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

Overview

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.
 

Keywords:

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