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

Wei, Wenhui; Zhou, Steve; Miao, Raymond; Pan, Chunshen; Xie, Lin; Başer, Onur; Gill, Jasvinder

doi:10.1007/s12325-014-0120-1

Cited by 20 publications

(34 citation statements)

References 28 publications

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“…We found a pooled RR for severe hypoglycaemia of 0.80 (95% CI 0.51‐1.3; I 2 = 0%) . Six of eight observational studies (N = 178 252) found no significant difference in the incidence of severe hypoglycaemia, although the studies reported the frequency in varying ways that could not be pooled . For nocturnal hypoglycaemia, we found a pooled RR of 0.97 (95% CI 0.86‐1.1; I 2 = 22.6%).…”

Section: Resultsmentioning

confidence: 77%

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Comparative effectiveness and harms of long‐acting insulins for type 1 and type 2 diabetes: A systematic review and meta‐analysis

Holmes

Crabtree

McDonagh

2019

Diabetes Obesity Metabolism

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Aim: To review evidence comparing benefits and harms of long-acting insulins in patients with type 1 and 2 diabetes.Methods: MEDLINE and two Cochrane databases were searched during February 2018. Two authors selected studies meeting inclusion criteria and assessed their quality. Comparative studies of adult or paediatric patients with diabetes treated with insulin degludec, detemir or glargine were included. Meta-analysis was used to combine results of similar studies, and the I 2 statistic calculated to assess statistical heterogeneity.Results: Of 2534 citations reviewed, 70 studies met the inclusion criteria. No statistically significant differences in HbA1c were seen between any two insulins or formulations. Hypoglycaemia was less probable with degludec than with glargine, including nocturnal hypoglycaemia in type 1 (rate ratio 0.68, 95% CI 0.56-0.81) and type 2 diabetes (rate ratio 0.73, 95% CI 0.65-0.82), and severe hypoglycaemia in type 2 diabetes (relative risk 0.72, 95% CI 0.54-0.96). Patients with type 2 diabetes had higher rates of withdrawal because of adverse events when treated with detemir compared with glargine (relative risk 2.1, 95% CI 1.4-3.3). Adults taking detemir gained about 1 kg less body weight than those taking degludec (type 1) or glargine (type 2).Conclusions: No differences in glycaemic control were seen between insulin degludec, detemir and glargine. Hypoglycaemia was less probable with degludec than glargine, and patients taking detemir gained less body weight than those given degludec or glargine. In type 2 diabetes, withdrawals as a result of adverse events were more probable with detemir than glargine. K E Y W O R D Sbasal insulin, glycaemic control, hypoglycaemia, systematic review, type 1 diabetes, type 2 diabetes

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Section: Resultsmentioning

confidence: 77%

“…The total number of patients in the remaining fair‐quality trials was 2762, with 12‐52 weeks of treatment. We included 12 observational studies (eight with hypoglycaemia outcomes and four with cancer outcomes), of which one was poor quality …”

Section: Resultsmentioning

confidence: 99%

Comparative effectiveness and harms of long‐acting insulins for type 1 and type 2 diabetes: A systematic review and meta‐analysis

Holmes

Crabtree

McDonagh

2019

Diabetes Obesity Metabolism

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“…As well as accidents and physical injury, the sequelae of hypoglycemia involve neurologic and cardiovascular complications discussed above [39]. Although reported rates of hypoglycemia in clinical trials vary considerably because of differences in study design, definitions used, and population included (among other factors) [40], a recent nonrandomized retrospective study using real-world outcomes from patients treated with Gla-100 or IDet in the United States suggested a rate of hypoglycemia of ~8% [41]. Treatment regimen and a history of hypoglycemia are the most important predictors of future hypoglycemic events, but renal insufficiency, older age, and history of hypoglycemiaassociated autonomic failure are also important risk factors [42].…”

Section: Hypoglycemia In T2dmmentioning

confidence: 99%

Hypoglycemia with New Generation Basal Analog Insulins: A Descriptive Critical Review

