OBJECTIVE: Many patients who would benefit from insulin therapy do not receive it in a timely manner. This study assessed HbA1c control and health care costs in a real world setting using a retrospective commercial claims database.
METHODS: Patients with a T2DM diagnosis (ICD-9-CM codes 250.x0 or 250.x2) from 1/1/2007 to 12/31/2014, were identified in the MarketScan database. Patients initiating basal insulin (BI) and with an HbA1c test >7% in the 6 months pre-BI initiation were identified. Patients were required to have 24 months pre- and 12 months post-BI initiation health plan enrollment and were stratified by time with uncontrolled HbA1c (>7%) before BI initiation (i.e, <6, 6-12, 12-18, 18-24 months). Study measures included pre- and post-BI initiation HbA1c and health care costs.
RESULTS: A total of 5,422 patients met the inclusion criteria. Before BI initiation, mean (SD) HbA1c was 9.8% (2.0), with 50.3% of patients uncontrolled <6, 18.3% 6-12, 13.7% 12-18, and 17.8% 18-24 months. There was little variation in baseline HbA1c by duration of time uncontrolled. Mean (SD) reduction in HbA1c was 1.4 (2.4) and 48.1% of patients had HbA1c > 8% during follow-up. Patients with uncontrolled HbA1c <6 months had the largest reduction in HbA1c (mean [SD] change of 1.8% [2.7], 58.4% HbA1c < 8%), while patients with uncontrolled HbA1c 18-24 months had the smallest change in HbA1c (mean [SD] change of 1.0% [2.0], 38.4% HbA1c < 8%). Costs ranged from mean (SD) $14,621 ($22,654) among patients uncontrolled for 12-18 months to $18,816 ($40,793) <6 months.
CONCLUSIONS: Despite improvements in HbA1c following BI initiation, almost half of patients had HbA1c >8% during follow-up, with patients with the longest period of uncontrolled Hba1c during baseline least likely to achieve HbA1c <8%. This study suggests there would be benefit from earlier introduction of BI or alternative therapeutic options to assist patients in achieving HbA1c targets.
