Advances in Therapy

, Volume 27, Issue 4, pp 211–222

Glycemic control and long-acting insulin analog utilization in patients with type 2 diabetes

  • Edith M. Heintjes
  • Trine L. Thomsen
  • Fernie J. A. Penning-van Beest
  • Torsten E. Christensen
  • Ron M. C. Herings
Original Research



The objective was to compare glycemic control, insulin utilization, and body weight in patients with type 2 diabetes (T2D) initiated on insulin detemir (IDet) or insulin glargine (IGlar) in a real-life setting in the Netherlands.


Insulin-naïve patients with T2D, starting treatment with IDet or IGlar between January 1, 2004 and June 30, 2008, were selected from the PHARMO data network. Glycemic control (hemoglobin A1c [HbA1c]), target rates (HbA1c <7%), daily insulin dose, and weight gain were analyzed comparing IDet and IGlar for patients with available HbA1c levels both at baseline and at 1-year follow-up. Analysis of all eligible patients (AEP) and a subgroup of patients without treatment changes (WOTC) in the follow-up period were adjusted for patient characteristics, propensity scores, and baseline HbA1c.


A total of 127 IDet users and 292 IGlar users were included in the WOTC analyses. The mean HbA1c dropped from 8.4%–8.6% at baseline to 7.4% after 1 year. Patients at HbA1c goal increased from 9% at baseline to 32% for IDet and 11% to 35% for IGlar, which was not significantly different (OR 0.75, 95% CI 0.46, 1.24). Weight gain (n=90) was less among IDet users (+0.4kg) than among IGlar users (+1.1kg), albeit not significant. The AEP analysis (252 IDet + 468 IGlar users) showed similar results with 33%–36% at goal (OR 0.81, 95% CI 0.57, 1.16), and median daily insulin doses of 25 IU/day (P=0.70).


There was no significant difference between users of IDet and IGlar with respect to glycemic control and insulin dose in a real-life setting. The low proportion of patients on target at baseline may indicate that insulin therapy is initiated too late. Moreover, the observation that one-third of the patients reached HbA1c target at follow-up may indicate that basal insulin analogs are not titrated intensively enough.


