TY - JOUR
T1 - Clinical and Economic Outcomes Associated with the Timing of Initiation of Basal Insulin in Patients with Type 2 Diabetes Mellitus Previously Treated with Oral Antidiabetes Drugs
AU - Levin, Philip
AU - Zhou, Steve
AU - Durden, Emily
AU - Farr, Amanda M.
AU - Gill, Jasvinder
AU - Wei, Wenhui
N1 - Funding Information:
P. Levin reports working on the advisory panel for Sanofi US, Inc. and Novo Nordisk; working as consultant for Novo Nordisk, Eli Lilly and Company, and Sanofi US, Inc.; receiving research support from Eli Lilly and Company, Sanofi US, Inc., Novo Nordisk, Amylin Pharmaceuticals, and Boehringer Ingelheim Pharmaceuticals; and participating in speakers bureaus for Eli Lilly and Company, Novo Nordisk, Amylin Pharmaceuticals, and Boehringer Ingelheim Pharmaceuticals. S. Zhou, J. Gill, and W. Wei, are employees of Sanofi US, Inc. E. Durden and A. M. Farr are employees of Truven Health Analytics, which receives funding from Sanofi US, Inc.
Publisher Copyright:
© 2016 The Authors Published by Elsevier HS Journals, Inc.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Purpose In patients with type 2 diabetes mellitus (T2DM) not achieving glycemic targets using oral antidiabetes drugs (OADs), studies suggest that timely insulin initiation has clinical benefits. Insulin initiation at the early versus late stage of disease progression has not been explored in detail. This retrospective database analysis investigated clinical and economic outcomes associated with the timing of insulin initiation in patients with T2DM treated with ≥1 OAD in a real-world US setting. Methods This study linked data from the Truven Health MarketScan® Commercial database, Medicare Supplemental database, and Quintiles Electronic Medical Records database. A total of 1830 patients with T2DM were included. Patients were grouped according to their OAD use before basal insulin initiation (1, 2, or ≥3 OADs) as a proxy for the timing of insulin initiation. Clinical and economic outcomes were evaluated over 1 year of follow-up. Findings During follow-up the 1 OAD group, compared with the 2 and ≥3 OADs groups, had a greater reduction in glycosylated hemoglobin A1c (-1.7% vs -1.0% vs -0.9%, respectively; P < 0.0001), greater achievement of glycemic target (38.2% vs 26.7% vs 19.6%, respectively; P < 0.0001), and a lower incidence of hypoglycemia (2.7% vs 6.6% vs 5.0%, respectively; P = 0.0002), with no difference in total health care costs ($21,167 vs $21,060 vs $20,133, respectively). Implications This study shows that early insulin initiation (represented by the 1 OAD group) may be clinically beneficial to patients with T2DM not controlled with OADs, without adding to costs. This supports the call for timely initiation of individualized insulin therapy in this population.
AB - Purpose In patients with type 2 diabetes mellitus (T2DM) not achieving glycemic targets using oral antidiabetes drugs (OADs), studies suggest that timely insulin initiation has clinical benefits. Insulin initiation at the early versus late stage of disease progression has not been explored in detail. This retrospective database analysis investigated clinical and economic outcomes associated with the timing of insulin initiation in patients with T2DM treated with ≥1 OAD in a real-world US setting. Methods This study linked data from the Truven Health MarketScan® Commercial database, Medicare Supplemental database, and Quintiles Electronic Medical Records database. A total of 1830 patients with T2DM were included. Patients were grouped according to their OAD use before basal insulin initiation (1, 2, or ≥3 OADs) as a proxy for the timing of insulin initiation. Clinical and economic outcomes were evaluated over 1 year of follow-up. Findings During follow-up the 1 OAD group, compared with the 2 and ≥3 OADs groups, had a greater reduction in glycosylated hemoglobin A1c (-1.7% vs -1.0% vs -0.9%, respectively; P < 0.0001), greater achievement of glycemic target (38.2% vs 26.7% vs 19.6%, respectively; P < 0.0001), and a lower incidence of hypoglycemia (2.7% vs 6.6% vs 5.0%, respectively; P = 0.0002), with no difference in total health care costs ($21,167 vs $21,060 vs $20,133, respectively). Implications This study shows that early insulin initiation (represented by the 1 OAD group) may be clinically beneficial to patients with T2DM not controlled with OADs, without adding to costs. This supports the call for timely initiation of individualized insulin therapy in this population.
KW - Key words early insulinization
KW - economic outcomes
KW - insulin initiation
KW - type 2 diabetes
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U2 - 10.1016/j.clinthera.2015.11.011
DO - 10.1016/j.clinthera.2015.11.011
M3 - Article
C2 - 26681210
AN - SCOPUS:84954363136
SN - 0149-2918
VL - 38
SP - 110
EP - 121
JO - Clinical therapeutics
JF - Clinical therapeutics
IS - 1
ER -