Adherence and persistence to a regimen of basal insulin in a pre-filled pen compared to vial/syringe in insulin-naïve patients with type 2 diabetes

Abstract

Objective:

This study was conducted to compare adherence and persistence of patients initiating basal insulin therapy with Levemir FlexPen versus those initiating basal insulin therapy with NPH via vial and syringe.

Materials and methods:

Data were gathered from a large US retrospective claims database, and included patients with type 2 diabetes that initiated basal insulin therapy with either Levemir FlexPen or NPH in vials. Patients were defined as adherent to therapy if they had a medication possession ratio (MPR) of ≥80% in the 12-month follow-up period and were defined as persistent with therapy if they had no gaps in insulin therapy in the follow-up period.

Results:

After controlling for confounders using logistic regression, patients initiating therapy with Levemir FlexPen had 39% higher adjusted odds of achieving an MPR ≥80% versus patients initiating therapy with NPH vial (OR 1.39; 95% CI: 1.04–1.85). Analysis of persistence using a Cox proportional hazards model indicated that patients initiating Levemir FlexPen had a 38% lower hazard of discontinuation compared to NPH vial (HR 0.62, 95% CI: 0.55–0.70).

Limitations:

Claims-based studies are limited to the extent that they accurately capture medical and pharmacy use. Also, relying on claims-based data limits the generalizability of the findings to similar populations and treatments.

Conclusions:

These results suggest that persistence and adherence with insulin may be improved for patients initiating basal insulin therapy with Levemir FlexPen versus NPH vial.

Key words::

• Adherence
• Claims analysis
• Diabetes
• Insulin initiation
• Pen device
• Persistence

Transparency

Declaration of funding

This study was funded by Novo Nordisk Pharmaceuticals Inc.

Declaration of financial/other relationships

C.C., M.A., and J.B. are employees of Novo Nordisk Pharmaceuticals Inc.; E.B. and F.L. are employees of OptumInsight which was contracted by Novo Nordisk Pharmaceuticals Inc. to conduct this study.

Acknowledgements

We would like to thank Feng Cao of OptumInsight for his assistance in programming the analytic dataset used in this study and Shawn Barry of OptumInsight for his assistance in the writing of this manuscript.