INITIATION OF BASAL INSULIN THERAPY AMONG PATIENTS WITH DIABETES MELLITUS IN JAPAN: A RETROSPECTIVE ANALYSIS IN A HOSPITAL SETTING

Friday, January 8, 2016
Foyer, G/F (Jockey Club School of Public Health and Primary Care Building at Prince of Wales Hospital)

Shuichi Suzuki, MPH1, Mayank Ajmera, MS, PhD2, Samantha Kurosky, MSPH2, Narayan Rajan, MA, MSc3, Kenji Ohwaki1 and Jay P. Bae, PhD4, (1)Eli Lilly Japan K. K., Kobe, Japan, (2)RTI Health Solutions, Research Triangle Park, NC, (3)Eli Lilly Australia Pty Limited, Sydney, Australia, (4)Eli Lilly and Company, Indianapolis, IN
Purpose: Describe real-world patient characteristics and treatment patterns among patients with diabetes who initiated insulin in the hospital-setting in Japan.

Method(s): A cohort of adults with type 1 or type 2 diabetes mellitus (T2DM) who first initiated insulin between 2012 and 2014 was identified in a large hospital-based medical claims database (Medical Data Vision). Demographic and clinical characteristics of patients with T2DM initiating basal insulin (BI) were reported during a 5-month pre–insulin-initiation index period.

Result(s): Of 35,409 patients with diabetes who initiated insulin therapy, 96.5% had T2DM. Among patients with T2DM 29.8% initiated BI therapy (70.3% in combination with prandial insulin [PI] and 29.7% with BI only). At BI initiation, the mean age was 64 years, mean pre-index HbA1c value was 9.1%, and 41.5% had a pre-index body mass index of ≥25. Overall, 87.5% of T2DM patients who receive BI initiated therapy when their HbA1c level was above 7%. Insulin glargine (IG) (77.5%) was most frequently initiated, followed by insulin detemir (IDt) (15.6%), and insulin degludec (IDg) (6.8%). The mean Charlson Comorbidity Index (CCI) score at BI initiation was highest among those receiving IDg (1.9), followed by IG (1.8), and IDt (1.4). Specifically, patients who initiated IDt had reported a lower frequency of myocardial infarction, congestive heart failure, cerebrovascular disease, hypertension, and diabetes-related ophthalmic and neurological complications compared to patients who initiated IDg or IG. Within each BI group, the mean CCI score was higher among those receiving PI compared to those who did not.

Conclusion(s): Considering the Japan Diabetes Society recommends a goal HbA1c level of <7% to reduce diabetes-related complications, the high baseline HbA1c suggests the need for better management and timely transition of treatments when first-line therapies (e.g., OADs) are failing. Those with a higher CCI score received IDg or IG compared to IDt and supplemented BI therapy with PI, suggesting clinical severity may be an important factor in determining the type of BI regimen initiated. Continued research on the type and timing of BI initiation is warranted.

See more of: SHORT-FORM ORAL PRESENTATIONS: SESSION 1

See more of: Making Difficult Clinical and Policy Decisions: The Example of Ageing and End of Life Care in Asia-Pacific