S. Oliveria

Barriers to the initiation of, and persistence with, insulin therapy

ABSTRACT Objectives: Many patients with Type 2 diabetes mellitus (DM) delay and/or discontinue the use of insulin. This study determined patient-perceived barriers to the initiation of, and persistence with, insulin therapy. Research design and methods: Patients ≥ 18 years with Type 2 DM and ≥ 1 elevated HbA1c test result (≥ 9%) were identified from computerized laboratory test results within a single healthcare system, a study limitation. Insulin use patterns were characterized by automated pharmacy claims data, and patients were classified into those who discontinued insulin use (discontinuers) or those who did not initiate insulin use (non-initiators). Telephone interviews were conducted to determine the barriers to initiation of, and persistence with, insulin therapy. Results: Response rates were 80.0% (73/91) for discontinuers and 82.0% (129/157) for non-initiators. Pharmacy claims data indicated that discontinuers stopped filling prescriptions for insulin; 46.6% of patients self-reported discontinuing insulin. The average time between first and last prescription for insulin among discontinuers was 4.9 years (SD = 4.4). The most common reasons for discontinuation were related to insulin injection (74.0%) and a doctors advice not to use insulin (47.1%). In the non-initiator group, 86.1% were never advised by a healthcare provider to take insulin. Conclusions: These findings suggest that issues related to insulin injection are the primary reason patients with Type 2 DM discontinue insulin therapy. Understanding these patterns is important to develop interventions to overcome barriers to treatment and improve the medical outcomes of patients with Type 2 DM.

Patient perceptions of nonmelanoma skin cancer before diagnosis.

BACKGROUND There is a paucity of data regarding patient perceptions of nonmelanoma skin cancer (NMSC). OBJECTIVE To describe patients perceptions of skin lesions before a diagnosis of NMSC. METHODS This was a descriptive study in a private practice setting. Patients with a previous biopsy of NMSC who presented for treatment were eligible. A self‐administered questionnaire assessed what patient perceptions of lesions diagnosed as NMSCs had been before they were aware of the diagnosis. Medical records were reviewed for tumor type, size, and location. RESULTS One hundred sixty‐three consecutive patients undergoing treatment for NMSC completed the questionnaire. The most common initial impressions of the lesion were skin cancer (20%), acne (19%), sore (10%), unknown (9%), dry skin (7%), age spot (6%), and injury (6%). Seventy‐two percent of patients were the first to notice the lesion. Patients with a history of skin cancer were more likely to think the lesion was a skin cancer on initial impression (28% vs 8%) (p < .001). CONCLUSIONS Understanding how patients perceive their skin cancers may aid in targeting educational strategies and increase awareness of skin cancer risk. Our data suggest that there are important subtleties in self‐identification that may need to be taken into consideration in any educational campaign targeting NMSC.

Liver injury in chemotherapy (CT)-treated breast, colorectal, and lung cancer (CA) patients (Pts) using automated health data.

e13566 Background: FDA guidance (2009) recommends that drug development trials use Hys Law (a specific pattern of elevated liver enzymes seen in the absence of other known causes of liver dysfunction) as a predictor of potential drug-induced liver injury. In populations with high risk of underlying liver disorders (e.g., hepatitis or CA), modified guidelines may be needed. Published reports of liver dysfunction in CA pts based on Hys law are sparse. While liver lab tests (LLT) are generally collected in trials, other causes of liver disorders may not be systematically available. This study quantifies the incidence of potential Hys Law (PHL) cases (using LLT only) in CT-treated CA pts and excluding pts with other causes of liver dysfunction.nnnMETHODSnNewly diagnosed breast CA (BC), colorectal CA (CRC), and lung CA (LC) pts between 2000 & 2007 were identified using Henry Ford Health System tumor registry. Eligible pts received CT and had ≥1 alanine aminotransferase (ALT) or aspartate aminotransferase (AST) and total bilirubin (TBL) test results on or after CA diagnosis. A PHL case using LLT only was defined as: ALT or AST>3x upper limit of normal (ULN), TBL>2x ULN, and alkaline phosphatase (ALP)<5x ULN with ≤2 months between 1st and 2nd qualifying LLT. Preliminary analysis excluding other known causes of liver dysfunction (i.e. liver metastases or pre-existing conditions) was performed.nnnRESULTSnTable of percent of PHL cases (with and without known liver dysfunction) in CT-treated pts by CA type and stage is shown.nnnCONCLUSIONSnThe proportion of CT-treated pts meeting PHL criteria (with and without known liver dysfunction) generally increased by stage across CA types. These data provide context for evaluating liver injury in trials and post-marketing surveillance of anti-cancer therapies. [Table: see text].