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Feature Articles

Treatment Patterns, Adherence, and Persistence Associated With Human Regular U-500 Insulin: A Real-World Evidence Study

  1. Jieling Chen,
  2. Christi Y. Kao,
  3. Xuanyao He,
  4. Ludi Fan,
  5. Jeffrey A. Jackson and
  6. Rattan Juneja
  1. Eli Lilly and Company, Indianapolis, IN
  1. Corresponding author: Jieling Chen, chen_jieling{at}lilly.com
Diabetes Spectrum 2020 Aug; 33(3): 264-272. https://doi.org/10.2337/ds19-0060
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Abstract

OBJECTIVE | Human regular U-500 insulin (U-500R) is concentrated insulin with basal and prandial activity that can be used as insulin monotherapy. The goal of this study was to better understand treatment patterns (total daily dose [TDD] and concomitant medications), adherence, and persistence in real-world patients treated with U-500R.

DESIGN AND METHODS | We selected patients from the Truven Health MarketScan database who initiated U-500R between 2010 and 2013. We collected data for three periods: pre-index (12 months before initiation), post-index (12 months after initiation or until a gap of ≥60 days in U-500R claims), and follow-up (12 months after post-index). Data were analyzed using descriptive statistics and a regression model as appropriate.

RESULTS | We identified 1,582 patients who met the selection criteria. The median TDD of U-500R during the post-index period was 333 units/day, with 70.0% of patients using 300–400 units/day. During the post-index period, 74.1% of patients had U-500R claims that did not overlap with prescriptions for other insulins, interpreted as U-500R monotherapy. Among patients with ≥1 U-500R fill in the post-index period (n = 1,208), 54.4% had a medication possession ratio (MPR, a measure of adherence) ≥80%. Although 849 patients had a gap of ≥60 days in U-500R claims in the post-index period, 602 of those resumed U-500R in the follow-up period. Of the 733 patients who had no gap in U-500R claims in the post-index period, 286 had a gap of ≥60 days in claims in year 2, and 447 continued with U-500R treatment beyond 2 years.

CONCLUSION | These results demonstrate that U-500R was commonly used as insulin monotherapy, with a median TDD >300 units/day. Compared with published, relevant studies of other insulins, U-500R showed similar or greater adherence and persistence rates. These new data may help guide clinical decision-making when choosing insulin therapy for patients requiring high doses of insulin.

Footnotes

  • J.A.J. is currently affiliated with the Bethesda Health Clinic, Tyler, TX; Center for Hope and Healing, Goshen, IN; and Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.

  • This article contains supplementary materials online at https://spectrum.diabetesjournals.org/lookup/suppl/doi:10.2337/ds19-0060/-/DC1.

  • © 2020 by the American Diabetes Association
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Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www.diabetesjournals.org/content/license.

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Diabetes Spectrum: 33 (3)

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August 2020, 33(3)
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Treatment Patterns, Adherence, and Persistence Associated With Human Regular U-500 Insulin: A Real-World Evidence Study
Jieling Chen, Christi Y. Kao, Xuanyao He, Ludi Fan, Jeffrey A. Jackson, Rattan Juneja
Diabetes Spectrum Aug 2020, 33 (3) 264-272; DOI: 10.2337/ds19-0060

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Treatment Patterns, Adherence, and Persistence Associated With Human Regular U-500 Insulin: A Real-World Evidence Study
Jieling Chen, Christi Y. Kao, Xuanyao He, Ludi Fan, Jeffrey A. Jackson, Rattan Juneja
Diabetes Spectrum Aug 2020, 33 (3) 264-272; DOI: 10.2337/ds19-0060
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