Objectives: Pharmacologic treatment of type 2 diabetes mellitus (T2DM) follows a stepwise approach. Typically, metformin monotherapy is first-line treatment, followed by other noninsulin antihyperglycemic agents (NIAHAs) or progression to insulin if glycated hemoglobin (A1C) targets are not achieved. We aimed to describe real-world patterns of basal insulin initiation in people with T2DM and A1C not at target despite treatment with at least 2 NIAHAs. Methods: A retrospective cohort study was conducted using administrative health data from Alberta, Canada, among adults with T2DM, indexed on the first test with 7.0% < A1C < 9.5% (April 1, 2011, to March 31, 2019), with at least 2 previous NIAHAs but no insulin. Kaplan-Meier (KM) methodology was used to analyze time to basal insulin initiation, with stratification by index A1C. Annual patient status was categorized into 5 groups: basal insulin initiation, death, NIAHA intensification, no change in therapy (subgroups of A1C <7.1% and A1C >= 7.1% [clinical inertia]), or discontinuance. Results: The cohort included 14,083 individuals. The KM cumulative probability of initiating basal insulin was 7.7% (95% confidence interval [CI] 7.3% to 8.2%) at 1 year, increasing to 43.1% (95% CI 42.1% to 44.1%) at 8 years of follow-up. Higher A1C levels were associated with greater proportions of basal insulin initiation. By year 8, proportions with NIAHA intensification and clinical inertia were 12.1% and 19.3%, respectively, relative to year 7. Conclusions: Despite current clinical practice guidelines recommending achieving A1C targets within 6 months, less than half of the individuals with T2DM and clear indications for basal insulin initiated treatment within 8 years. Efforts to reduce delays in basal insulin initiation are needed. (c) 2024 The Author(s). Published by Elsevier Inc. on behalf of Canadian Diabetes Association. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Objectives: Diabetes requires ongoing monitoring and care to prevent long-term adverse health out -comes. In Canada, quarantine restrictions were put into place to address the coronavirus-2019 (COVID-19) pandemic in March 2020. Primary care diabetes clinics limited their in-person services and were advised to manage type 2 diabetes (T2D) through virtual visits and reduce the frequency of routine diabetes-related lab tests and screening. Methods: This retrospective cross-sectional study used de-identified patient records from a primary care electronic medical records database in Ontario, Canada, to identify people with T2D who had at least 1 health-care touchpoint between March 1, 2018, and February 28, 2021. Outcomes were described on a monthly or yearly basis: 1) number of people with primary care visits (in-person vs virtual); 2) number of people with referrals; 3) number of people with each of the vital/lab measures; and 4) results of the vital/lab measures. Results: A total of 16,845 individuals with T2D were included. Compared with the pre-pandemic period, the COVID-19 period had a 16.8% reduction in the T2D population utilizing any primary care and an increase of 330.4% in the number of people with at least 1 virtual visit. Compared with the pre-pandemic period, fewer people had vital/lab measures in the pandemic period. However, among the people with the test results available, the average values for all tests were similar in the pre-and pandemic periods. Conclusion: Further research is needed to understand the impact of the reduction of in-person clinical care on the entire population with T2D. & COPY; 2023 The Author(s). Published by Elsevier Inc. on behalf of Canadian Diabetes Association. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Background: This study describes the impact of the pandemic on the management of people with type 2 diabetes (PwT2D) in a primary care network with existing virtual care capabilities in Ontario, Canada. Methods: Using de-identified primary care electronic medical records, PwT2D who had at least one healthcare touchpoint between March 1, 2018 and February 28, 2021 were analyzed by time period (baseline: 2018-19, pre-COVID-19: 2019-20, COVID-19: 2020-21) . The primary outcome measures include the number of people with at least one visit, number of people with vital measurements or lab tests, and the vital or lab results. Results: The three time periods had a similar average age and gender distribution (Table 1) . Compared to the pre-COVID-period, fewer people had any healthcare touchpoint (17% reduction) . In-person visits were reduced while more people had virtual visits. Fewer people had test results recorded during the COVID-vs. two pre-COVID-time periods, however, average results were similar across all three time periods. Conclusion: Our study described the immediate impact of the COVID-pandemic on patterns of primary care for PwT2D. While the total number people getting tests remains below pre-pandemic levels, of those who sought care, the mean A1c, LDL-c and eGFR were comparable across the three time periods. Disclosure A.Y.Cheng: Advisory Panel; Abbott, AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, HLS Theraoeutics, Insulet Corporation, Janssen Pharmaceuticals, Inc., Medtronic, Novo Nordisk, Sanofi, Board Member; Type 1 Diabetes Think Tank Network, Other Relationship; Diabetes Canada, Speaker's Bureau; Bausch Health, Canada, Merck & Co., Inc. S.B.Harris: Consultant; Abbott, AstraZeneca, Eli Lilly and Company, Novo Nordisk, Sanofi, Other Relationship; Abbott, AstraZeneca, Bayer Inc., Dexcom, Eli Lilly and Company, HLS Therapeutics, Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi, Research Support; Applied Therapeutics Inc., AstraZeneca, Canadian Institutes of Health Research, Juvenile Diabetes Research Foundation (JDRF) , Novo Nordisk, Sanofi, The Lawson Foundation. I.E.Krawchenko: Speaker's Bureau; Janssen Pharmaceuticals, Inc. R.Tytus: Other Relationship; Banty , Boehringer Ingelheim International GmbH, Canadian Health Research Company, Merck & Co., Inc., Novo Nordisk, Pfizer Inc. J.Hahn: Employee; Novo Nordisk Canada Inc. A.R.Liu: Employee; Novo Nordisk A/S, Novo Nordisk Canada Inc. Y.Wang: Other Relationship; Novo Nordisk Canada Inc. S.Golden: Other Relationship; Novo Nordisk Canada Inc. R.Goldenberg: Consultant; IQVIA Inc., Speaker's Bureau; Amgen Canada, AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Canada Inc., Sanofi.

