Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: a comparative retrospective database study

Abstract

ObjectivesTo compare real-world outcomes of initiating insulin glargine (GLA) versus neutral protamine Hagedorn (NPH) insulin among employees with type 2 diabetes mellitus (T2DM) who had both employer-sponsored health insurance and short-tem-disability coverages.DesignRetrospective cohort study.SettingMarketScan Commercial Claims and Encounters/Health and Productivity Management Databases 2003–2009.ParticipantsAdult employees with T2DM who were previously treated with oral antidiabetic drugs and/or glucagon-like-peptide 1 receptor agonists and initiated GLA or NPH were included if they were continuously enrolled in healthcare and short-term-disability coverages for 3 months before (baseline) and 1 year after (follow-up) initiation. Treatment selection bias was addressed by 2:1 propensity score matching. Sensitivity analyses were conducted using different matching ratios.Primary and secondary outcome measuresOutcomes during 1-year follow-up were measured and compared: insulin treatment persistence and adherence; hypoglycaemia rates and daily average consumption of insulin; total and diabetes-specific healthcare resource utilisation and costs and loss in productivity, as measured by short-term disability, and the associated costs.ResultsA total of 534 patients were matched and analysed (GLA: 356; NPH 178) with no significant differences in baseline characteristics. GLA patients were more persistent and adherent (both p<0.05), had lower rates of hospitalisation (23% vs 31.4%; p=0.036) and endocrinologist visits (19.1% vs 26.9%; p=0.038), similar hypoglycaemia rates (both 4.4%; p=1.0), higher diabetes drug costs ($2031 vs $1522; p<0.001), but similar total healthcare costs ($14 550 vs $16 093; p=0.448) and total diabetes-related healthcare costs ($4686 vs $5604; p=0.416). Short-term disability days and costs were numerically lower in the GLA cohort (16.0 vs 24.5 days; p=0.086 and $2824 vs $4363; p=0.081, respectively). Sensitivity analyses yielded similar findings.ConclusionsInsulin GLA results in better persistence and adherence, compared with NPH insulin, with no overall cost disadvantages. Better persistence and adherence may lead to long-term health benefits for employees with T2DM.

Basal insulin persistence, associated factors, and outcomes after treatment initiation among people with type 2 diabetes mellitus in the US

“…For example, in a study of a large commercially insured insulin-na€ ıve population in the US, Ascher-Svanum et al found that only 18% of the people with T2DM who initiated insulin continued treatment in the year after initiation without any interruption or discontinuation 10 . With regards to basal insulin in particular, studies have found that approximately 55-80% of people with T2DM (identified from large commercial insurance databases) who were prescribed insulin glargine remained treatment persistent within the year after initiation [11][12][13][14] . In a separate study evaluating persistence with injectable antihyperglycemic medications among a managed care population, Cooke et al reported that 29% of patients initiating basal insulin or exenatide were persistent at 12 months after initiation 15 .…”

Place of insulin therapy in current approaches to the treatment of type 2 diabetes

“…Несмотря на то что человеческий НПХ-инсулин по-прежнему остается эффективным и востребованным базальным инсулином, аналоги длительного действия, первым из которых стал гларгин, быстро заняли свою нишу в лечении диабета как препараты с меньшей крат-ностью введения и более низким риском развития гипо-гликемии [19,20].…”

“…Важным результатом яви-лось то, что нормализация уровня ГПН при терапии глар-гином никак не отразилась на исходах ССЗ у участников с ранними стадиями дисгликемии в течение всего периода Одной из простых, но достаточно эффективных схем для старта является применение готовых смесей инсулина в режиме от одной до трех инъекций в сутки исследования и не сопровождалась увеличением общей смертности. Кроме того, было показано, что применение гларгина позволило замедлить прогрессирование заболе-вания от стадии предиабета к явному СД2 на 28% [20].…”

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

“…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. A database study from the US indicated that early discontinuation of insulin (basal or premixed insulin) in type 2 diabetes was related to approximately 10% higher acute health care costs compared to patients who did continue their insulin therapy.…”

“…2 Few studies have examined the persistence of type 2 diabetes patients on BOT in a real -world setting. [3][4][5][6][7] There is evidence from German studies that BOT initiation with insulin glargine may be associated with a higher persistence compared to initiation with NPH insulin. [5][6] Little information is available about the impact of basal insulin changes on associated health care costs in real-world primary care settings.…”