1106-P: Predictors of Insulin Total Daily Dose (TDD) in U.S. Adults with Type 2 Diabetes on Multiple Daily Injections (MDI)—Retrospective Observational Study
Authors: SHAH VIRAL N. , WRIGHT EUGENE E. , THACH ANDREW V. , MILLER EDEN , JAVADI PASHA , DAVIES SHAWN , BAUER ELISE , SIERADZAN RAY 
Published: June 2024

Introduction & Objective: Factors affecting insulin dose for adults with T2D on MDI are less known. This retrospective observational study evaluated potential factors impacting TDD.
Methods: US adults (≥18 years old) with T2D using MDI (defined as basal and prandial insulin, ≥3 daily injections) were included from the IQVIA ambulatory electronic medical record dataset (01/2017 - 07/2022). The TDD was calculated at first evidence of MDI (index). We used a generalized linear model regression analysis with log link functions to model the relationship between TDD and clinically relevant factors affecting TDD.
Results: Analyses included 41,215 adults with T2D (52% female; 62% Caucasian,14% African-American; mean [±SD] age 58±13 yr, mean BMI 34±7 kg/m2). Mean TDD was 96±58 U; and 23% of adults were using TDD &lt;50 U/day; 41%, 50-100 U/day; 21%, 100-150 U/day; and 15% &gt;150 U/day. Significant predictors of lower TDD were female sex (vs males; incident rate ratio (IRR)=0.93, p&lt;0.001; interpreted as 7% lower on average), African-American race (vs white; IRR=0.85, p&lt;0.001), US Census Regions other than the South (vs South; IRR=0.81-0.92, p&lt;0.001), utilization of sulfonylureas or metformin in 6-month pre-index period (IRR=0.94-0.95, p&lt;0.01), and utilization of 2-3 additional diabetes medications (regardless of class) in pre-index period (vs MDI only; IRR=0.80-0.92, p&lt;0.05). Predictors of greater TDD included age 30-64 yr (vs ≥65 years; IRR=1.07-1.12, p&lt;0.001; interpreted as 7-12% greater on average), increased BMI (IRR=1.03, p&lt;0.001; 3% for each unit increase in BMI, p&lt;0.001) and utilization of GLP1 or SGLT2 in 6-month pre-index period (IRR=1.08-1.12, p&lt;0.001).
Conclusions: Among adults with T2D receiving MDI, the mean TDD was 96±58 U. Significant predictors of TDD included both demographic and clinical characteristics (e.g., race, sex, BMI) and utilization of other diabetes medications.

Disclosure
V.N. Shah: Consultant; Dexcom, Inc., Insulet Corporation. Research Support; Insulet Corporation. Advisory Panel; Novo Nordisk. Research Support; Novo Nordisk. Advisory Panel; Sanofi, Medscape. Consultant; embecta, Tandem Diabetes Care, Inc. E.E. Wright: Advisory Panel; Abbott. Consultant; Abbott. Speaker's Bureau; Abbott. Consultant; Abbott Diagnostics. Advisory Panel; ADA/ACC Diabetes by Heart Program, Bayer Inc. Consultant; Bayer Inc. Speaker's Bureau; Bayer Inc. Advisory Panel; Boehringer-Ingelheim. Consultant; Boehringer-Ingelheim. Speaker's Bureau; Boehringer-Ingelheim. Advisory Panel; Lilly Diabetes. Consultant; Lilly Diabetes. Speaker's Bureau; Lilly Diabetes. Advisory Panel; embecta. Consultant; embecta, GlaxoSmithKline plc. Speaker's Bureau; GlaxoSmithKline plc. Advisory Panel; Medtronic, Renalytix. Consultant; Renalytix. Speaker's Bureau; Renalytix. Advisory Panel; Sanofi. Speaker's Bureau; Sanofi. Advisory Panel; Stability Health. Consultant; Up-To-Date. A.V. Thach: Employee; embecta. Research Support; dQ&A. Employee; AbbVie Inc., Sunovion Pharmaceuticals Inc. E. Miller: Advisory Panel; Abbott, American Diabetes Association. Speaker's Bureau; Boehringer-Ingelheim, Bayer Inc., Eli Lilly and Company. Advisory Panel; embecta, Insulet Corporation, LifeScan Diabetes Institute, Novo Nordisk, Sanofi-Aventis U.S. P. Javadi: Employee; embecta, Insulet Corporation. S. Davies: None. E. Bauer: None. R. Sieradzan: Employee; embecta. Stock/Shareholder; embecta.

Funding
Research study funded by embecta