DIAEXPLORER: a survey of insulin treatment and incidence of chronic complications in type 2 diabetics in Slovakia

Authors: Ingrid Dravecká 1;  Marek Macko 2;  Katarína Černá 3
Authors‘ workplace: I. interná klinika LF UPJŠ a UNLP Košice 1;  DIABETOL, s. r. o., Prešov 2;  Diabetologická ambulancia UNB, Nemocnica akademika Ladislava Dérera, Bratislava 3
Published in: Forum Diab 2023; 12(3): 66-76
Category: Original Article


Introduction: Available data on insulin treatment in Slovakia are only from statistical reports of the National Health Information Centre (NCZI), the results of which are provided with up to an 18-month delay and sources from health insurance companies are scarcely available. A one-off cross-sectional non-interventional DIAEXPLORER survey was conducted in 2022. Objective: to determine the use of insulin regimens in type 2 diabetics, the quality of diabetes compensation, persistence and adherence of treatment, the presence of microvascular and macrovascular complications and consideration of modification of insulin regimen in further therapy. Cohort and methods: The cohort consisted of 1 310 patients. The required data were obtained within normal therapeutic practice from 45 diabetes outpatient clinics across Slovakia. 3 insulin regimens were studied: BOT (basal-supported oral therapy) – basal insulin added to oral hypoglycemic therapy/oral antidiabetic drugs (OAD), BBT (basal-bolus insulin therapy) – basal insulin with prandial insulin with/without OAD treatment and MIX – premixed insulin treatment with/without OAD therapy. Results: The number of men was 665, as well as 665 women. The mean age was 66.3 years, the median duration of diabetes was 15.3 years, the mean duration of treatment with the BOT/BBT/MIX insulin regimen was 3.9/5.4/6.6 years. The mean HbA1c was 8.5 % (DCCT) and very similar in insulin regimens. In 15 % of patients, HbA1c was ≤ 7 %. The mean dose of basal insulin in the BOT/BBT regimen was 27.3/67.6 U/day, the mean dose of prandial insulin in the BBT regimen was 38.6 U/day. Microvascular diseases were present in 75 % and macrovascular diseases in 40 % of patients, respectively. Physicians evaluated 53 % of patients as satisfactory and good treatment. In approximately 70 %, physicians chose to change treatment, most often with the BOT regimen, without changing treatment with the MIX regimen. The most preferred treatment change (44–59 %) was to switch to a fixed combination of basal insulin with a GLP1 receptor agonist (GLP1-RA). Conclusions: The review showed comparable long-term compensation, reduced adherence to treatment and the need for modification of the insulin regimen, primarily by simplifying it through the use of a fixed combination of basal insulin with GLP1-RA.


DIAEXPLORER survey – insulin treatment – insulin basal/prandial/premixed – oral antidiabetic drugs (OAD)

