Both the global incidence and prevalence of type 2 diabetes are increasing rapidly, and cases are expected to reach 329 million by 2030. The most striking increases have been in developing countries. In Saudi Arabia today, 24 % of citizens have type 2 diabetes, a 10-fold increase in prevalence since 1982. Current type 2 diabetes prevalence exceeds 8 % in Brazil, China, India, and the Russian Federation, and exceeds 12 % in Mexico, Turkey, and the United Arab Emirates. The morbidity and mortality burden as well as the economic toll associated with type 2 diabetes are substantial. Type 2 diabetes is a major risk factor for heart disease and stroke and the fifth leading cause of death worldwide. In the U.S. alone, type 2 diabetes-related health expenditures exceeded $174 billion in 2007, with 1/3 of those expenditures, $58 billion, spent on preventable complications.
Anti-hyperglycemic medications can effectively reduce blood glucose levels and prevent or forestall diabetes-related complications, yet poor disease control is common, especially when patients' progressive disease merits the addition of insulin therapy. Among the barriers to insulin initiation and glycemic control are patients' injection fears and perceived social stigma; providers' concerns about hypoglycemia, weight gain, and patients' ability to follow more complex regimens; and health system factors, such as patients' out-of-pocket costs for and access to medications. Preliminary cross-sectional evidence suggests that barriers to and facilitators for insulin intensification, e.g., adding bolus doses and/or increasing injection frequency, are distinct from those for insulin initiation. At present, there is no longitudinal evidence to identify and quantify barriers to insulin intensification. Because many patients' glycemic levels merit such intensification to achieve glycemic targets over time, these barriers must be enumerated and addressed.
The 2-year, longitudinal MOSAIc (Multinational Observational Study Assessing Insulin use: understanding the challenges associated with progression of therapy) study was designed to identify patient, physician, and health system factors that influence insulin intensification among patients with type 2 diabetes and to quantify the relationships between these factors and long-term clinical outcomes. In this paper, we describe and explore the heterogeneity of baseline demographic, clinical, and psychosocial characteristics among 4,341 MOSAIc patients enrolled in 18 different countries. These data provide a unique, holistic glimpse into the clinical and psychosocial experience of patients with type 2 diabetes worldwide, and lay the foundation for MOSAIc's longitudinal analyses.