Background: COVID-public health measures may have impacted diabetes care through delayed care and reduced medication access. This study describes antihyperglycemic medication prescription patterns among adults with type 2 diabetes (T2D) before and during the COVID-pandemic in Canada. Methods: Using IQVIA’s longitudinal pharmacy based prescription data, antihyperglycemic prescriptions from March 1, 2018 to February 28, 2021 were analyzed among adults who had ≥1 prescription for a non-insulin antihyperglycemic drug. The number of people who: 1) had antihyperglycemic prescriptions,2) were newly started on antihyperglycemic drugs, and3) were newly diagnosed with T2D (inferred from prescriptions) were reported. Results: The number of people who had ≥1 antihyperglycemic prescription was comparable in the year of the COVID-pandemic (March 2020 to February 2021) and the year prior (March 20to February 2020) . The number of people who newly initiated a GLP-1RA, SGLT2i or second-generation basal insulin analogue decreased for the first few months of the pandemic (April to September 2020) with recovery thereafter. The number of people who were newly diagnosed with T2D decreased by 7% in the COVID-year. Conclusion: Fewer people initiated newer antihyperglycemic medications and fewer people were newly diagnosed with T2D in the first few months for the pandemic which may reflect reduced health care access. Disclosure A.Y.Cheng: Advisory Panel; Abbott, AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, HLS Theraoeutics, Insulet Corporation, Janssen Pharmaceuticals, Inc., Medtronic, Novo Nordisk, Sanofi, Board Member; Type 1 Diabetes Think Tank Network, Other Relationship; Diabetes Canada, Speaker's Bureau; Bausch Health, Canada, Merck & Co., Inc. R.Goldenberg: Consultant; IQVIA Inc., Speaker's Bureau; Amgen Canada, AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Canada Inc., Sanofi. I.E.Krawchenko: Speaker's Bureau; Janssen Pharmaceuticals, Inc. R.Tytus: Other Relationship; Banty , Boehringer Ingelheim International GmbH, Canadian Health Research Company, Merck & Co., Inc., Novo Nordisk, Pfizer Inc. J.Hahn: Employee; Novo Nordisk Canada Inc. A.R.Liu: Employee; Novo Nordisk A/S, Novo Nordisk Canada Inc. T.Lan: Other Relationship; Novo Nordisk Canada Inc. B.Millson: Other Relationship; Novo Nordisk Canada Inc. S.B.Harris: Consultant; Abbott, AstraZeneca, Eli Lilly and Company, Novo Nordisk, Sanofi, Other Relationship; Abbott, AstraZeneca, Bayer Inc., Dexcom, Eli Lilly and Company, HLS Therapeutics, Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi, Research Support; Applied Therapeutics Inc., AstraZeneca, Canadian Institutes of Health Research, Juvenile Diabetes Research Foundation (JDRF) , Novo Nordisk, Sanofi, The Lawson Foundation.

