Open Access Research article

Insulin use and persistence in patients with type 2 diabetes adding mealtime insulin to a basal regimen: a retrospective database analysis

Machaon M Bonafede1*, Anupama Kalsekar26, Manjiri Pawaskar3, Kimberly M Ruiz4, Amelito M Torres45, Karen R Kelly6 and Suellen M Curkendall4

Author Affiliations

1 Outcomes Research, Thomson Reuters Inc, 37 Lowell Street, Andover MA 01810, USA

2 Current Address: Global Health Economics and Outcomes Research, Bristol Myers Squibb, PO Box 4000, Province Line Road, Princeton, NJ 08543, USA

3 Global Health Outcomes: Endocrine/Obesity/Metabolism, Eli Lilly and Company, Lilly Technology Center, Indianapolis, IN 46285, USA

4 Outcomes Research, Thomson Reuters Inc, 4301 Connecticut Ave NW, Suite 330. Washington DC 20008, USA

5 Current Address: Healthcare Research and Analytics, GE Healthcare, 101 Cargenie Center, Princeton, NJ 08540, USA

6 Diabetes and Devices Platform, Eli Lilly and Company, Lilly Technology Center, Indianapolis, IN 46202, USA

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BMC Endocrine Disorders 2011, 11:3  doi:10.1186/1472-6823-11-3

Published: 12 January 2011



The objective of this study was to characterize insulin use and examine factors associated with persistence to mealtime insulin among patients with type 2 diabetes (T2D) on stable basal insulin therapy initiating mealtime insulin therapy.


Insulin use among patients with T2D initiating mealtime insulin was investigated using Thomson Reuters MarketScan® research databases from July 2001 through September 2006. The first mealtime insulin claim preceded by 6 months with 2 claims for basal insulin was used as the index event. A total of 21 months of continuous health plan enrollment was required. Patients were required to have a second mealtime insulin claim during the 12-month follow-up period. Persistence measure 1 defined non-persistence as the presence of a 90-day gap in mealtime insulin claims, effective the date of the last claim prior to the gap. Persistence measure 2 required 1 claim per quarter to be persistent. Risk factors for non-persistence were assessed using logistic regression.


Patients initiating mealtime insulin (n = 4752; 51% male, mean age = 60.3 years) primarily used vial/syringe (87%) and insulin analogs (60%). Patients filled a median of 2, 3, and 4 mealtime insulin claims at 3, 6, and 12 months, respectively, with a median time of 76 days between refills. According to measure 1, persistence to mealtime insulin was 40.7%, 30.2%, and 19.1% at 3, 6, and 12 months, respectively. Results for measure 2 were considerably higher: 74.3%, 55.3%, and 42.2% of patients were persistent at 3, 6, and 12 months, respectively. Initiating mealtime insulin with human insulin was a risk factor for non-persistence by both measures (OR < 0.80, p < 0.01). Additional predictors of non-persistence at 12 months included elderly age, increased insulin copayment, mental health comorbidity, and polypharmacy (p < 0.05 for all).


Mealtime insulin use and persistence were both considerably lower than expected, and were significantly lower for human insulin compared to analogs.