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Newer long-acting insulin prescriptions for patients with type 2 diabetes: prevalence and practice variation in a retrospective cohort study.

Dankers, M., Hek, K., Nelissen-Vrancken, M., Houweling, S.T., Mantel-Teeuwisse, A., Dijk, L. van. Newer long-acting insulin prescriptions for patients with type 2 diabetes: prevalence and practice variation in a retrospective cohort study. British Journal of General Practice: 2022, 72(719), p. e430 - e436
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Background
Little is known about the prescription of expensive non-recommended newer long-acting insulins (glargine 300 U/ml and degludec) for type 2 diabetes mellitus (T2DM) patients.

Aim
To identify practice variation in and practice and patient-related characteristics associated with the prescription of newer long-acting insulins to T2DM patients in primary care.

Design and Setting
Retrospective cohort study in Dutch general practices (Nivel Primary Care Database). Method The first prescription for intermediate or long-acting insulins in 2018 was identified for patients aged ≥40 using other T2DM drugs. Per practice, the median percentage and interquartile range (IQR) of patients with newer insulin prescriptions were calculated. Multilevel logistic regression models were constructed to calculate intraclass correlation coefficients (ICC) and quantify the association of patient and practice characteristics with prescriptions for newer insulins (odds ratio’s (OR) and 95% confidence intervals (CI)).

Results
7,757 patients with prescriptions for intermediate or long-acting insulins from 282 general practices were identified. A median percentage of 21.2% (IQR=12.5-36.4%) of all patients prescribed intermediate or long-acting insulins per practice received a prescription for newer insulins. After multilevel modelling, the ICC decreased from 20% to 19%. Female sex (OR=0.77;95%CI=0.69–0.87), age ≥86 years compared to 40-55 years (OR=0.22;95%CI=0.15-0.34), prescriptions for metformin (OR=0.66;95%CI=0.53-0.82), sulphonylurea (OR=0.58;95%CI=0.51-0.66) or other newer T2DM drugs (OR=3.10;95%CI=2.63-3.66) and dispensing practices (OR=1.78;95%CI=1.03-3.10) were associated with the prescription of newer insulins.

Conclusion
The interpractice variation in the prescription of newer insulins is large and could only be partially explained by patient and practice related differences. This indicates substantial opportunities for improvement.