The aim of the study was to examine glycaemic control and safety of insulin degludec (degludec) in patients with either type 1 diabetes (T1D) or type 2 diabetes (T2D) under routine care settings in Canada. Data were extracted from medical records of adults with T1D or T2D who switched to degludec (± prandial insulin) from another basal insulin (± prandial insulin) ≥ 6 months prior to data collection. The primary endpoint was change in glycated haemoglobin (HbA1c) at 6 ± 3 months after degludec initiation. Secondary endpoints included change in hypoglycaemia rate in the 6 months before versus the 6 months after switching, and change in mean total daily insulin dose. Of 667 patients assessed for eligibility, 626 were included. After 6 ± 3 months, HbA1c decreased from baseline in patients with T1D (− 0.3% [− 0.42, − 0.14]95% CI; p < 0.001) and in patients with T2D (− 0.4% [− 0.55, − 0.30]95% CI; p < 0.001). In patients with T1D, there were significant reductions in the rates of overall (rate ratio [RR] 0.70), non-severe (RR 0.69), non-severe nocturnal (RR 0.36), and severe nocturnal hypoglycaemia (RR 0.12; all p ≤ 0.004). In patients with T2D there was a significant reduction in non-severe nocturnal hypoglycaemia (RR 0.22; p < 0.001). Mean daily basal insulin dose decreased in patients with T1D (− 1.6 units [− 2.8, − 0.4]95% CI; p = 0.008); there was no significant change in patients with T2D (− 0.6 units [− 2.7, 1.4]95% CI; p = 0.543). In routine clinical practice, improved glycaemic control was observed in patients with T1D or T2D switching to insulin degludec from other basal insulins, with either improvement or no change in hypoglycaemia rates. ClinicalTrials.gov NCT03674866

This is the first US real-world study describing change in HbA1C in 206 adults with type 2 diabetes (T2D) initiating IDegLira (fixed-ratio combination of degludec and liraglutide) after treatment with basal insulin (Basal), glucagon-like peptide-1 receptor agonist (GLP-1RA), or no injectable therapy (N-INJ). Patients with HbA1C data 6 months prior to and post-index date (June 2018) were included, from the Practice Fusion Electronic Health Record database.

Objectives: There is a paucity of information concerning the cost of hypoglycemia events in Canadians with type 1 or type 2 diabetes. The objective of this study was to estimate the direct health-care costs and indirect costs associated with hypoglycemia based on a Canadian cohort of 498 patients from the global Hypoglycemia Assessment Tool (HAT) study. Methods: A costing model was developed to estimate the direct costs related to experiencing hypoglycemia by using health-care resources associated with hospital admissions and additional clinical appointments that were prospectively reported 1 month after baseline in the HAT study. Data collected retrospectively on work absenteeism in the year prior to baseline were used to estimate the indirect costs of hypoglycemia events. All costs were annualized and reported in 2016 Canadian dollars. Results: Of the 403 patients with diabetes who experienced hypoglycemia events in the first month after baseline (81%), 10 (2.5%) patients required hospitalization or clinical appointments. Over 1 year, the mean direct health-care costs were estimated to be C$90,300 (C$1,777 per patient) for hospitalizations and C$14,695 (C$204 per person) for additional clinical appointments. Work absenteeism resulted in a total annual indirect cost of C$20,937 for time off due to sick leave (C$500 per patient), arriving late (C$187 per patient) or leaving work early (C$128 per patient). The annual direct and indirect costs of hypoglycemia events total C$125,932. Conclusions: The impact of hypoglycemia events on health-care resource utilization and work productivity leads to substantial direct and indirect costs in Canadian patients with diabetes. (C) 2018 Canadian Diabetes Association.

