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

Abstract

Introduction

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

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

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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

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