dose glycemic control HbA1c insulin detemir insulin glargine retrospective cohort study type 2 diabetes utilization 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–853.CrossRefGoogle Scholar
  2. 2.
    Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008;358:580–591.CrossRefPubMedGoogle Scholar
  3. 3.
    Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577–1589.CrossRefPubMedGoogle Scholar
  4. 4.
    Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–2572.CrossRefPubMedGoogle Scholar
  5. 5.
    Pedersen O, Gaede P. Intensified multifactorial intervention and cardiovascular outcome in type 2 diabetes: the Steno-2 study. Metabolism. 2003;52:19–23.CrossRefPubMedGoogle Scholar
  6. 6.
    Rutten G, De Grauw W, Nijpels G, et al. NHG-Standaard Diabetes mellitus type 2. 2006 [in Dutch]. Huisarts en Wetenschap. 2006;49:137–152.Google Scholar
  7. 7.
    American Diabetes Association. Standards of medical care in diabetes - 2008. Diabetes Care. 2008;31(suppl. 1):12–54.CrossRefGoogle Scholar
  8. 8.
    Nathan DM, Buse JB, Davidson MB, et al. Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2006;29:1963–1972.CrossRefPubMedGoogle Scholar
  9. 9.
    Meneghini L. Demonstrating strategies for initiation of insulin therapy: matching the right insulin to the right patient. Int J Clin Pract. 2008;62:1255–1264.CrossRefPubMedGoogle Scholar
  10. 10.
    Mudaliar S, Edelman SV. Insulin therapy in type 2 diabetes. Endocrinol Metab Clin North Am. 2001;30:935–982.CrossRefPubMedGoogle Scholar
  11. 11.
    Brunton SA. Nocturnal hypoglycemia: answering the challenge with long-acting insulin analogs. MedGenMed. 2007;9:38.PubMedGoogle Scholar
  12. 12.
    Hermansen K, Davies M, Derezinski T, Martinez Ravn G, Clauson P, Home P. A 26-week, randomized, parallel, treat-to-target trial comparing insulin detemir with NPH insulin as add-on therapy to oral glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetes Care. 2006;29:1269–1274.CrossRefPubMedGoogle Scholar
  13. 13.
    Johansen OE, Vanberg PJ, Kilhovd BK, Jorgensen AP. Changing basal insulin from NPH to detemir or glargine in patients with type 1 diabetes and a history of severe hypoglycemia. Vasc Health Risk Manag. 2009;5:121–128.PubMedGoogle Scholar
  14. 14.
    Meneghini LF, Rosenberg KH, Koenen C, Merilainen MJ, Luddeke HJ. Insulin detemir improves glycaemic control with less hypoglycaemia and no weight gain in patients with type 2 diabetes who were insulin naive or treated with NPH or insulin glargine: clinical practice experience from a German subgroup of the PREDICTIVE study. Diabetes Obes Metab. 2007;9:418–427.CrossRefPubMedGoogle Scholar
  15. 15.
    Monami M, Marchionni N, Mannucci E. Long-acting insulin analogues versus NPH human insulin in type 2 diabetes: a meta-analysis. Diabetes Res Clin Pract. 2008;81:184–189.CrossRefPubMedGoogle Scholar
  16. 16.
    Philis-Tsimikas A. An update on the use of insulin detemir, with a focus on type 2 diabetes (drug evaluation update). Expert Opin Pharmacother. 2008;9:2181–2195.CrossRefPubMedGoogle Scholar
  17. 17.
    Rossetti P, Porcellati F, Fanelli CG, Perriello G, Torlone E, Bolli GB. Superiority of insulin analogues versus human insulin in the treatment of diabetes mellitus. Arch Physiol Biochem. 2008;114:3–10.CrossRefPubMedGoogle Scholar
  18. 18.
    King AB. No higher dose requirements with insulin detemir than glargine in type 2 diabetes: a crossover, double-blind, and randomized study using continuous glucose monitoring. J Diabetes Sci Technol. 2010;4:151–154.PubMedGoogle Scholar
  19. 19.
    Hollander P, Cooper J, Bregnhoj J, Pedersen CB. A 52-week, multinational, open-label, parallel-group, noninferiority, treat-to-target trial comparing insulin detemir with insulin glargine in a basal-bolus regimen with mealtime insulin aspart in patients with type 2 diabetes. Clin Ther. 2008;30:1976–1987.CrossRefPubMedGoogle Scholar
  20. 20.
    Raskin P, Gylvin T, Weng W, Chaykin L. Comparison of insulin detemir and insulin glargine using a basal-bolus regimen in a randomized, controlled clinical study in patients with type 2 diabetes. Diabetes Metab Res Rev. 2009;25:542–548.CrossRefPubMedGoogle Scholar
  21. 21.
    Haak T, Tiengo A, Draeger E, Suntum M, Waldhausl W. Lower within-subject variability of fasting blood glucose and reduced weight gain with insulin detemir compared to NPH insulin in patients with type 2 diabetes. Diabetes Obes Metab. 2005;7:56–64.CrossRefPubMedGoogle Scholar
  22. 22.
    Dornhorst A, Luddeke HJ, Koenen C, et al. Transferring to insulin detemir from NPH insulin or insulin glargine in type 2 diabetes patients on basal-only therapy with oral antidiabetic drugs improves glycaemic control and reduces weight gain and risk of hypoglycaemia: 14-week follow-up data from PREDICTIVE. Diabetes Obes Metab. 2008;10:75–81.PubMedGoogle Scholar