Objectives: DAWN2 assessed the psychosocial impact of diabetes on persons with diabetes (PWDs), family members and healthcare professionals (HCPs) across 17 countries. This article reports on the Canadian cohort of PWDs.Methods: PWDs completed online, validated self-report scales assessing quality of life (QOL), self-management, beliefs, social support and priorities for improving diabetes care. Analyses used unweighted data.Results: Of 500 participants (80 type 1, 420 type 2) positive self-reported QOL was common (64.6%) and likely depression less common (12.8%). Diabetes distress, however, was identified by almost half of PWDs with type 1 diabetes, and one-quarter of PWDs with type 2 (47.5% vs. 25.7% type 2; p<0.001). Numerous life areas were negatively impacted, particularly finances, work and emotional well-being for those with type 1 diabetes (p<0.001 vs. type 2). Most PWDs reported support from family, friends and HCPs, but few reported being asked by HCPs how diabetes affected their lives. Most PWDs participated in (type 1, 90.0%; type 2, 85.7%) and valued (type 1, 84.7%; type 2, 78.1%) diabetes education. Few PWDs relied on community supports (type 1, 17.5%; type 2, 26.9%), and discrimination was not uncommon for those with type 1 (33.8% vs. 12.4% for type 2; p<0.001).Conclusions: PWDs experience psychological challenges that should be addressed within diabetes management services. (C) 2015 Canadian Diabetes Association.

The DAWN2 study involved 17 countries, including Canada, and enrolled people with diabetes (PWD), family members (FMs) and healthcare professionals (HCPs) to identify required areas of improvement in diabetes self-management and psychosocial factors. In Canada, 500 PWD, 121 FMs and 280 HCPs were recruited, and completed surveys of validated, adapted and newly developed questions. Data were descriptively analyzed. Results, presented as percent of responses, indicated that substantial improvements were required by PWD regarding eating healthily (78% PWD, 62% FMs, 64% HCPs), being physically active (74% PWD, 74% FMs, 80% HCPs) and maintaining healthy weight (70% PWD, 57% FMs, 72% HCPs). Of HCPs, 57% reported that diabetes self-management education and psychological support and care resources needed to be more available for PWD. Further, HCPs said it would be helpful if PWD prepared questions about their diabetes in advance of consultation (86%), told HCPs how to best support them (86%), independently sought information they needed to self-manage (77%) and participated in community activities for improved diabetes care and support (90%). HCPs also felt that diabetes medications needed to be more affordable (62%) and that PWD required better access to the newest diabetes treatments (50%), basic medications (23%) and blood sugar testing supplies/devices (27%). FMs (62%) wanted to know how to deal positively with emotional issues of living with diabetes. Acceptance of people with diabetes as equal members of society still needed addressing (28% PWD, 11% FMs, 11% HCPs). Improvements in all areas depend on the collaboration of HCPs, FMs and PWD.

