Clinical and economic outcomes in patients with type 2 diabetes initiating insulin glargine disposable pen versus exenatide BID

Başer, Onur; Wei, Wenhui; Baser, E.; Xie, Lin

doi:10.3111/13696998.2011.605818

Cited by 23 publications

(17 citation statements)

References 27 publications

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“…Treatment persistence was defined as patients remaining on the index insulin (insulin glargine for GLA-C and GLA-S, and insulin detemir for DET-C and DET-S) during the follow-up period without discontinuation after the index date [7, 8, 18–20]. Study medication was considered discontinued if the prescription was not refilled within the expected time of medication coverage (the 90th percentile of the time, stratified by the metric quantity supplied, between first and second fills among patients with at least one refill).…”

Section: Methodsmentioning

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: Methodsmentioning

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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“…Twenty-three prospective studies35–57 and seven retrospective studies18,58–63 compared GLP-1RAs with insulin products.…”

Section: Efficacy Of Glp-1ras Versus Other Glucose-lowering Therapiesmentioning

confidence: 99%

Glucagon-like peptide-1 receptor agonists: a systematic review of comparative effectiveness research

Levin¹,

Nguyen²,

Wittbrodt³

et al. 2017

DMSO

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BackgroundGlucagon-like peptide-1 receptor agonists (GLP-1RAs) act by increasing insulin secretion, decreasing glucagon secretion, slowing gastric emptying, and increasing satiety.ObjectivePublished evidence directly comparing GLP-1RAs with other approved treatments for type 2 diabetes (T2D) was systematically reviewed.MethodsA literature search was performed using MEDLINE and Embase databases to identify papers comparing GLP-1RAs with other classes of glucose-lowering therapy in patients with T2D.ResultsOf the 1303 papers identified, 57 met the prespecified criteria for a high-quality clinical trial or retrospective study. The efficacy and tolerability of approved GLP-1RAs (exenatide twice daily or once weekly, dulaglutide, liraglutide, lixisenatide, and albiglutide) were compared with insulin products (23 prospective studies + seven retrospective studies), dipeptidyl peptidase-4 inhibitors (11 prospective studies + three retrospective studies), sulfonylureas (nine prospective studies + one retrospective study), thiazolidinediones (five prospective studies), and metformin (two prospective studies). GLP-1RAs are effective as a second-line therapy in improving glycemic parameters in patients with T2D. Reductions in glycated hemoglobin from baseline with GLP-1RAs tended to be greater or similar compared with insulin therapy. GLP-1RAs were consistently more effective in reducing body weight than most oral glucose-lowering drugs and insulin and were associated with lower hypoglycemia risk versus insulin or sulfonylureas. GLP-1RAs improved cardiovascular risk factors, and preliminary data suggest they improve cardiovascular outcomes in patients with T2D compared with oral glucose-lowering drugs. However, results from ongoing studies are awaited to confirm these early findings.ConclusionThis systematic review found that GLP-1RAs are an effective class of glucose-lowering drugs for T2D.

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“…In fact, the 12 month persistence rates in the current study were higher than in similar previous Study medication was considered discontinued if the prescription was not refilled within the expected time of medication coverage, which was defined as the 90th, 75th or 50th percentile of the time between first and second fills among patients with at least one refill. studies based on pharmacy claims data 10,20,21 . Additionally, any difference in the proportion of pen users between groups (which is unobservable in our data) may diminish comparability.…”

Section: Study Limitationsmentioning

confidence: 99%

Real-world comparative outcomes of US type 2 diabetes patients initiating analog basal insulin therapy

Davis

Tangirala

Meyers

et al. 2013

Current Medical Research and Opinion

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Results from this real-world EMR analysis suggest that among T2DM patients, initiating insulin treatment with insulin glargine may be associated with better treatment persistence and glycemic control, with similar prevalence of hypoglycemia and weight change, compared with initiating with insulin detemir. This study is limited by the retrospective nature of the data collection using EMRs and inability to confirm accuracy and completeness of data by secondary chart review.

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Clinical and economic outcomes in patients with type 2 diabetes initiating insulin glargine disposable pen versus exenatide BID

Cited by 23 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

Glucagon-like peptide-1 receptor agonists: a systematic review of comparative effectiveness research

Real-world comparative outcomes of US type 2 diabetes patients initiating analog basal insulin therapy

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