Stewart B. Harris

Aim Patient‐ and physician‐associated barriers impact the effectiveness of basal insulin (BI) titration in the management of type 2 diabetes (T2D). We evaluated the experiences of patients with T2D and physicians with BI titration education. Materials and Methods In this observational, cross‐sectional study, patients with T2D and physicians treating patients with T2D were identified by claims in the Optum Research Database and were invited to complete a survey. Eligible patients had 12 months of continuous health‐plan enrolment with medical and pharmacy benefits during the baseline period, and recent initiation of BI therapy. Eligible physicians had initiated BI for ≥1 eligible patient with T2D during the past 6 months. Results In total, 416 patients and 386 physicians completed the survey. Ninety per cent of physicians reported treating ≥50 patients with T2D; 66% treated ≥25% of patients with BI. Whereas 74% of patients reported that BI titration was explained to them by a physician, 96% of physicians reported doing so. Furthermore, 20% of patients stated they were offered educational materials whereas 56% of physicians reported having provided materials. Physicians had higher expectations of glycaemic target achievement than were seen in the patient survey; their main concern was the patients' ability to titrate accurately (79%). Conclusions There is a marked difference in patients' and physicians' experiences of BI titration education. Novel tools and strategies are required to enable effective BI titration, with more educational resources at the outset, and ongoing access to tools that provide clear, simple direction for self‐titration with less reliance on physicians/health care providers.

Aims Among adults with insulin‐ and/or secretagogue‐treated diabetes in the United States, very little is known about the real‐world descriptive epidemiology of iatrogenic severe (level 3) hypoglycaemia. Addressing this gap, we collected primary, longitudinal data to quantify the absolute frequency of events as well as incidence rates and proportions. Materials and Methods iNPHORM is a US‐wide, 12‐month ambidirectional panel survey (2020‐2021). Adults with type 1 diabetes mellitus (T1DM) or insulin‐ and/or secretagogue‐treated type 2 diabetes mellitus (T2DM) were recruited from a probability‐based internet panel. Participants completing ≥1 follow‐up questionnaire(s) were analysed. Results Among 978 respondents [T1DM 17%; mean age 51 (SD 14.3) years; male: 49.6%], 63% of level 3 events were treated outside the health care system (e.g. by family/friend/colleague), and <5% required hospitalization. Following the 12‐month prospective period, one‐third of individuals reported ≥1 event(s) [T1DM 44.2% (95% CI 36.8%‐51.8%); T2DM 30.8% (95% CI 28.7%‐35.1%), p = .0404, α = 0.0007]; and the incidence rate was 5.01 (95% CI 4.15‐6.05) events per person‐year (EPPY) [T1DM 3.57 (95% CI 2.49‐5.11) EPPY; T2DM 5.29 (95% CI 4.26‐6.57) EPPY, p = .1352, α = 0.0007]. Level 3 hypoglycaemia requiring non‐transport emergency medical services was more common in T2DM than T1DM ( p < .0001, α = 0.0016). In total, >90% of events were experienced by <15% of participants. Conclusions iNPHORM is one of the first long‐term, prospective US‐based investigations on level 3 hypoglycaemia epidemiology. Our results underscore the importance of participant‐reported data to ascertain its burden. Events were alarmingly frequent, irrespective of diabetes type, and concentrated in a small subsample.