Abstract
Objective:
To evaluate outcomes in insulin-naive patients with type 2 diabetes mellitus (T2DM) who initiated insulin glargine or insulin detemir.
Methods:
Retrospective data were analyzed from the US General Electric Centricity electronic medical records (EMR) database from patients (≥18 years old) with T2DM initiating insulin glargine or detemir between January 1, 2006, and December 31, 2010. Included patients had EMR data for ≥6 months prior to (baseline) and ≥12 months after (follow-up) the index date (date of first insulin prescription), and at least one OAD and/or GLP-1 receptor agonist prescription order during baseline, but no previous insulin prescription. Patients were matched on baseline characteristics 5:1, insulin glargine to detemir, to ameliorate selection bias. Outcomes assessed were persistence with insulin therapy, glycemic control, hypoglycemia, body weight, and body mass index over follow-up.
Results:
Insulin glargine and detemir groups were similar in terms of gender (51.0% and 51.5% female, P = 0.7356), age (57.8 and 57.4 years, P = 0.3368), A1C (9.4% and 9.4%, P = 0.6642), and body weight (101.9 kg and 102.4 kg, P = 0.4920) at baseline. During follow-up, patients initiating insulin glargine were more persistent (80.1% vs 67.8%, P < 0.0001) and had a greater change in A1C (−1.11% vs −0.96%, P = 0.0479). Percentage change in weight (0.91% and 0.65%, P = 0.2734) and hypoglycemia prevalence (3.6% vs 4.1%, P = 0.4338) were similar between groups.
Conclusions:
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.
Transparency
Declaration of funding
This study was funded by Sanofi US Inc.
Author contributions: K.L.D., W.W. and M.T. were involved in concept and study design, review of data, drafting and review of manuscript. K.L.D. and J.L.M. were involved in analysis of data, drafting and review of manuscript.
Declaration of financial/other relationships
K.L.D. and J.L.M. are employees of RTI Health solutions, contracted on behalf of Sanofi US Inc. W.W. and M.T. are employees of Sanofi US Inc.
CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.
Acknowledgments
The authors received writing/editorial support in the preparation of this manuscript provided by Ewen Legg PhD of Excerpta Medica, funded by Sanofi US Inc.
This data has previously been published as an abstract and presented as a poster at the 48th Annual Meeting of the European Association for the Study of Diabetes 2012.