  1. world in 2021. Dostupné z WWW: <https://diabetesatlas.org/atlas/tenth-edition/>.
  2. Davies MJ, Aroda VR, Collins BS et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2022; 45(11): 2753–2786. Dostupné z DOI: <https://doi.org/10.2337/dci22–0034>.
  3. American Diabetes Association. Standards of MedicalCare in Diabetes – 2022 Abridged for Primary Care Providers. Clin Diabetes 2022; 40(1): 10–38. Dostupné z DOI: <http://dx.doi.org/10.2337/cd22-as01>.
  4. Ray KK, Kendall DM, Zhao Z et al. A multinational observation study assessing insulin use: Understanding the determinants associated with progression of therapy. Diabetes Obes Metab 2019; 21(5): 1101–1110. Dostupné z DOI: <http://dx.doi.org/10.1111/dom.13622>.
  5. Chan JC, Gagliardino JJ, Ilkova H et al. One in Seven Insulin-Treated Patients in Developing Countries Reported Poor Persistence with Insulin Therapy: real World Evidence from the Cross-Sectional International Diabetes Management Practices Study (IDMPS). Adv Ther 2021; 38: 3281–3298. Dostupné z DOI: <http://dx.doi.org/10.1007/s12325–021–01736–4>.
  6. Cramer JA, Pugh MJ. The Influence of Insulin on Glycemic Control: How well do adults follow prescriptions for insulin? Diabetes Care 2005; 28(1): 27–83. Dostupné z DOI: <http://dx.doi.org/10.2337/diacare.28.1.78>.
  7. Guerci B, Chanan N, Kaur S et al. Lack of Treatment Persistence and Treatment Nonadherence as Barriers to Glycemic Control in Patients with Type 2 Diabetes. Diabetes. Ther 2019; 10(2): 437–449. Dostupné z DOI: <http://dx.doi.org/10.1007/s13300–019–0590-x>.
  8. Basu S, Yudkin JS, Sylvia Kehlenbrink et al. Estimation of Global Insulin Use for Type 2 Diabetes Mellitus, 2018–2030: a microsimulation analysis. Lancet Diabetes Endocrinol 2019; 7(1): 25–33. Dostupné z DOI: <http://dx.doi.org/10.1016/S2213–8587(18)30303–6>. Erratum in Lancet Diabetes Endocrinol. 2019; 7(1):e1. Dostupné z DOI: <http://dx.doi.org/10.1016/S2213–8587(18)30344–9>.
  9. Bakkila BF, Basu S, Lipska KJ et al. Catastrophic Spending On Insulin In The United Stades, 2017–18. Health Aff (Millwood) 2022; 41(7): 1053–1060. Dostupné z DOI: <http://dx.doi.org/10.1377/hlthaff.2021.01788>.
  10. Cramer JA. A systematic review adherence with medications for diabetes. Diabetes Care 2004; 27(5):1218–1224. Dostupné z DOI: <http://dx.doi.org/10.2337/diacare.27.5.1218>.
  11. Rathmann W, Czech M, Franek E et al. Regional differences in insulin therapy regiment in five European countries. Int J Clin Pharmacol Ther 2017; 55(5): 403 -408. Dostupné z DOI: <http://dx.doi.org/10.5414/CP202906>.
  12. Mokáň M, Martinka E, Galajda P. Diabetes mellitus a vybrané metabolické ochorenia. P + M: Turany 2008. ISBN 978–80–969713–9–8.
  13. Lee WC, Balu S, Cobden D et al. Prevalence and economic consequences of medication adherence in diabetes: a systematic literature review. Manag Care Interface 2006; 19(7): 31–41.
  14. Liebl A, Neiss A, Spannheimer A et al. Costs of type 2 diabetes in Germany. Results of the CODE-2 study. Dtsch Med Wochenschr 2001; 126(20): 585–589. Dostupné z DOI: <http://dx.doi.org/10.1055/s-2001–14102>.
  15. Kangas T, Reunanen A, Koivisto V et al. Direct costs of health care of drug-treated diabetic patients in Finland in 1989. In: Kangas T. The Finn Diab Report. Health care of people with diabetes in Finland. Addendum: 1995. Dostupné z WWW: https://www.julkari.fi/handle/10024/91090>.
  16. Henriksson F, Agardh CD, Berne C et al. Direct medical costs for patients with type 2 diabetes in Sweden. J Intern Med 2000; 248(5): 387–396. Dostupné z DOI: <http://dx.doi.org/10.1046/j.1365–2796.2000.00749.x>.
  17. Baser O, Tangirala K, Wei W et al. Real-world outcomes of initiating insulin glargine-based treatment versus premixed analog insulins among US patients with type 2 diabetes failing oral antidiabetic drugs. Clinicoecon Outcomes Res 2013; 5: 497–505. Dostupné z DOI: <http://dx.doi.org/10.2147/CEOR.S49279>.
  18. Donnelly LA, Morris AD, Evans JM. [DARTS/MEMO collaboration]. Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes. QJM 2007; 100(6): 345–350. Dostupné z DOI: <http://dx.doi.org/10.1093/qjmed/hcm031>.
  19. Qiao Q, Ouwens MJ, Grandy S et al. Adherence to GLP-1 receptor agonist therapy administered by once-daily or once-weekly injection in patients with type 2 diabetes in Germany. Diabetes Metab Syndr Obes 2016; 9: 201–205. Dostupné z DOI: <http://dx.doi.org/10.2147/DMSO.S99732>.
  20. Wei W, Zhou S, Miao R et al. Much ado about nothing? A real-world study of patients with type 2 diabetes switching basal insulin analogs. Adv Ther 2014; 31(5): 539–560. Dostupné z DOI: <http://dx.doi.org/10.1007/s12325–014–0120–1>.
  21. Pscherer S, Chou E, Dippel FW et al. Treatment persistence after initiating basal insulin in type 2 diabetes patients: a primary care data base analysis. Prim Care Diabetes 2015; 9(5): 377–384. Dostupné z DOI: <http://dx.doi.org/10.1016/j.pcd.2015.01.011>.
  22. Rajagopalan R, Joyce A, Ollendorf D et al. Medication compliance in type 2 diabetes patients: retrospective data analysis Value Health 2003; 6(3): 328. (Abstract). Dostupné z DOI: <http://dx.doi.org/10.1016/S1098–3015(10)64171-X>.
  23. Peyrot M, Barnett AH, Meneghini LF et al. Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in InsulinTherapy study. Diabet Med 2012; 29(5): 682–689. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1464–5491.2012.03605.x>.
  24. Ratanawongsa N, Crosson JC, Schillinger D et al. Getting under the skin of clinical inertia in insulin initiation: the translating research in to action for diabetes (TRIAD) insulin starts project. Diabetes Educ 2012; 38(1): 94–100. Dostupné z DOI: <http://dx.doi.org/10.1177/0145721711432649>.
  25. Gordon J, Evans M, McEwan P et al. Evaluation of Insulin Use and Value for Money in Type 2 Diabetes in the United Kingdom. Diabetes Ther 2013; 4(1): 51–66. Dostupné z DOI: <http://dx.doi.org/10.1007/s13300–012–0018–3>.
  26. Anderson RT, Marrero D, Skovlund SE et al. Self-reported compliance with insulin injection therapy in subjects with type 1 and 2 diabetes (Abstract). Diabetes Metab 2003; 29: A275.
  27. Morris AD, Boyle DI, McMahon AD et al. [DARTS/MEMO Collaboration]. Adherence to insulin treatment, glycemic control, and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit Lancet 1997; 350(9090): 1505–1510. Dostupné z DOI: <http://dx.doi.org/10.1016/s0140–6736(97)06234-x>.
  28. Martinka E, Dravecká I, Tkáč I. Racionalizácia predošlej liečby viacerými podaniami inzulínu prechodom na fixnú kombináciu bazálneho inzulínu degludek a agonistu GLP1-receptorov liraglutid (IDegLira): výsledky štúdie SIMPLIFY po 14 týždňoch. Forum Diab 2022; 11(Suppl 1): 6–14.
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