among all patients with basal insulin use for hypoglycemia events.

CONCLUSIONS: This analysis showed that patients with consistently below target A1C with first-generation basal insulin had more hypoglycemia events than patients with consistently above target A1C and had lower PDC for basal insulin compared with those with above target or fluctuating A1C.