817-P: Demographic, Clinical, and Treatment Characteristics of Patients with Timely vs. Delayed Basal Insulin Initiation

Introduction & Objective: Basal insulin is indicated for patients with uncontrolled type 2 diabetes (uT2D) after trials of glucose-lowering medications (GLMs). Despite its benefit, it remains underutilized and is often initiated after delay as a last resource. This study examined the demographic, clinical, and treatment characteristics of patients with timely vs delayed basal insulin initiation.

Methods: In the 2011-2018 Merative^TM Claims-EHR Database, adults with uT2D who were candidates for basal insulin (HbA1c>7%, ≥2 GLMs totaling ≥180 days’ supply, no new GLM class in the next 90 days) and newly initiated treatment were selected (index date=first basal insulin fill). Timely and delayed initiators started treatment <6 months and ≥6 months after meeting uT2D criteria, respectively. Patients had ≥12 months of pre- and post-enrollment, no claims for type 1 diabetes or pregnancy, and ≥1 claim for T2D. Demographic, clinical, and treatment characteristics were compared between cohorts.

Results: Among 1,054 (29.2%) timely and 2,561 (70.8%) delayed initiators, mean time from uT2D to basal insulin was 59±55 days and 741±504 days, respectively. Timely initiators were younger and more likely to be female. Delayed initiators used more GLM classes than timely initiators in both pre- and post-periods. Delayed initiators had more HbA1c results in the pre-period (2.1±1.5 vs 1.9±1.2), indicating possible increased monitoring prior to basal insulin initiation, while timely initiators had a significantly larger HbA1c decrease from the pre- to post-periods (-1.3±1.9 vs -1.0±1.8, p<0.001).

Conclusion: Although basal insulin use led to reductions in HbA1c in both cohorts, greater benefits were observed with timely initiation. Patterns of GLM use and HbA1c monitoring suggested delayed basal insulin initiation was associated with more attempts to manage T2D with other GLMs, potentially prolonging exposure to hyperglycemia and increasing lifetime disease management costs.