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Two‐year glycaemic control and healthcare expenditures following initiation of insulin glargine versus neutral protamine Hagedorn insulin in type 2 diabetes
Author(s) -
Rhoads G. G.,
Dain M. P.,
Zhang Q.,
Kennedy L.
Publication year - 2011
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/j.1463-1326.2011.01394.x
Subject(s) - medicine , insulin glargine , nph insulin , insulin , type 2 diabetes , diabetes mellitus , basal (medicine) , endocrinology , pediatrics
Aims: To compare 2‐year glycaemic control, hypoglycaemia and healthcare expenditures following insulin glargine (glargine, n = 2105) or neutral protamine Hagedorn (NPH) insulin (NPH, n = 734) initiation in patients with type 2 diabetes (T2D). Methods: Retrospective cohort study using an integrated US health insurance administrative database was conducted. Individuals with a diabetes diagnostic claim and initiated basal insulin therapy with glargine or NPH from 2001 to 2005 dispensed at least one oral antidiabetic drug prescription during 6 months prior to basal insulin initiation and enrolled in the same health insurance plan from 6 months before to 12 months or more after insulin initiation were identified. Repeated measures mixed‐effects models evaluated glycaemic and financial outcomes to account for factors potentially contributing to selection of insulin therapy, that is, age, gender, baseline HbA1c level, health expenditures, co‐morbidities, healthcare utilization, pharmacy co‐payment and follow‐up antidiabetic medications. Results: Adjusted mean HbA1c value in the first year following insulin initiation was significantly lower for glargine versus NPH initiators (Δ = −0.43, p = 0.006); this difference diminished in the second year (Δ = −0.16, p = 0.375). First‐year adjusted quarterly hypoglycaemia incidence rates were lower for glargine (2.1%) versus NPH (2.4%) (p = 0.02) as was the second‐year quarterly rate (1.8 vs. 2.2%; p = 0.01). Both the first‐ and second‐year adjusted total healthcare expenditures were lower in the glargine versus NPH group (year 1: $18 720 vs. $19 996, p = 0.005; year 2: $15 008 vs. $17 336; p < 0.001). Conclusions: Glargine therapy may be an effective long‐term option for improving glycaemic control, with lower rates of hypoglycaemia and healthcare costs in patients with T2D.