Insulin degludec (IDeg) is a new basal insulin with an ultra-long and stable glucose-lowering effect. A previous meta-analysis showed that IDeg was associated with lower rates of confirmed (plasma glucose [PG] <3.1 mmol/L or severe requiring assistance) and nocturnal confirmed hypoglycemia vs. insulin glargine (IGlar) in patients with type 2 diabetes (T2D). We performed a post-hoc meta-analysis using an alternative definition of hypoglycemia. This patient-level meta-analysis included all 5 phase 3a, randomized, treat-to-target trials comparing once-daily IDeg (n=2262) and IGlar (n=1110) in T2D. Trials were open label and 26 or 52 weeks. Confirmed hypoglycemia comprised severe episodes requiring assistance or PG <2.3 mmol/L; nocturnal-confirmed hypoglycemia included confirmed episodes with an onset between 12:01 am and 5:59 am. There was a significant 33% lower rate of overall confirmed hypoglycemia for IDeg vs. IGlar for the full meta-analysis population (rate ratio [RR] IDeg/IGlar: 0.67 [0.56; 0.82], p<0.0001) and a significant 45% lower rate in a subset of patients (IDeg: n=1290; IGlar: n=632) who were insulin naïve prior to trial entry (RR: 0.55 [0.39; 0.76], p<0.001). IDeg was also associated with a 27% lower rate of nocturnal confirmed hypoglycemia vs. IGlar in the full population (RR: 0.73 [0.53; 1.01], p=0.06). Lower rates of overall and nocturnal-confirmed hypoglycemia were observed for IDeg compared with IGlar in patients with T2D, regardless of whether a PG concentration of <3.1 mmol/L or <2.3 mmol/L is used as the criterion for hypoglycemia.

DAWN2 in 17 countries, including Canada, aimed to assess barriers and facilitators of active and successful diabetes management among people with diabetes (PWD), family members (FM) and healthcare professionals (HCP). Methodology was consistent across all 17 countries. Surveys, developed and translated for PWDs, FMs and HCPs, incorporated standardized, adapted and new open-ended questions. Participant recruitment was inclusive and representative. Questionnaires were administered online, by telephone or in-person. Descriptive quantitative and qualitative analyses were conducted; 8596 PWDs globally including 500 Canadians (80 T1, 420 T2), 2057 FMs globally including 121 Canadians and 4785 HCPs globally including 281 Canadians (120 GPs, 80 specialists, 41 nurses, 40 dietitians) participated. Highlights (Canadian % and cross-country ranges) included:•∼66% PWDs (16 to 73%) reported good quality of life. ∼ 10% FMs (4 to 20%) and 11% PWDs (7 to 24%) reported likely depression.•63% PWDs (19 to 68%) considered HCPs supportive, but perceptions differed; e.g. 30% PWDs said HCPs asked them about problems/effects of their medications vs. 70% HCPs.•>50% PWDs (52 to 97%) said FMs supported their diabetes management. 40% FMs wanted more involvement.•71% PWDs (26 to 87%) attended and found diabetes education sessions helpful.•∼50% PWDs and HCPs (45 to 86%), and 40% FMs (20-60%) said earlier diagnosis and treatment needed improving. ∼60% HCPs said the same for psychological resources (41 to 80%), self-management education (26 to 81%), affordable diabetes medications and more qualified educators/nurse specialists (28 to 91%).•∼50% HCPs (31 to 89%) wanted more training in medical management of diabetes. Results are useful benchmarks for driving change to support PWD, FMs and HCPs in their roles in diabetes management.

Canada, 1 of 17 countries participating in the DAWN2 study, identified areas to improve for diabetes self-management among people with diabetes (PWD), family members (FMs) and healthcare professionals (HCPs). Five hundred PWDs, 121 FMs and 281 HCPs were surveyed using validated, adapted and newly developed questions. Descriptive statistical analyses for continuous and categorical data are shown as percentages. Sixty-four percent of type 2 (T2) PWD said they rarely/never let others know how they could support them. Fifty-five percent type 1 and 68% T2 PWD never/rarely took part in community activities to improve diabetes care. ∼50% FM (46% taking insulin, 55% non-insulin) said the person they live with sometimes got annoyed when they tried to help. The patient behaviours that HCPs considered very helpful were when patients let HCPs know how best they can support them, and when they prepared questions in advance of consultation (68% of nurses/dietitians; 36% of physicians). The majority (69% to 78%) of PWD said they were trying/would like to eat healthier, be more physically active and maintain a healthy weight. HCPs agreed that the majority (70% to 82%) of their patients needed improvements in these same areas. For 53% of FMs (insulin), the primary responsibility they felt was theirs, and not the PWDs, was to plan and cook healthy meals. FMs viewed searching for useful information about diabetes, and planning time for physical activity as a shared responsibility. Multiple stakeholders identified areas of diabetes self-management needing improvement, and collaboration to support behavioural changes, as important.

