Clinical outcomes after 24 months of insulin therapy in patients with type 2 diabetes in five countries: results from the TREAT study

Oğuz, Aytekin; Benroubi, Marian; Brismar, Kerstin; Melo, Paulo Roberto Santana de; Morar, C; Cleall, Simon; Giaconia, Joseph M.; Schmitt, H

doi:10.1185/03007995.2013.803053

Cited by 28 publications

(33 citation statements)

References 26 publications

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“…However, many patients will ultimately require insulin therapy, either alone or in combination with other agents to maintain glucose control [8]. Insulin therapy is the oldest and most effective glucose-lowering treatment available [7], and patients with T2DM who start on insulin soon after the failure of oral antidiabetic drug (OAD) therapy have a greater likelihood of attaining the standard glycemic goal [glycated hemoglobin (HbA1c) <7%] relative to those whose insulin treatment is delayed [9, 10]. …”

Section: Introductionmentioning

confidence: 99%

Early Discontinuation and Restart of Insulin in the Treatment of Type 2 Diabetes Mellitus

et al. 2014

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IntroductionAlthough the largest improvement in glycemic control occurs within the first 90 days of insulin therapy, little is known about early persistence on insulin therapy. This research aimed to identify predictors of early discontinuation and of subsequent restart of basal or mixture insulin among patients with type 2 diabetes mellitus (T2DM) and to assess the economic cost associated with such behaviors over a 1-year period.MethodsTruven’s Health Analytics Commercial Claims and Encounters database was utilized for the study. Logistic regressions were used to examine factors associated with early discontinuation of insulin (basal or mixture) and, among patients who discontinued early, the factors associated with restarting. Cost regressions were estimated using generalized linear models with a gamma distribution and logistic link. Kaplan–Meier survival curves were used to examine time to discontinuation and time to restart among those who discontinued.ResultsMultivariate analyses revealed that patient characteristics, prior healthcare resource utilization, comorbid diagnoses, and type of initiated insulin were associated with early discontinuation of insulin and of restarting among patients who discontinued early. Acute care (hospitalization and emergency room) costs were 9.6% higher among patients who discontinued early (P < 0.001), although outpatient, drug, and total costs were significantly lower among individuals who discontinued early. Among the early discontinuation subgroup, restarting insulin was associated with higher costs. Specifically: 11.3% higher acute care costs (P < 0.001), 24.0% higher outpatient costs (P < 0.001), 80.2% higher drug costs (P < 0.001), and 30.3% higher total costs (P < 0.001), compared to patients who discontinued early but did not restart insulin therapy in the 1-year post-period.ConclusionAmong patients with T2DM who were initiated on insulin therapy, early discontinuation of insulin and its subsequent restart were associated with significantly higher acute care costs, which may signal a more complex and challenging subgroup of patients who tend to be less engaged in outpatient care and may have poorer long-term outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-014-0065-z) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Early Discontinuation and Restart of Insulin in the Treatment of Type 2 Diabetes Mellitus

et al. 2014

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“…After 2 years of insulin treatment, overall mean HbA 1c further decreased to 7.6% in TREAT, regardless of the starting insulin regimen 25 . Thus, it seems reasonable that a mean HbA 1c of $7.5% can be achieved with insulin treatment and at minimal cost increment vs previous oral therapy.…”

Section: Discussionmentioning

confidence: 90%

“…and at 12 months post-initiation in INSTIGATE, mean (SD) HbA 1c was 9.2% (2.0%) and 6.7% (0.8%) in Germany, 9.7% (1.6%) and 7.4% (1.1%) in Greece, and 9.2% (1.5%) and 7.6% (1.3%) in Spain, respectively. Mean (SD) HbA 1c levels at insulin initiation and at 12 months post-initiation in TREAT were 9.0% (1.7%) and 7.3% (0.8%) in Greece, 9 25 .…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…For both studies, sample sizes were pre-planned in the protocol and calculated by country, with the aim of providing adequate precision for the estimation of mean direct costs, assuming that 10% of data collected might be incomplete or inadequate for use 24,25 .…”

Section: Statistical Analysesmentioning

confidence: 99%

“…The Insulin Titration-Gaining an Understanding of the Burden of Type 2 Diabetes in Europe (INSTIGATE) study and the Treatment Factors and Costs Associated with Insulin Therapy in Patients with Type 2 Diabetes (TREAT) study were observational studies of patients with T2DM initiating any insulin therapy during routine clinical care [20][21][22][23][24][25][26] . INSTIGATE was initially conducted for 6 months and extended to up to 2 years in Germany, Greece, and Spain, while TREAT was conducted for 2 years in Greece, Portugal, Romania, Sweden, and Turkey.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of insulin initiation on resource utilization and direct costs of treatment over 12 months in patients with type 2 diabetes in Europe: results from INSTIGATE and TREAT observational studies

Brismar

Benroubi

Nicolay

et al. 2013

Journal of Medical Economics

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Minimizing Hypoglycemia and Weight Gain with Intensive Glucose Control: Potential Benefits of a New Combination Therapy (IDegLira)

Morales

Merker

2015

Adv Ther

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Due to the progressive nature of type 2 diabetes (T2D), the majority of patients require increasing levels of therapy to achieve and maintain good glycemic control. At present, once patients become uncontrolled on oral antidiabetic therapies, the two primary treatment options are glucagon-like peptide-1 receptor agonists (GLP-1RAs) or basal insulin, although earlier use of GLP-1RAs has also been advocated. While both of these drug classes have proven efficacy in treating T2D, there can be limitations to their use in some patients, and resistance to further treatment intensification among both patients and physicians. More recently, treatment incorporating both a GLP-1RA and a basal insulin has been used successfully in the clinic and the first such combination product, IDegLira (insulin degludec + liraglutide), has recently been approved for use in Europe. IDegLira combines insulin degludec and the GLP-1RA liraglutide in a single injection. In both insulin-naïve and basal insulin-treated individuals with T2D, IDegLira has demonstrated greater reductions in glycated hemoglobin (HbA1c) than either of the individual components, with a low rate of hypoglycemia and weight loss. IDegLira may provide a new option for patients requiring treatment intensification but for whom increased weight or a higher risk of hypoglycemia are barriers. This article discusses the rationale behind combining these two drug classes and reviews the available clinical evidence for the efficacy and safety of IDegLira.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0208-2) contains supplementary material, which is available to authorized users.

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Clinical outcomes after 24 months of insulin therapy in patients with type 2 diabetes in five countries: results from the TREAT study

Abstract: Mean baseline HbA1c was high, indicating delayed initiation of insulin treatment. Blood pressure and lipids were suboptimally controlled. Insulin regimens varied between countries, changed little and resulted in similar HbA1c levels after 24 months.

Cited by 28 publications

References 26 publications

Early Discontinuation and Restart of Insulin in the Treatment of Type 2 Diabetes Mellitus

Early Discontinuation and Restart of Insulin in the Treatment of Type 2 Diabetes Mellitus

Evaluation of insulin initiation on resource utilization and direct costs of treatment over 12 months in patients with type 2 diabetes in Europe: results from INSTIGATE and TREAT observational studies

Minimizing Hypoglycemia and Weight Gain with Intensive Glucose Control: Potential Benefits of a New Combination Therapy (IDegLira)

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