Baser Onur, Tangirala Krishna, Wei Wenhui, Xie Lin
STATinMED Research Inc, Ann Arbor, MI, NJ, USA ; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, NJ, USA.
Clinicoecon Outcomes Res. 2013 Oct 3;5:497-505. doi: 10.2147/CEOR.S49279. eCollection 2013.
In patients with type 2 diabetes mellitus, basal-bolus strategies can improve treatment by offering dosing flexibility, and improved satisfaction, adherence, and clinical outcomes. The purpose of this study was to compare real-world outcomes between US patients initiating analog insulin therapy with insulin glargine and those initiating with a premixed analog insulin (PMX).
This was a retrospective study of data from patients (≥18 years) with type 2 diabetes mellitus in the IMPACT® database who initiated insulin treatment with insulin glargine (GLA) or a PMX. Clinical and economic outcomes were measured over one year, including persistence and adherence, consumption of insulin, glycemic outcomes, incident hypoglycemia, and health care resource utilization and cost.
Data from 2,502 patients were included in the analyses (n = 834 for PMX, n = 1,668 for GLA). Compared with PMX, persistence was higher and consumption of insulin was lower for GLA (both P < 0.0001). Adherence, glycemic outcomes, and hypoglycemia-related events were similar between groups, as were health care utilization and total health care costs. Diabetes-related drug and supply costs were lower for GLA than for PMX (P < 0.0001 and P = 0.046, respectively).
In US patients with type 2 diabetes mellitus, initiating insulin with once-daily GLA, rather than a PMX, is associated with increased treatment persistence and similar clinical and hypoglycemic outcomes, but lower diabetes pharmacy and supply costs. GLA may be a more flexible option than PMX. However, these results also show suboptimal glycemic control in the real-world setting despite change in treatment regimens and call for optimization in management of patients with type 2 diabetes mellitus.
在2型糖尿病患者中，基础-餐时胰岛素治疗方案通过提供剂量灵活性、提高满意度、依从性和临床结局来改善治疗效果。本研究的目的是比较美国开始使用甘精胰岛素进行胰岛素类似物治疗的患者与开始使用预混胰岛素类似物（PMX）治疗的患者的实际治疗效果。
这是一项对IMPACT®数据库中≥18岁的2型糖尿病患者数据进行的回顾性研究，这些患者开始使用甘精胰岛素（GLA）或PMX进行胰岛素治疗。在一年的时间里对临床和经济结局进行了测量，包括持续性和依从性、胰岛素用量、血糖结局、低血糖事件以及医疗资源利用和成本。
分析纳入了2502例患者的数据（PMX组834例，GLA组1668例）。与PMX相比，GLA组的持续性更高，胰岛素用量更低（均P<0.0001）。两组之间的依从性、血糖结局和低血糖相关事件相似，医疗资源利用和总医疗成本也相似。GLA组的糖尿病相关药物和耗材成本低于PMX组（分别为P<0.0001和P=0.046）。
在美国2型糖尿病患者中，起始胰岛素治疗时使用每日一次的GLA而非PMX，与治疗持续性增加、临床和低血糖结局相似，但糖尿病药房和耗材成本更低有关。GLA可能是比PMX更灵活的选择。然而，这些结果也表明，尽管治疗方案有所改变，但在现实环境中血糖控制仍不理想，需要对2型糖尿病患者的管理进行优化。
