Human regular U-500 insulin (U-500R) is highly concentrated with both basal and prandial activity. It can be used as insulin monotherapy. This study sought to provide a better understanding of treatment patterns in a real-world environment for patients treated with U-500R.

Patients with type 2 diabetes initiating U-500R between 2010 and 2013 (N=1582) were selected from Truven Health MarketScan® database. The study had 3 periods: pre-index (12 month before initiation), post-index (12 month after initiation or until U-500R discontinuation), and follow-up (12 month after post-index). U-500R treatment patterns, medication possession ratio (MPR), and persistence with its contributing baseline factors were examined. The resumption of U-500R was studied during follow-up (i.e., after a gap ≥ 60 days between ends of supply from one fill to the next).

During post-index, 74.1% of patients had U-500R claims that did not overlap with other insulins. Only 7.6% had continuous U-500R claims overlapping ≥ 60 days with continuous claims of other insulins. The median U-500R average daily dose was 333 units. Among 12patients with more than one U-500R fill, 54.39% had MPR ≥80% and 26.08% patients between 60% and 80%. Within one year, 849 patients discontinued U-500R. Median time to discontinuation was 264 days. Patients 45 to 75 years old, treated with more types of insulins, or with rapid acting insulin use during pre-index were less likely to have a U-500R treatment gap (P <0.05). During follow-up, 602 (70.9%) of patients resumed U-500R. The median time from end of post-index to U-500R restart was 135 days. Out of the 733 patients with U-500R use beyond one year, 286 patients discontinued U-500R in the second year and 447 continued U-500R beyond two years.

The study suggests that U-500R is commonly used as insulin monotherapy. The observed adherence/persistence could be the result of the simplicity of U-500R regimen, which might benefit high-dose insulin-treated patients.


J. Chen: None. X. He: None. C.Y. Kao: None. J.A. Jackson: Other Relationship; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company.

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