There are several reasons why a low number of people with diabetes are achieving glycemic control. Three reasons for not achieving the glycemic goals for people on basal insulin are: 

• Fear of hypoglycemia 
• Lack of experience in self-management
• Inadequate insulin titration

Severe hypoglycemia is significantly associated with adverse clinical outcomes, including mortality. SIMILAR 2 trial observed similar glycemic control with less hypoglycemia after switching to Gla-300 vs other basal insulins in real life.