A Retrospective Observational Cohort Study to Investigate Uncontrolled Hyperglycemia and Delay in Basal Insulin Intensification and Non-Intensification Among Individuals With Type 2 Diabetes in Denmark

Author(s)

Rudolfsen JH1, Gowda A2, Røder KL3, de Laguiche E4
1EY Denmark, Copenhagen, 84, Denmark, 2Novo Nordisk, Søborg, Denmark, 3EY Denmark, Frederiksberg, Denmark, 4Novo Nordisk, Copenhagen, 84, Denmark

OBJECTIVES: To investigate uncontrolled hyperglycemia (UH) duration in adults with type 2 diabetes (T2D) receiving basal insulin in Denmark and describe basal insulin intensification patterns.

METHODS: This retrospective, observational cohort analysis used real-world data from Danish health and administrative registers (2012–2022). Eligible participants (aged ≥18 years) had T2D, received basal insulin, and had UH (HbA1c >7.0%) for ≥6 months after basal insulin initiation (index event). Timely treatment intensification (TTI) was defined as initiation of bolus or pre-mixed insulin, a fixed-ratio combination of basal insulin/glucagon-like peptide-1 receptor agonist, or a non-insulin glucose-lowering agent within 6 months post-index event whilst delayed treatment intensification (DTI) was the absence of treatment intensification (TI) within 6 months of the index event. Follow-up ended at TI, death or study completion.

RESULTS: Overall, 17,777 individuals with UH were analyzed: 47.4% received no TI; 33.2% had DTI; 19.4% had TTI. Mean age (standard deviation [SD]) was similar for TTI and DTI groups (65.7 [13.4] vs 65.7 [12.7] years) but higher in individuals with no TI (71.3 [12.6] years). Comorbidity burden was highest for individuals with no TI (mean Charlson Comorbidities Index [SD]: 2.9 [3.5]) in the 5 years before study completion, followed by TTI (2.0 [2.9]) and DTI (1.6 [2.5]) groups. Mean HbA1c (SD) at TI was comparable with DTI and TTI (9.2% [3.8%] and 9.0% [4.0%]). A higher proportion of individuals with TTI than DTI initiated bolus insulin (39.5% vs 31.4%), while more individuals with DTI than TTI intensified treatment with a non-insulin glucose-lowering agent (40.7% vs 34.4%). On average, individuals with DTI spent 1.9 years with UH; 25.0% of these spent >2.6 years with UH before TI.

CONCLUSIONS: Timely basal insulin intensification was uncommon in T2D, with one-third of individuals experiencing a delay and almost half not intensifying basal insulin treatment despite having uncontrolled hyperglycemia for ≥6 months.

Conference/Value in Health Info

2024-11, ISPOR Europe 2024, Barcelona, Spain

Value in Health, Volume 27, Issue 12, S2 (December 2024)

Code

RWD135

Disease

Diabetes/Endocrine/Metabolic Disorders (including obesity)

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