Cost comparison of insulin glargine with insulin detemir in a basal-bolus regime with mealtime insulin aspart in type 2 diabetes in Germany

Different injection frequencies of basal insulins in type 2 diabetes patients under real-life conditions: a retrospective database analysis

AIMS

Little is known about routine use of basal insulins [glargine, detemir, neutral protamine Hagedorn (NPH)] in primary care patients with type 2 diabetes. The aim was to compare injection frequencies of basal insulins in type 2 diabetes in primary care practices, both for basal-supported oral therapy (BOT) and basal-bolus treatment [intensified conventional therapy (ICT)] regimens.

METHODS

Primary care data from 4211 glargine (BOT/ICT, 2247/1964), 1290 detemir (490/800), and 3876 NPH (1331/2425) insulin users were retrospectively analyzed (Disease Analyzer database, May 2009-April 2012). Logistic regression (>1 daily injection) and propensity scores were used to adjust for various confounders (age, sex, type of physician, dosage, body mass index, glycosylated hemoglobin).

RESULTS

Overall, >1 daily injections were observed in 7.5% of glargine users (BOT, 6.2%; ICT, 9.0%), which was lower than for detemir (overall, 25.4%; BOT, 22.0%; ICT, 27.4%) and NPH (25.4%; BOT, 23.9%; ICT, 27.2%) insulin (all p < .001). The adjusted odds of having >1 injection was lower for glargine compared with detemir (odds ratio, 0.26; 95% CI 0.22-0.32) and NPH-insulin (0.20; 0.17-0.23). Similar results were found for BOT or ICT and after propensity score matching.

CONCLUSIONS

Glargine is associated with significantly lower injection frequencies than other basal insulins. These findings might impact patient-reported outcomes, quality of life, treatment satisfaction, and economic aspects of diabetes treatment.

Treatment of type 1 and type 2 diabetes mellitus with insulin detemir, a long-acting insulin analog

Insulin detemir is a long-acting basal insulin approved for use in patients with type 1 (T1DM) or type 2 diabetes (T2DM). Insulin detemir has demonstrated equivalent glycemic control and hypoglycemic risk when compared to insulin glargine, and insulin detemir has generally but not consistently demonstrated less weight gain than insulin glargine in T2DM. The benefits of basal insulin analogs relative to NPH insulin are well recognized, including less FBG variability, lower risk of hypoglycemia, and less weight gain specifically with insulin detemir. However, NPH insulin continues to be widely prescribed, which may be due in part to economic considerations. While NPH insulin generally costs less per prescription, insulin detemir has been shown to be cost effective compared to NPH insulin as well as insulin glargine. Therefore, insulin detemir is an effective option from both clinical and economic perspectives for patients with T1DM or T2DM who require basal insulin to achieve glycemic control.