RTI Health Solutions, Research Triangle Park, NC 27709, USA.
Curr Med Res Opin. 2013 Sep;29(9):1083-91. doi: 10.1185/03007995.2013.811403. Epub 2013 Jun 21.
To evaluate outcomes in insulin-naive patients with type 2 diabetes mellitus (T2DM) who initiated insulin glargine or insulin detemir.
Retrospective data were analyzed from the US General Electric Centricity electronic medical records (EMR) database from patients (≥18 years old) with T2DM initiating insulin glargine or detemir between January 1, 2006, and December 31, 2010. Included patients had EMR data for ≥6 months prior to (baseline) and ≥12 months after (follow-up) the index date (date of first insulin prescription), and at least one OAD and/or GLP-1 receptor agonist prescription order during baseline, but no previous insulin prescription. Patients were matched on baseline characteristics 5:1, insulin glargine to detemir, to ameliorate selection bias. Outcomes assessed were persistence with insulin therapy, glycemic control, hypoglycemia, body weight, and body mass index over follow-up.
Insulin glargine and detemir groups were similar in terms of gender (51.0% and 51.5% female, P = 0.7356), age (57.8 and 57.4 years, P = 0.3368), A1C (9.4% and 9.4%, P = 0.6642), and body weight (101.9 kg and 102.4 kg, P = 0.4920) at baseline. During follow-up, patients initiating insulin glargine were more persistent (80.1% vs 67.8%, P < 0.0001) and had a greater change in A1C (-1.11% vs -0.96%, P = 0.0479). Percentage change in weight (0.91% and 0.65%, P = 0.2734) and hypoglycemia prevalence (3.6% vs 4.1%, P = 0.4338) were similar between groups.
Results from this real-world EMR analysis suggest that among T2DM patients, initiating insulin treatment with insulin glargine may be associated with better treatment persistence and glycemic control, with similar prevalence of hypoglycemia and weight change, compared with initiating with insulin detemir. This study is limited by the retrospective nature of the data collection using EMRs and inability to confirm accuracy and completeness of data by secondary chart review.
评估起始胰岛素甘精或地特胰岛素的 2 型糖尿病（T2DM）患者的结局。
分析 2006 年 1 月 1 日至 2010 年 12 月 31 日期间美国通用电气 Centricity 电子病历（EMR）数据库中起始胰岛素甘精或地特胰岛素的 T2DM 患者（≥18 岁）的回顾性数据。纳入标准为：在索引日期（首次胰岛素处方日期）前至少有 6 个月（基线）和之后至少 12 个月（随访）的 EMR 数据，并且在基线时至少有一次 OAD 和/或 GLP-1 受体激动剂处方，但无既往胰岛素处方。通过 5：1 按胰岛素甘精/地特胰岛素进行匹配，以改善选择偏倚。随访期间评估的结局为胰岛素治疗的持久性、血糖控制、低血糖、体重和体重指数。
胰岛素甘精和地特胰岛素组在性别（51.0%和 51.5%为女性，P=0.7356）、年龄（57.8 岁和 57.4 岁，P=0.3368）、A1C（9.4%和 9.4%，P=0.6642）和体重（101.9kg 和 102.4kg，P=0.4920）方面相似。在随访期间，起始胰岛素甘精的患者更具持久性（80.1% vs 67.8%，P<0.0001），A1C 变化更大（-1.11% vs -0.96%，P=0.0479）。体重变化百分比（0.91%和 0.65%，P=0.2734）和低血糖发生率（3.6%和 4.1%，P=0.4338）两组相似。
这项基于真实世界 EMR 分析的结果表明，在 T2DM 患者中，与起始使用胰岛素地特胰岛素相比，起始使用胰岛素甘精治疗可能与更好的治疗持久性和血糖控制相关，且低血糖和体重变化的发生率相似。本研究受到使用 EMR 进行回顾性数据收集的限制，并且无法通过二次图表审查确认数据的准确性和完整性。