DAWN2 examined perspectives of Canadian people with diabetes (PWDs), family members (FMs) and healthcare professionals (HCPs) regarding healthcare provision, and people in 16 other countries. Surveys developed and translated for PWDs, FMs and HCPs incorporated new, standardized and adapted questions. Participant recruitment was inclusive and representative. Descriptive quantitative analysis results are presented in percentages and cross-country ranges. \Five hundred PWDs (80 T1, 420 T2), 121 FMs and 281 HCPs (120 GPs, 80 specialists, 41 nurses, 40 dietitians) participated. 61.3% (18.5% to 67.6%) of PWDs reported healthcare teams were supportive. PWDs reported seeing HCPs in the past year for A1c (74.8%; 61.6% to 92.8%), feet examination (56.3%; 14.8 to 81.8), anxiety and depression (36.4%; 14.6 to 57.3) and types of foods eaten (42.9%; 26.6 to 63.8). 25.0% PWDs (3.3% to 45.2%) had difficulty paying for diabetes medications, but few had difficulty accessing medications (6.28%; 2.4 to 23.8) or supplies (10.2%; 5.9 to 16.5). PWDs differed from HCPs in these beliefs (PWDs; HCPs respectively): were encouraged to seek support for diabetes care (17.3%; 42.6%), were contacted after a visit (16.4%; 24.0%) and care was well organized (56%; 63.4%). HCPs identified major improvements needed in self-management education (57.4%; 26.4% to 81.4%), psychological resources (62.4%; 40.6% to 79.6%), T2 diabetes prevention (78.4%; 60.4% to 90.5%) and earlier diagnosis/treatment (53.6%; 45.0% to 85.5%). 42.7% of FMs (20.0% to 60.3%) believed medical care, including regular follow up, needed major improvement. Although PWDs were positive about general care, major improvements in several areas were noted by HCPs and FMs. These findings are relevant for policy planning and service provision.

The DAWN2 study assessed helpfulness of diabetes education and availability of other support from the perspective of people with diabetes (PWD), family members (FM) and healthcare providers (HCPs). Five hundred PWDs (80 T1, 420 T2), 121 FMs and 281 HCPs participated. Surveys incorporated questions from the original DAWN study, standardized instruments, adapted validated instruments and new items. Descriptive statistical analyses for quantitative data are expressed as percentages. While 76% T1 PWD and 68% T2 PWD had one-on-one sessions with an instructor about diabetes and treatment, 70% found them helpful. 64% T1 FM and 58% T2 FM reported never attending an education program. Despite this, FM reported dietary guidelines and knowing how best to support PWD were the most important information for them. PWD and FM most likely relied on printed information and websites to help manage diabetes and ∼50% identified relying on advice outside regular office visits. Although most PWD and FM indicated they did not use telephone hotlines, 22% of T1 FM indicated they would like one and 37% to 52% HCP wanted to offer personalized websites and telephone hotlines. Thirty-two percent to 45% HCP identified coaches/support people as important for PWD. Only 8% to 15% HCP had training opportunities dealing with psychological/emotional aspects of diabetes. The study identified available education for PWD, but recognized the need for further education and support outside of regular visits, particularly for FM. HCP education is also needed, especially in managing the psychological aspects of diabetes.

