Does Pen Help? A Real-World Outcomes Study of Switching from Vial to Disposable Pen Among Insulin Glargine-Treated Patients with Type 2 Diabetes Mellitus

Xie, Lin; Zhou, Steve; Wei, Wenhui; Gill, Jasvinder; Pan, Chunshen; Başer, Onur

doi:10.1089/dia.2012.0253

Cited by 39 publications

(38 citation statements)

References 27 publications

(49 reference statements)

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“…13,15 Low heterogeneity was estimated in this subanalysis. A nonnaïve population 23,26 showed a less marked trend, with important heterogeneity (I 2 = 80%; χ 2 significant). Baser et al 12 reported that mean change in MPR in patients who exchanged vial for pen device was 0.22 ± 0.01, compared with 0.13 ± 0.36 for those who continued on vial (P = .0011).…”

Section: Adherencementioning

confidence: 96%

“…Six studies with a follow-up of 12 months were found, [13][14][15]18,19,26 with statistically significant difference in favor of pen ( Figure 2F), but important heterogeneity (I 2 = 89%) was detected. A subanalysis was performed using the studies with similar definitions of discontinuation threshold.…”

Section: Persistencementioning

confidence: 99%

“…Ahmann et al 10 reported non-statistically significant differences in the number of patients with any hypoglycemia episode (47.8% vs 47.7%, P = .99), symptomatic hypoglycemia (34.8% vs 39.9%, P = .79), or severe hypoglycemia (4.4% vs 7.2%, P = .2958) at 30 weeks. Four studies 14,15,18,26 reported hypoglycemia results at 12 months and a meta-analysis was performed. We found a statistical significant difference favoring pen devices, without heterogeneity ( Figure 2D).…”

Section: Hypoglycemiamentioning

confidence: 99%

“…13,15,23,26 Proportion of days covered (PDC) is calculated in a similar fashion to MPR. 16 Four studies 13,15,23,26 assessed final MPR at 12-month follow-up, and showed statistically significant difference favoring pen, but had considerable heterogeneity (I 2 = 95%) ( Figure 2E). When insulin-naïve and nonnaïve populations were compared, and a greater difference was seen in the former population.…”

Section: Adherencementioning

confidence: 99%

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Pen Devices for Insulin Self-Administration Compared With Needle and Vial

Lasalvia

Barahona-Correa

Romero-Alvernia

et al. 2016

J Diabetes Sci Technol

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Objectives: Pen devices offer advantages compared with vial and syringe (VaS). The purpose of this article was to evaluate efficacy of pen devices compared to VaS. Methods: A systematic review of literature was performed in 8 different databases. References were independently screened and selected. Primary observational or experimental studies comparing pen devices with VaS for insulin administrations were included. Studies on specific populations were excluded. Risk of bias was evaluated using appropriate tools. Data on glycosylated hemoglobin (HbA1c), hypoglycemia, adherence, persistence, patient preference, and quality of life (QOL) were collected. Meta-analysis was performed when appropriate. Heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses of the available data was done. Results: In all, 10 348 articles were screened. A total of 17 studies were finally selected: 7 experimental and 10 analytical. The populations of the included articles were mainly composed of adults with type 2 diabetes mellitus. Important risk of bias was found in all of the articles, particularly experimental studies. Meta-analyses were performed for HbA1c, hypoglycemia, adherence and persistence. Pen device showed better results in mean HbA1c change, patients with hypoglycemia, adherence and persistence compared to VaS. No difference was observed in number of patients achieving <7% HbA1c. Preference studies showed a tendency favoring pen devices, however nonvalidated tools were used. One QoL study showed improvements in some subscales of SF-36. Conclusions: There is evidence that pen devices offer benefits in clinical and, less clearly, patient-reported outcomes compared to VaS for insulin administration. However, these results should be taken with caution.

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Section: Adherencementioning

confidence: 96%

Section: Persistencementioning

confidence: 99%

Section: Hypoglycemiamentioning

confidence: 99%

Section: Adherencementioning

confidence: 99%

See 2 more Smart Citations

Pen Devices for Insulin Self-Administration Compared With Needle and Vial

Lasalvia

Barahona-Correa

Romero-Alvernia

et al. 2016

J Diabetes Sci Technol

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“…Based on published literature, treatment persistence was defined as the patient remaining on study drugs during the follow-up period, without discontinuation or switching after study drug initiation. [22][23][24][25][26] Study medication was considered discontinued if the prescription was not refilled within the expected time of medication coverage, defined as the 90th percentile of the mean time between the initial and second prescription fills, stratified by the metric quantity supplied between first and second fills among patients with at least 1 refill. Patients who restarted their initial medication during follow-up with the time period between 2 refills being greater than the "expected time of medication coverage" were considered nonpersistent patients.…”

Section: Follow-up Study Outcomesmentioning

confidence: 99%

Does Device Make Any Difference? A Real-world Retrospective Study of Insulin Treatment Among Elderly Patients With Type 2 Diabetes