  23. 23.
    Fakhoury W, Lockhart I, Kotchie RW, Aagren M, LeReun C. Indirect comparison of once daily insulin detemir and glargine in reducing weight gain and hypoglycaemic episodes when administered in addition to conventional oral anti-diabetic therapy in patients with type-2 diabetes. Pharmacology. 2008;82:156–163.CrossRefPubMedGoogle Scholar
  24. 24.
    Borah BJ, Darkow T, Bouchard J, Aagren M, Forma F, Alemayehu B. A comparison of insulin use, glycemic control, and health care costs with insulin detemir and insulin glargine in insulin-naive patients with type 2 diabetes. Clin Ther. 2009;31:623–631.CrossRefPubMedGoogle Scholar
  25. 25.
    Fontaine P, Gin H, Pinget M, et al. Effect of insulin detemir dose frequency on clinical outcomes in patients with diabetes in PREDICTIVE. Adv Ther. 2009;26:535–551.CrossRefPubMedGoogle Scholar
  26. 26.
    Meneghini LF, Dornhorst A, Sreenan S. Once-daily insulin detemir in a cohort of insulin-naive patients with type 2 diabetes: a sub-analysis from the PREDICTIVE study. Curr Med Res Opin. 2009;25:1029–1035.CrossRefPubMedGoogle Scholar
  27. 27.
    Herings RMC. The PHARMO System. CNS Spectr. 2007:9(suppl. 16):14–17.Google Scholar
  28. 28.
    Herings RMC, Bakker A, Stricker BH, Nap G. Pharmaco-morbidity linkage: a feasibility study comparing morbidity in two pharmacy based exposure cohorts. J Epidemiol Community Health. 1992;46:136–140.CrossRefPubMedGoogle Scholar
  29. 29.
    van Herk-Sukel MP, van de Poll-Franse LV, Lemmens VE, et al. New opportunities for drug outcomes research in cancer patients: the linkage of the Eindhoven Cancer Registry and the PHARMO Record Linkage System. Eur J Cancer. 2009;46:395–404.CrossRefPubMedGoogle Scholar
  30. 30.
    Marks JB. How do detemir and glargine compare when added to oral agents in insulin-naive patients with type 2 diabetes mellitus? Nat Clin Pract Endocrinol Metab. 2008;4:490–491.CrossRefPubMedGoogle Scholar
  31. 31.
    Yenigun M, Honka M. Switching patients from insulin glargine-based basal-bolus regimens to a once daily insulin detemir-based basal-bolus regimen: results from a subgroup of the PREDICTIVE study. Int J Clin Pract. 2009;63:425–432.CrossRefPubMedGoogle Scholar
  32. 32.
    Brown JB, Nichols GA, Perry A. The burden of treatment failure in type 2 diabetes. Diabetes Care. 2004;27:1535–1540.CrossRefPubMedGoogle Scholar
  33. 33.
    Rubino A, McQuay LJ, Gough SC, Kvasz M, Tennis P. Delayed initiation of subcutaneous insulin therapy after failure of oral glucose-lowering agents in patients with type 2 diabetes: a population-based analysis in the UK. Diabet Med. 2007;24:1412–1418.CrossRefPubMedGoogle Scholar
  34. 34.
    Goodall G, Sarpong EM, Hayes C, Valentine WJ. The consequences of delaying insulin initiation in UK type 2 diabetes patients failing oral hyperglycaemic agents: a modelling study. BMC Endocr Disord. 2009;9:19.CrossRefPubMedGoogle Scholar
  35. 35.
    Calvert MJ, McManus RJ, Freemantle N. Management of type 2 diabetes with multiple oral hypoglycaemic agents or insulin in primary care: retrospective cohort study. Br J Gen Pract. 2007;57:455–460.PubMedGoogle Scholar
  36. 36.
    Rutten GEHM, Verhoeven S, Heine RJ, et al. NHG-standaard diabetes mellitus type 2 (eerste herziening) [in Dutch]. Huisarts en Wetenschap. 1999;42:67–84.Google Scholar
  37. 37.
    Czupryniak L. Guidelines for the management of type 2 diabetes: is ADA and EASD consensus more clinically relevant than the IDF recommendations? Diabetes Res Clin Pract. 2009;86(suppl. 1):22–25.CrossRefGoogle Scholar
  38. 38.
    Nelson SE, Palumbo PJ. Addition of insulin to oral therapy in patients with type 2 diabetes. Am J Med Sci. 2006;331:257–263.CrossRefPubMedGoogle Scholar
  39. 39.
    Siebenhofer-Kroitzsch A. Our goal: HbA1c 7% or even higher? Symposium S23. Michael Berger Debate: HbA1c - where to set the target? Presented at: 45th Annual Meeting of the European Association of the Study of Diabetes (EASD 2009); September 29–October 2, 2009; Vienna, Austria.Google Scholar
  40. 40.
    McFarlane SI. Insulin therapy and type 2 diabetes: management of weight gain. J Clin Hypertens (Greenwich). 2009;11:601–607.CrossRefGoogle Scholar

Copyright information

© Springer Healthcare 2010

Authors and Affiliations

  • Edith M. Heintjes
    • 1
  • Trine L. Thomsen
    • 2
  • Fernie J. A. Penning-van Beest
    • 1
  • Torsten E. Christensen
    • 2
  • Ron M. C. Herings
    • 1
    • 3
  1. 1.PHARMO InstituteUtrechtThe Netherlands
  2. 2.Novo Nordisk A/SVirumDenmark
  3. 3.Department of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands

Personalised recommendations