Insulin analogues dosing and costs - comparing real-life daily doses of insulin detemir and insulin glargine in type 2 diabetes patients

Abstract

BackgroundThe uncertainties regarding dose similarities between basal long-acting insulin analogues remain. Recent real-world studies indicate dose similarities between insulin detemir and insulin glargine, but further studies are still warranted.The aim of this study was to compare real-life daily doses of insulin detemir and insulin glargine in type 2 diabetes patients when administered once daily.MethodsWe analysed 536 patient cases from general practice (63%) and endocrinological outpatient clinics (37%). A self-administered questionnaire completed by the treating physician was used to obtain data on patient characteristics (gender, age, weight, height, latest HbA1c-value), daily doses, administration of and number of years treated with insulin detemir and insulin glargine, concomitant insulin use and use of non-insulin anti-diabetic medication. Both bivariate analyses and multivariate regression analyses were applied to examine whether there were differences in the daily doses of insulin detemir and insulin glargine.ResultsThere was no significant difference in the mean daily doses of insulin detemir (0.414 U/kg) and insulin glargine (0.416 U/kg) (p = 0.4341). In multivariate regression analyses, age and BMI had a significant influence on daily insulin dose with the dose increasing 0.003 U/kg (p = 0.0375) and 0.008 U/kg (p = 0.0003) with every 1 increment in age and BMI, respectively.ConclusionsDose similarities between insulin detemir and insulin glargine were seen in type 2 diabetes patients when administered once daily. Thus, the use of insulin detemir and insulin glargine is not associated with different medical costs if the price and treating algorithm are similar.

Changes in HbA1c, insulin dose and incidence of hypoglycemia in patients with type 1 diabetes after switching to insulin degludec in an outpatient setting: an observational study

“…However, a comparison of once-daily dosing of both basal insulins in type 2 diabetes suggested that a higher dose requirement for insulin detemir was required versus insulin glargine 13 . While yet other studies have demonstrated that dosing for insulin detemir and insulin glargine is similar once settings and dosing frequency are taken into account [14][15][16] , our observations are nevertheless consistent with the notions of both twice-daily administration increasing the basal insulin dose requirement, and of insulin detemir having a lower unit potency.…”

Comparing Dosing of Basal Insulin Analogues Detemir and Glargine

“…Other observational studies have used "real-life" comparisons in which data were obtained through provider questionnaires. [21][22][23] Often providers were not selected at random and may have possessed bias toward either basal insulin. 21 With respect to dosing equivalency, results of these studies should be interpreted with caution given the subjective nature of data collection and relatively uncontrolled environment of these studies.…”

Lower risk of hypoglycaemia and greater odds for weight loss with initiation of insulin detemir compared with insulin glargine in Turkish patients with type 2 diabetes mellitus: local results of a multinational observational study

“…Basal insulin formulations have been continuously improved over the years and have become widely used as they have many pharmacodynamic and pharmacokinetic advantages over neutral protamine Hagedorn (NPH) insulin including a longer duration of action, reduced variable absorption profiles and a reduced marked peak effect [ 3 ]. Insulin detemir and insulin glargine are widely used as add-on therapies for patients not responding to oral anti-diabetic drug (OAD) regimens, but there are few studies directly comparing the two insulin analogues in routine care [ 4 - 6 ].…”