The second Diabetes Attitudes, Wishes and Needs (DAWN2) study assessed impact of diabetes on psychological well-being, distress and life dimensions for people with diabetes (PWD, n=8596) and family members (FM, n=2057) in 17 countries. This paper examines the Canadian sample. Five hundred PWDs (80 Type 1—T1, 420 Type 2—T2) and 121 FMs living with PWDs participated. The WHO-5 Well-Being Index, the Problem Areas in Diabetes (PAID-5) and items assessing life dimensions were used. Descriptive statistical analyses for continuous and categorical data are shown as mean percentages. Cross-country variance is expressed as a range. 64.4% of Canadian PWDs (cross-country range 15.7 to 72.7%) and 76.0% of FMs (22.5 to 76.0%) reported good quality of life. Likely depression was low for both PWD (12.8%; 6.5 to 24.1%) and FM (5.8%; 4.2 to 20.0%). In contrast diabetes distress was common in PWD (27.8%; 12.5 to 48.8%) and significantly more common in those with T1 (48%) and T2 on insulin (31%) than those with T2 and no medication (17%; p<0.05). Further, large numbers of PWDs and FMs reported that diabetes negatively impacted their life functions, including emotional well-being (PWD=47.6%; 32.0 to 76.9%; FM=38.0%; 31.8 to 63.0%), leisure (PWD=40.6%; 19.5 to 57.0%; FM=26.9%; 14.5 to 46.6%) and work or studies for PWDs (27.6%; 16.7 to 50.7%) and FMs (10.1%; 11.8 to 47.4%) . These findings illustrate that while PWD and FM function well in many ways, significant diabetes-related concerns are present. Diabetes distress and interference with life is common, especially for T1 and T2 on insulin and also for FM.

Insulin Degludec (IDeg) is a new basal insulin that has an ultra-long and flat time-action profile. This study compared IDeg with insulin glargine (IGlar) in patients with type 2 diabetes (T2DM) requiring >60 U/day of basal insulin. This meta-analysis investigated HbA1c, fasting plasma glucose (FPG), and rates of overall confirmed (PG<3.1 mmol/L or requiring assistance) and nocturnal (00:01−05:59 hours) confirmed hypoglycemia in a pooled population of T2DM patients receiving >60 U of basal insulin at trial completion. Five phase-3a, open-label, randomized, treat-to-target trials with IDeg (n=2,262) vs. IGlar (n=1,110) administered once daily by subjects with T2DM were included. Statistical analysis used ANCOVA (HbA1c and FPG) and negative binomial regression (rates of hypoglycemia). At end-of-trial, a similar percentage of IDeg- and IGlar-treated T2DM subjects required >60 U of basal insulin daily [IDeg, 35.1% (795/2262); IGlar, 33.7% (374/1110)]. Similar glycemic control was obtained for IDeg vs IGlar (HbA1c: 0.05%, NS). End-of-trial FPG values were lower with IDeg than IGlar: −0.33 mmol (p=0.04).There was a 21% lower rate of overall confirmed hypoglycemic episodes for IDeg (rate ratio (RR) IDeg/IGlar: 0.79, p=0.02) and a 52% lower rate of nocturnal confirmed hypoglycemic episodes for IDeg (RR: 0.48, p<0.0001). In patients with T2DM requiring >60 U/day of basal insulin, at similar levels of HbA1c, IDeg achieves significantly lower rates of hypoglycemia compared with IGlar. These findings are consistent with results for the overall trial population, confirming that IDeg is a safe and effective basal insulin choice for T2DM patients across the spectrum of insulin requirements.

IMPROVE™ is a multi nationol open-label, observational study of 26 weeks of biphasic insulin aspart 30/70 (NovoMix® 30") in routine clinica! treatment of individuals with imadequately controlled type 2 diabetes, This analysis reports pooled safety and efficacy rcsults from patients enrolled in the study by 22 February 2008 in six countries [Canada (n=1557), China (n=21,725). India (n=16,587), Japan (n=2121), Poland (n =4101), and Russia (n=2027);global n=48.118].