Clinical characteristics and patient treatment satisfaction with Humalog U-200 in patients with type 2 diabetes mellitus: an observational study.

Background: There are limited data on the real-world evidence of Humalog 200 units/ml KwikPen (U-200) insulin. We assessed the use of U-200 insulin in UK routine clinical practice to provide information on clinical characteristics, treatment satisfaction and short-term clinical outcomes. Methods: Nine patients with type 2 diabetes who initiated U-200 in secondary care and a further 12 identified from primary care electronic database were enrolled. A treatment satisfaction questionnaire was administered to the 19 secondary care patients. Follow-up data on clinical parameters were collected at 3 and 6 months following initial U-200 insulin administration and the data were used to assess changes in clinical outcomes from baseline. Results: Secondary care patients had a mean age 60 ± 11 years, mean HbA1c of 8.6% ± 1.3% and a mean BMI of 39.7 ± 5.3 kg/m2 at baseline. Primary care database patients had a mean age 57 ± 13 years, mean HbA1c 10.3% ± 1.7 and a mean BMI 42.3 ± 3.8 kg/m2. The nine participants' responses to the questionnaire suggested a high preference for U-200 over a previous mealtime insulin pen (PMIP). On average, the patients agreed that U-200 was quicker to inject, had a better controlled home blood glucose reading and less discomfort at the injection site compared to a PMIP. Patients were willing to continue with their U-200 treatment. No significant HbA1c reduction was observed at 3 months in the secondary care group (-0.5%), but marked significant reduction in HbA1c was seen at 3 months in the primary care dataset to (-2.8%; p < .0004). There was also some suggestion of weight loss in both the secondary and primary care groups. Conclusion: Humalog U-200 insulin users were comprised mainly of older patients with diabetes complications and high HbA1c levels at the time of U-200 initiation. Overall, U-200 improved patients' satisfaction with diabetes treatment and short-term metabolic outcomes.