Comparison of daily insulin dose and other antidiabetic medications usage for type 2 diabetes patients treated with an analog basal insulin

Abstract

Objective:

Few comparisons of real-world insulin detemir (DET) and insulin glargine (GLAR) utilization have been conducted, which would assist payers and other healthcare decision makers assess the cost effectiveness of these treatment alternatives. The aim of this study was to compare the amount of insulin utilized in a large cohort of patients with type 2 diabetes treated with either DET or GLAR in the real-world setting considering the use of other antidiabetic agents.

Research design and methods:

A nested case–control study was conducted using data from a large US medical and pharmacy claims data warehouse. Adults with type 2 diabetes newly treated with DET or GLAR were included. From this overall cohort, a subset of DET patients were matched 1:1 to GLAR on age, baseline antidiabetic use, and comorbidities. Descriptive statistics were used to compare patient characteristics between treatment groups; a Wilcoxon rank sum test was used to compare insulin utilization in terms of the patient level daily average consumption (DACON).

Main outcomes measures:

Mean DACON by analog basal insulin.

Results:

This study included 18,763 patients; 2215 (11.8%) were treated with DET and 16,548 (88.2%) with GLAR. DET patients were slightly younger (59.6 vs. 60.3 years; p ≤ 0.01); gender did not differ (46% female). From the overall cohort, 1581 DET patients were matched to 1581 GLAR patients. Mean (median) DACON did not differ overall (35 [26] units for DET vs. 32 [27] units for GLAR; p = 0.06) or in the matched cohort (35 [26] units for DET vs. 32 [27] units for GLAR; p = 0.146). In the matched cohort, there were no differences in non-insulin antidiabetic use after DET or GLAR was started.

Conclusions:

In a real-world setting, insulin utilization did not differ between DET and GLAR controlling for patient characteristics and considering concomitant antidiabetic treatments, which could influence insulin use. A limitation is that the dispensing data as used in this study may not accurately reflect daily insulin dose because patients may discard unused insulin portions when the vial or pre-filled syringe reaches its in-use expiration date. Additional research is warranted to determine if there are differences in DET and GLAR utilization over time.

Key words::

• Hypoglycemic agents
• Insulin detemir, Insulin glargine
• Type 2 diabetes mellitus

Transparency

Declaration of funding

Funding for this study was provided by Novo Nordisk, Inc., a manufacturer of insulins, including insulin detemir.

Declaration of financial/other relationships

Authors J.B. and M.A. are employees of Novo Nordisk, Inc. C.M.M. reports having served on a Novo Nordisk advisory board.

Acknowledgements

Parts of this manuscript were presented at the 14th Annual International Meeting International Society of Pharmacoeconomics and Outcomes Research (ISPOR), May 19, 2009, Orlando, FL and the International Diabetes Federation 20th World Diabetes Congress, October 21–22, 2009, Montreal, Canada.