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. 2013 Oct 3:5:497-505.
doi: 10.2147/CEOR.S49279. eCollection 2013.

Real-world outcomes of initiating insulin glargine-based treatment versus premixed analog insulins among US patients with type 2 diabetes failing oral antidiabetic drugs

Onur Baser  1 , Krishna Tangirala, Wenhui Wei, Lin Xie
Affiliations

Real-world outcomes of initiating insulin glargine-based treatment versus premixed analog insulins among US patients with type 2 diabetes failing oral antidiabetic drugs

Onur Baser et al. Clinicoecon Outcomes Res. .

Abstract

Background: In patients with type 2 diabetes mellitus, basal-bolus strategies can improve treatment by offering dosing flexibility, and improved satisfaction, adherence, and clinical outcomes. The purpose of this study was to compare real-world outcomes between US patients initiating analog insulin therapy with insulin glargine and those initiating with a premixed analog insulin (PMX).

Methods: This was a retrospective study of data from patients (≥18 years) with type 2 diabetes mellitus in the IMPACT® database who initiated insulin treatment with insulin glargine (GLA) or a PMX. Clinical and economic outcomes were measured over one year, including persistence and adherence, consumption of insulin, glycemic outcomes, incident hypoglycemia, and health care resource utilization and cost.

Results: Data from 2,502 patients were included in the analyses (n = 834 for PMX, n = 1,668 for GLA). Compared with PMX, persistence was higher and consumption of insulin was lower for GLA (both P < 0.0001). Adherence, glycemic outcomes, and hypoglycemia-related events were similar between groups, as were health care utilization and total health care costs. Diabetes-related drug and supply costs were lower for GLA than for PMX (P < 0.0001 and P = 0.046, respectively).

Conclusion: In US patients with type 2 diabetes mellitus, initiating insulin with once-daily GLA, rather than a PMX, is associated with increased treatment persistence and similar clinical and hypoglycemic outcomes, but lower diabetes pharmacy and supply costs. GLA may be a more flexible option than PMX. However, these results also show suboptimal glycemic control in the real-world setting despite change in treatment regimens and call for optimization in management of patients with type 2 diabetes mellitus.

Keywords: clinical outcomes; insulin glargine; premixed insulin; rapid acting insulin; treatment persistence; type 2 diabetes mellitus.

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Figures

Figure 1
Figure 1
Treatment persistence (A) and adherence (B) in the PMX and GLA cohorts. Abbreviations: GLA, insulin glargine; PMX, premixed analog insulin; MPR, medication possession ratio.
Figure 2
Figure 2
Kaplan–Meier curves for the time to adding RAI (A) and for time to treatment discontinuation (B). Abbreviations: GLA, insulin glargine; RAI, rapid-acting insulin; PMX, premixed analog insulin.
Figure 3
Figure 3
A1c reduction (A) and DACON (B) at the end of one-year follow-up. Abbreviations: A1c, glycated hemoglobin; DACON, daily average consumption; GLA, insulin glargine; PMX, premixed analog insulin.
Figure 4
Figure 4
Hypoglycemia incidence (A) and prevalence (B) at the end of one-year follow-up. Abbreviations: ER, emergency room; GLA, insulin glargine; PMX, premixed analog insulin.
Figure 5
Figure 5
Health care cost outcomes at one-year follow-up. Abbreviations: ER, emergency room; GLA, insulin glargine; PMX, premixed analog insulin.
See this image and copyright information in PMC

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