1243-P: Novel Use of Natural Language Processing to Identify Reasons for Insulin Discontinuation in Patients with T2DM: A Real-World Evidence Study

Abstract

Insulin is an important part of treatment of type 2 diabetes mellitus (T2DM). Nevertheless, reasons for discontinuation of insulin therapy are poorly understood. We conducted a real-world-evidence analysis of EMR data at Partners HealthCare to study adults with T2DM who were prescribed insulin between 2010 and 2016. Reasons for insulin discontinuation were identified from a combination of structured EMR data and natural language processing analysis of EMR notes using a validated tool (sensitivity 76.9% and positive predictive value 89.7%). The mean age of study patients was 60.2 years; 52.7% were male. Among 7,009 study patients, 2,957 (42.2%) discontinued insulin within 12 months after study start. In multivariable logistic regression analysis adjusted for demographics and comorbidities, patients were more likely to discontinue either basal or bolus insulin if they were on a basal-bolus regimen compared to basal only (OR 1.56, 95% CI 1.33 to 1.83; p < 0.001) or if they were being seen by an endocrinologist (OR 2.58; 95% CI 2.22 to 2.99; p < 0.001). Most patients (2,121/71.7%) had one or more reasons for discontinuation documented. The most common reasons were improving blood glucose (BG) control (33.2%), weight loss (likely ultimately also leading to lower BG) (18.5%) and initiation of non-insulin diabetes medications (16.7%). In multivariable analysis, patients were more likely to stop insulin due to achievement of good BG control if they were treated by an endocrinologist (OR 2.52; 95% CI 2.11 to 3.00; p < 0.001) or by a female physician (OR 1.43; 95% CI 1.26 to 1.63; p < 0.001). This study represents a successful attempt to use natural language processing to understand reasons for insulin discontinuation. Insulin discontinuation is common, and particularly so for patients on a basal-bolus regimen. Achievement of glycemic control, weight loss and initiation of other diabetes medications were the most common reasons for insulin discontinuation. Disclosure J. Wu: None. F.J. Morrison: None. Z. Zhao: Employee; Self; Lilly Diabetes. X. He: Employee; Self; Eli Lilly and Company. M. Shubina: None. S. Malmasi: None. W. Ge: None. X. Peng: None. A. Turchin: Advisory Panel; Self; Monarch Medical Technologies. Research Support; Self; Eli Lilly and Company. Stock/Shareholder; Self; Brio Systems. Funding Eli Lilly and Company