512-P: Physician Perspectives and Experiences with Basal Insulin Titration in Type 2 Diabetes: A U.S. Cross-Sectional Survey

Introduction: Appropriate titration of basal insulin (BI) is essential to achieve glycemic control in patients with type 2 diabetes (T2D) . However, optimal glucose control is often unattained due to challenges with BI titration. This survey study reports physician experiences with BI titration.

Methods: Physicians in the Optum Research Database who treated ≥30 patients with T2D, with ≥1 who initiated BI from 10/01/20 to 03/31/21, were asked to complete a one-time mailed survey.

Results: Among 386 responders, 70% were male, 76% in general practice, 63% had ≥20-years’ experience, and 29% practiced in rural regions. Most (90%) physicians reported seeing >50 patients with T2D in the prior 6 months, and 66% treated ≥25% of them with BI. The majority (77%) expected glucose control attainment within 12 weeks, and 51% estimated <25% of patients were unable to reach HbA1c goal. Most (86%) physicians explained titration to all/most of their patients new to BI. Only 27% expected patients to self-manage titration; 60% managed titration for them, and 13% did both. Most (84%) physicians had in-office titration education by healthcare providers, 42% provided ongoing access to them; only 13% provided digital tools. The majority expressed concerns about patients’ abilities to follow titration algorithms (79%) , and to monitor blood glucose effectively (66%) , as well as lack of engagement in the titration process (72%) .

Conclusion: Physicians reported counseling most new-to-BI patients for titration and providing ongoing clinical guidance and non-digital support tools. Despite this, the majority of physicians expressed concern about patients' abilities to manage self-titration effectively. These findings support the need for novel approaches or tools to support patients during BI titration.