Analysis of glycaemic control and weight change in patients initiated with human or analog insulin in an US ambulatory care setting

McAdam‐Marx, Carrie; Bouchard, Jonathan; Aagren, Mark; Nelson, Rebecca; Brixner, Diana I.

doi:10.1111/j.1463-1326.2009.01128.x

Cited by 10 publications

(9 citation statements)

References 27 publications

(25 reference statements)

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“…In contrast, a study of 306 patients enrolled in a large United States (US) managed care organization found that glycemic control after 180 days was similar for insulin glargine and insulin detemir [9]. In addition, McAdam-Marx et al reported that patients with T2DM initiating insulin detemir were 30% less likely to gain 0.9 kg or more in body weight, with no significant difference in HbA 1c values, compared with insulin glargine [10]. …”

Section: Introductionmentioning

confidence: 99%

Much Ado About Nothing? A Real-World Study of Patients with Type 2 Diabetes Switching Basal Insulin Analogs

et al. 2014

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IntroductionType-2 diabetes mellitus (T2DM) is a progressive disease, and many patients eventually require insulin therapy. This study examined real-world outcomes of switching basal insulin analogs among patients with T2DM.MethodsUsing two large United States administrative claims databases (IMPACT® and Humana®), this longitudinal retrospective study examined two cohorts of adult patients with T2DM. Previously on insulin glargine, Cohort 1 either continued insulin glargine (GLA-C) or switched to insulin detemir (DET-S), while Cohort 2 was previously on insulin detemir, and either continued insulin detemir (DET-C) or switched to insulin glargine (GLA-S). One-year follow-up treatment persistence and adherence, glycated hemoglobin (HbA1c), hypoglycemia events, healthcare utilization and costs were assessed. Selection bias was minimized by propensity score matching between treatment groups within each cohort.ResultsA total of 5,921 patients (mean age 60 years, female 50.0%, HbA1c 8.6%) were included in the analysis (Cohort 1: IMPACT®: n = 536 DET-S matched to n = 2,668 GLA-C; Humana®: n = 256 DET-S matched to n = 1,262 GLA-C; Cohort 2: n = 419 GLA-S matched to n = 780 DET-C), with similar baseline characteristics between treatment groups in each cohort. During 1-year follow-up, in Cohort 1, DET-S patients, when compared with GLA-C patients, had lower treatment persistence/adherence with 33–40% restarting insulin glargine, higher rapid-acting insulin use, worse HbA1c outcomes, significantly higher diabetes drug costs, and similar hypoglycemia rates, health care utilization and total costs. However, in Cohort 2 overall opposite outcomes were observed and only 19.8% GLA-S patients restarted insulin detemir.ConclusionsThis study showed contrasting clinical and economic outcomes when patients with T2DM switched basal insulin analogs, with worse outcomes observed for patients switching from insulin glargine to insulin detemir and improved outcomes when switching from insulin detemir to insulin glargine. Further investigation into the therapeutic interchangeability of insulin glargine and insulin detemir in the real-world setting is needed.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0120-1) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Much Ado About Nothing? A Real-World Study of Patients with Type 2 Diabetes Switching Basal Insulin Analogs

et al. 2014

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“…The main message of this study is that the patient’s glucose profile predicts risk of weight gain, which is a known problem in starting insulin treatment in type 2 diabetes patients [17, 18]. This profile can be easily calculated from the fasting glucose/HbA1c ratio.…”

Section: Discussionmentioning

confidence: 99%

Starting bedtime glargine versus NPH insulin in poorly controlled type 2 diabetic patients with various hyperglycemia types (fasting type or postprandial type)

2013

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Our aim was to compare the effects of an intermediate acting human insulin (NPH) and a long-acting insulin analog, insulin glargine, in insulin naïve type 2 diabetes patients, stratified by the type of hyperglycemia (fasting or postprandial type). Based on different action profiles, we hypothesized that patients having different hyperglycemia types would react differently when treated with these insulins. This is a post hoc analysis of the Lanmet study data. The Lanmet study was a randomized, 36-week controlled insulin initiation study in type 2 diabetes patients. 109 subjects with baseline HbA1c >8.0 % (64 mmol/mol) completed the study. The patients were divided into two groups according to fasting glucose (mmol/l)/HbA1c (%) ratio. Patients with a ratio ≥1.3 were defined as having fasting type and those with a ratio <1.3 as having postprandial type hyperglycemia. The main outcome measures were change in HbA1c and body weight, and final insulin dose. Independently of insulin type, compared to patients with postprandial type hyperglycemia, those with fasting type hyperglycemia had 2.1 kg/m2 greater initial BMI (p = 0.044), gained 2.0 kg more weight (p = 0.020, adjusted for baseline BMI p = 0.035), and had 36 % greater final insulin dose/kg (p = 0.001). With respect to hyperglycemia type, there was no difference between NPH and glargine in their effects on HbA1c. When starting bedtime insulin in type 2 diabetes patients, those with fasting type hyperglycemia are prone to greater weight gain. Hyperglycemia type does not help in identifying patients who would benefit specially from either NPH insulin or insulin glargine.

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“…Therapy with insulin detemir has been shown to result in less weight gain compared with insulin glargine use in both a head-to-head trial and a retrospective analysis of real-world data. 23 Insulin analog therapy is amenable to patient-driven dose adjustment, which can be advantageous for younger patients with busy lives as well as those with limited mobility and those who have difficulty obtaining transportation to their doctor. The use of a self-titration algorithm for adjusting basal insulin dosing versus standard-of-care, physician-guided dose adjustment was evaluated in the PREDICTIVE 303 (Predictable Results and Experience in Diabetes Through Intensification and Control to Target: an International Variability Evaluation) trial.…”

Section: Individualizing Glycemic Targetsmentioning

confidence: 99%

Insulin analogs for the management of type 2 diabetes

Taylor

Campbell

2013

American Journal of Health-System Pharmacy

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Analysis of glycaemic control and weight change in patients initiated with human or analog insulin in an US ambulatory care setting

Abstract: HbA1C outcomes in the ambulatory care setting were generally not different between insulin classes. The likelihood of weight gain was less with insulin detemir than with insulin glargine. Thus, real-world weight outcomes for basal analog insulin may differ by specific product.

Cited by 10 publications

References 27 publications

Much Ado About Nothing? A Real-World Study of Patients with Type 2 Diabetes Switching Basal Insulin Analogs

Much Ado About Nothing? A Real-World Study of Patients with Type 2 Diabetes Switching Basal Insulin Analogs

Starting bedtime glargine versus NPH insulin in poorly controlled type 2 diabetic patients with various hyperglycemia types (fasting type or postprandial type)

Insulin analogs for the management of type 2 diabetes

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