Miao

Wei

Lin³

et al. 2014

J Diabetes Sci Technol

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Background: We compared real-world clinical and economic outcomes for insulin glargine treatment administered by disposable pen and traditional vial-and-syringe injections among elderly patients with type 2 diabetes mellitus (T2DM). Methods: Using a large database of US retirees, this retrospective longitudinal study examined 1-year follow-up outcomes in patients with T2DM aged 65 years or older who were either insulin naïve and initiated insulin glargine via disposable pen (pen initiators [PI]) or vial (vial initiators [VI]) or were already insulin glargine users but either continued with a vial (vial continuers [VC]) or switched to a disposable pen (pen switchers [PS]). Results: There were 7856 propensity-score-matched patients, including 2930 each in the PI and VI cohorts, and 998 each in the VC and PS cohorts. Compared with vial-and-syringe users, the disposable pen users had significantly greater treatment persistence (P < .0001 for both comparisons), duration of persistence (P < .0001 for both), and adherence (P < .01 for both) and lower insulin daily average consumption (P < .05 for both). Compared with the VI cohort, the PI cohort had significantly fewer hypoglycemia-related events (P = .0164). Total health care costs were comparable for the respective matched cohorts. Conclusions: In elderly patients with T2DM receiving insulin glargine therapy, initiating or switching to a disposable pen was associated with better treatment persistence and adherence than initiating or continuing with vial-and-syringe, without increased total health care costs. Among insulin-naïve patients, initiating insulin glargine by disposable pen was also associated with significantly reduced risk of hypoglycemia compared with vial-and-syringe patients.

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The INITIATOR Study: Pilot Data on Real-World Clinical and Economic Outcomes in US Patients with Type 2 Diabetes Initiating Injectable Therapy

et al. 2013

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IntroductionType 2 diabetes mellitus (T2DM) progression often results in treatment intensification with injectable therapy to maintain glycemic control. Using pilot data from the Initiation of New Injectable Treatment Introduced after Anti-diabetic Therapy with Oral-only Regimens study, real-world treatment patterns among T2DM patients initiating injectable therapy with insulin glargine or liraglutide were assessed.MethodsThis was a retrospective analysis of claims from the OptumInsight™ (OI; January 1, 2010 to July 30, 2010) and HealthCore® (HC; January 1, 2010 to June 1, 2010) health insurance databases. Baseline characteristics, health care resource utilization, and costs were compared between adults with T2DM initiating injectable therapy with insulin glargine pen versus liraglutide. Follow-up outcomes, including glycated hemoglobin A1c (A1C), hypoglycemia, health care utilization, and costs, were assessed.ResultsAt baseline, almost one in three liraglutide patients (OI, n = 363; HC, n = 521) had A1C <7.0%, while insulin glargine patients (OI, n = 498; HC, n = 1,188) had poorer health status, higher A1C (insulin glargine: 9.8% and 9.1% versus liraglutide: 7.9% and 7.7%, OI and HC, respectively, both P < 0.001), and were less likely to be obese (insulin glargine: 10.8% and 9.2% versus liraglutide: 17.4% and 18.8%, OI and HC, respectively, both P < 0.01). The percentage of patients experiencing a hypoglycemic event was numerically higher for insulin pen use for both cohorts (OI 4.4% versus 3.0%; HC 6.2% versus 2.3%). During follow-up, in the insulin glargine cohort, annualized diabetes-related costs remained unchanged ($8,344 versus $7,749 OI, and $7,094 versus $7,731 HC), despite a significant increase in pharmacy costs, due to non-significant decreases in medical costs, while the liraglutide cohort had a significant increase in annualized diabetes-related costs ($4,510 versus $7,731 OI, and $4,136 versus $7,111 HC; both P < 0.001) due to a non-significant increase in medical costs coupled with a significant increase in pharmacy costs.ConclusionThese descriptive data identified differences in demographic and baseline clinical characteristics among patients initiating injectable therapies. The different health care utilization and cost patterns warrant further cost-effectiveness analysis.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-013-0074-8) contains supplementary material, which is available to authorized users.

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Does Pen Help? A Real-World Outcomes Study of Switching from Vial to Disposable Pen Among Insulin Glargine-Treated Patients with Type 2 Diabetes Mellitus

Abstract: Switching from insulin glargine vial-and-syringe administration to pen delivery resulted in improved treatment adherence and persistence, with comparable clinical and economic outcomes.

Cited by 39 publications

References 27 publications

Pen Devices for Insulin Self-Administration Compared With Needle and Vial

Pen Devices for Insulin Self-Administration Compared With Needle and Vial

Does Device Make Any Difference? A Real-world Retrospective Study of Insulin Treatment Among Elderly Patients With Type 2 Diabetes

The INITIATOR Study: Pilot Data on Real-World Clinical and Economic Outcomes in US Patients with Type 2 Diabetes Initiating Injectable Therapy

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