Clinical Outcomes of Patients with Type 2 Diabetes Treated with Multiple Daily Injection (MDI) of Insulin—A Retrospective Cohort Analysis

Abstract

Objective: We retrospectively analyzed clinical outcomes in type 2 diabetes mellitus (T2DM) multiple daily injections (MDI) insulin therapy patients compared with non-MDI insulin therapy patients. MDI was defined as patients having at least one basal and one prandial/bolus insulin prescription during a one year period starting October 2015. Methods: We compared a cohort of patients with an ICD-10 code of E11, 18 years of age and older, not pregnant, with a minimum of one office visit between October 2015 and April 2016. Data such as HbA1c, LDL, Body Mass Index (BMI), cardiovascular and renal disease were pooled from one hospital EMR system in the southeastern United States for MDI (n=11742) and non-MDI (n=56025) patients. T-tests were conducted. Results: All mean differences were significant (p<0.001). Overall, the average patient population in the MDI group was 2.4 years younger with a slightly larger proportion of female gender in the MDI group. Patients in the MDI group had an average HbA1c of 8.3% (SD=1.9) vs. 7.2% (SD=1.4) in the non-MDI group, but average proportion of patients with glycemic control (HbA1c <7%) was 23.9% vs. 54.8% respectively. The rate of cardiovascular disease in the MDI group was 37.8% vs. 21.8% in the non-MDI group. The rates of renal disease in the MDI group at 30.8% far exceeded the rates in the non-MDI group at 13.5%. Average BMI of 33.9 kg/m2 (SD=8.4) in the MDI group was greater than the non-MDI group at 32.9 kg/m2 (SD=8.6). The percentage of patients with blood pressure less than 140/90 mmHg was 78.3% in the MDI group vs. 81.4% in the non-MDI group, but the average LDL was 87.4 mg/dL (SD=37.4) vs. 88.7 mg/dL (SD=32.2) respectively. Conclusion: These results suggest MDI insulin therapy patients have poorer glycemic control and greater rates of macro and micro vascular complications compared with non-MDI insulin therapy patients within a large healthcare system. Disclosure T. Ludden: None. A. Ermakova: Employee; Self; Becton, Dickinson and Company. Y. Xiong: Employee; Self; Becton, Dickinson and Company. R. Sieradzan: Employee; Self; Becton, Dickinson and Company. N.C. Sacks: Consultant; Self; Becton, Dickinson and Company. P.L. Cyr: Consultant; Self; Becton, Dickinson and Company. S. Phillips: None. S.D. Taylor: Employee; Self; Becton, Dickinson and Company.