Comparing clinical outcomes and costs for different treatment intensification approaches in patients with type 2 diabetes uncontrolled on basal insulin: Adding glucagon-like peptide 1 receptor agonists versus adding rapid-acting insulin or increasing basal insulin dose

Philip Levin, Tao Fan, Xue Song, Damion Nero, Brian Davis, Bong Chul Chu

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Not all patients with type 2 diabetes achieve recommended glycated hemoglobin A1c (A1C) levels after adequate titration of basal insulin (BI). Current intensification approaches include addition of rapid-acting insulin (RAI) or a glucagon-like peptide 1 receptor agonist (GLP- 1 RA), but it is not clear which strategy results in better long-term outcomes. Methods: This retrospective analysis of health insurance claims data in the U.S. MarketScan database compared glycemic control and healthcare resource utilization and costs 12 months after adding a GLP-1 RA to BI versus adding a RAI or increasing BI doses. Propensity score matching was used in the comparative effectiveness analysis. Results: A total of 8,034 patients underwent treatment intensification within 6 months of showing poor glycemic control; 4,134 patients had their BI dose adjusted, and 2,076 and 331 received RAI and GLP-1 RA, respectively. A1C changes were similar for the GLP-1 RA and RAI cohorts but higher for the GLP-1 RA versus the dose-adjustment group. The hypoglycemia rate was lower after adding GLP-1 RA versus RAI or increasing BI dose. No overall changes in utilization of healthcare resources or diabetes-related costs were observed between intensification strategies, although prescription costs were higher for the GLP-1 RA cohort. Conclusion: BI in combination with GLP-1 RAs appears to be an effective intensification strategy, further reducing A1C levels and hypoglycemia frequency compared to increasing BI doses. GLP-1 RA addition also decreases hypoglycemia frequency versus BI dose increases and RAI addition, without raising overall healthcare costs.

Original languageEnglish (US)
Pages (from-to)1316-1324
Number of pages9
JournalEndocrine Practice
Volume23
Issue number11
DOIs
StatePublished - Nov 2017
Externally publishedYes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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