Prevalence and Patient-Specific Factors Associated with Insulin Over-Basalization within Advanced Primary Care Clinics
Document Type
Conference Proceeding - Restricted Access
Publication Date
5-8-2026
Abstract
Less than 30% of patients with type 2 diabetes mellitus (T2DM) on basal insulin achieve a hemoglobin A1c (A1c) less than 7.0%. One contributing factor is insulin over-basalization (OB), defined as continued titration of basal insulin despite achieving fasting plasma glucose (FPG) targets. OB may increase the risk of hypoglycemia and offer minimal improvement in overall glycemic control. The 2025 American Diabetes Association (ADA) Standards of Care no longer recommend using basal insulin doses greater than 0.5 units/kg/day to identify OB. There are currently no published studies on insulin OB using the updated ADA definition. This study aims to evaluate the prevalence of insulin OB using updated clinical criteria and identify associated patient-specific factors to inform practice changes that may improve diabetes outcomes.
This was a single-center, retrospective chart review that assessed patients with T2DM on basal insulin who received care at Corewell Health Advanced Primary Care Clinics between August 1, 2024, and July 31, 2025. This study compared patients who were OB to those who were not OB. OB was defined as an A1c greater than 7.0% with a lab-drawn glucose less than 130 mg/dL. Lab-drawn glucose within 30 days of A1c was used instead of FPG due to lack of available FPG data. Data collection included glycemic metrics, type of basal insulin, insulin dose, duration of insulin use, concurrent diabetes medication classes, total number of medications, whether diabetes was pharmacist-managed, adverse events, and patient comorbidities. Statistical analyses included Fisher's Exacts tests for categorical data, T-tests for normally distributed numeric data, and Wilcoxon Rank Sum tests for abnormally distributed data.
Results will be reviewed to identify opportunities for intervention, with recommendations provided to Corewell Health Advanced Primary Care Clinics.
Recommended Citation
Beck S, Marciniak K, Dudick B, Feucht C, Inteso C. Prevalence and patient-specific factors associated with insulin over-basalization within advanced primary care clinics. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.
Comments
2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1936