Thrasher¹

2015

J Diabetes Metab

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Optimizing the treatment of people with diabetes relies on balancing the benefits of glycemic control with the risk of hypoglycemia. Although insulin is essential for treating patients with type 1 diabetes mellitus, patient and physician concerns regarding an increased risk of hypoglycemia can lead to delays in initiating insulin treatment in patients with type 2 diabetes mellitus. This clinical inertia contributes to reduced glycemic control and poorer outcomes for patients. Advances in insulin agents have reduced the risk of hypoglycemia. In particular, the introduction of insulin glargine, the first basal analog insulin with a 24-hour glucose-lowering profile with no pronounced peak, represented a significant step towards achieving this goal.To further improve patient management, a number of insulin formulations and molecules are in development and are designed to have pharmacokinetic/pharmacodynamic (PK/PD) profiles allowing closer mimicking of normal physiologic insulin release. Here we review these new agents, and discuss their hypoglycemic risk as reported in clinical trials. In addition, the difficulties in making comparative evaluations from studies with different patient populations and definitions of hypoglycemia are discussed. Solutions to improve future clinical trials are suggested. In general, the improved PK/PD profiles of new-generation insulins appear to result in better clinical outcomes in terms of hypoglycemia. What is needed are head-to-head trials using standardized methods and criteria to allow clinicians to compare hypoglycemia rates between insulins, and help them to discuss appropriate choices of therapy with their patients.

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“…In a US study, significantly higher diabetes drug and diabetes supply costs were found in patients who switched from insulin glargine to insulin detemir compared to those who continued on insulin glargine. 3 In another US study, the total overall health care costs were similar for insulin glargine and NPH insulin patients, as were the total diabetes-related health care costs. 4 In German studies, lower treatment costs were found under insulin glargine compared to insulin detemir 7 and human insulin 8 based on longer persistence.…”

mentioning

confidence: 94%

Early Discontinuation and Related Treatment Costs After Initiation of Basal Insulin in Type 2 Diabetes Patients

Anderten

Dippel

Kostev³

2015

J Diabetes Sci Technol

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Aims:The aim was to compare early discontinuation and related treatment costs in type 2 diabetes in primary care after initiation of insulin glargine or human basal insulin (NPH). Methods: Overall, 2765 glargine and 1554 NPH patients from 1072 general practices were analyzed (Disease Analyser). Early discontinuation was defined as switching to a different basal insulin or another insulin treatment regimen within 90 days after first basal insulin prescription (index date, ID). Treatment costs were assessed 365 days prior and post ID in both groups. Propensity score matching and linear regression was used to adjust cost differences (post vs prior ID: discontinued vs continued patients) for age, sex, diabetes duration, antidiabetic comedication, diabetologist care, disease management program participation, costs before ID, and Charlson Comorbidity Index. Results: Within 3 months after ID, 13% of glargine patients switched to other insulin treatment regimens (NPH: 18%; P < .05). After propensity score matching, adjusted cost differences in 146 discontinued versus 1342 continued glargine patients were calculated (NPH: 146 vs 1342). Diabetes-related prescription costs were lower among persistent glargine patients compared to persistent NPH patients ; P = .0109). Mean cost difference for diabetes-related prescriptions was lower among those who persisted on glargine compared to those who switched to other treatment regimens , P = .0780). Conclusions: Treatment persistence within 3 months after basal insulin initiation was significantly higher under insulin glargine compared to NPH. Diabetes-related prescription costs were significantly lower among patients who adhered to insulin glargine compared to persistent NPH patients.

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

Cited by 20 publications

References 28 publications

Comparative effectiveness and harms of long‐acting insulins for type 1 and type 2 diabetes: A systematic review and meta‐analysis

Comparative effectiveness and harms of long‐acting insulins for type 1 and type 2 diabetes: A systematic review and meta‐analysis

Hypoglycemia with New Generation Basal Analog Insulins: A Descriptive Critical Review

Early Discontinuation and Related Treatment Costs After Initiation of Basal Insulin in Type 2 Diabetes Patients

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