University of Utah Department of Pharmacotherapy, Salt Lake City, Utah 84108, USA.
Curr Med Res Opin. 2010 Jan;26(1):191-201. doi: 10.1185/03007990903432470.
Few comparisons of real-world insulin detemir (DET) and insulin glargine (GLAR) utilization have been conducted, which would assist payers and other healthcare decision makers assess the cost effectiveness of these treatment alternatives. The aim of this study was to compare the amount of insulin utilized in a large cohort of patients with type 2 diabetes treated with either DET or GLAR in the real-world setting considering the use of other antidiabetic agents.
A nested case-control study was conducted using data from a large US medical and pharmacy claims data warehouse. Adults with type 2 diabetes newly treated with DET or GLAR were included. From this overall cohort, a subset of DET patients were matched 1:1 to GLAR on age, baseline antidiabetic use, and comorbidities. Descriptive statistics were used to compare patient characteristics between treatment groups; a Wilcoxon rank sum test was used to compare insulin utilization in terms of the patient level daily average consumption (DACON).
Mean DACON by analog basal insulin.
This study included 18,763 patients; 2215 (11.8%) were treated with DET and 16,548 (88.2%) with GLAR. DET patients were slightly younger (59.6 vs. 60.3 years; p < or = 0.01); gender did not differ (46% female). From the overall cohort, 1581 DET patients were matched to 1581 GLAR patients. Mean (median) DACON did not differ overall (35 [26] units for DET vs. 32 [27] units for GLAR; p = 0.06) or in the matched cohort (35 [26] units for DET vs. 32 [27] units for GLAR; p = 0.146). In the matched cohort, there were no differences in non-insulin antidiabetic use after DET or GLAR was started.
In a real-world setting, insulin utilization did not differ between DET and GLAR controlling for patient characteristics and considering concomitant antidiabetic treatments, which could influence insulin use. A limitation is that the dispensing data as used in this study may not accurately reflect daily insulin dose because patients may discard unused insulin portions when the vial or pre-filled syringe reaches its in-use expiration date. Additional research is warranted to determine if there are differences in DET and GLAR utilization over time.
鲜有研究对德谷胰岛素（DET）和甘精胰岛素（GLAR）的真实世界应用进行比较，而这将有助于支付方和其他医疗保健决策者评估这些治疗选择的成本效益。本研究旨在比较在考虑其他抗糖尿病药物使用的情况下，2 型糖尿病患者在真实环境中使用 DET 或 GLAR 治疗时的胰岛素使用量。
本研究采用美国大型医疗和药房理赔数据库中的数据进行嵌套病例对照研究。纳入新接受 DET 或 GLAR 治疗的 2 型糖尿病成人患者。在这个总体队列中，根据年龄、基线抗糖尿病药物使用和合并症，对部分 DET 患者进行 1:1 匹配 GLAR 患者。采用描述性统计方法比较治疗组患者特征；采用 Wilcoxon 秩和检验比较患者水平的平均日消耗（DACON）。
分析模拟基础胰岛素的平均 DACON。
本研究共纳入 18763 例患者；2215 例（11.8%）接受 DET 治疗，16548 例（88.2%）接受 GLAR 治疗。DET 患者年龄稍小（59.6 岁 vs. 60.3 岁；p≤0.01）；性别无差异（46%女性）。在总体队列中，1581 例 DET 患者匹配了 1581 例 GLAR 患者。总体上，平均（中位数）DACON 无差异（DET 为 35[26]单位，GLAR 为 32[27]单位；p=0.06）或在匹配队列中（DET 为 35[26]单位，GLAR 为 32[27]单位；p=0.146）。在匹配队列中，在开始 DET 或 GLAR 治疗后，非胰岛素抗糖尿病药物的使用没有差异。
在真实环境中，在考虑患者特征和同时使用的抗糖尿病药物治疗的情况下，DET 和 GLAR 的胰岛素利用没有差异，这可能会影响胰岛素的使用。限制因素是，本研究中使用的配药数据可能无法准确反映每日胰岛素剂量，因为当小瓶或预充式注射器达到其使用有效期时，患者可能会丢弃未使用的胰岛素部分。需要进一步研究以确定 DET 和 GLAR 的利用是否随时间而不同。
