Evaluation of Dosing and Clinical Outcomes in Patients Undergoing Conversion of Insulin Glargine to Insulin Detemir

Bryant, Ginelle A.; McDanel, Deanna; Horner, Kathleen E.; Farris, Karen B.; Newkirk, E.

doi:10.1002/phar.1168

Cited by 19 publications

(29 citation statements)

References 18 publications

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“…No difference in hypoglycemia was observed in the commercially insured IMPACT ® population. In contrast to previously published studies showing that insulin dose was typically higher with insulin detemir than insulin glargine [5, 15, 28], it was similar among the matched GLA-C and DET-S patients based on the DACON estimate from the pharmacy claims data. In our study, however, DET-S patients had a much higher rate of RAI use than did GLA-C patients.…”

Section: Discussioncontrasting

confidence: 95%

“…These data support previously published studies that show a low incidence of hypoglycemia among patients with T2DM treated with either insulin glargine or insulin detemir [4, 5, 15]. Similar to the PREDICTIVE trial [13], the prevalence rate of hypoglycemia was lower after switching from insulin glargine to insulin detemir in the Medicare cohort in our study; however, the event rates were similar in both groups.…”

Section: Discussionsupporting

confidence: 92%

“…The improvements in glycemic control observed in the current study conflict with results from the PREDICTIVE trial [13, 14] but are consistent with those from two US studies [15, 16]. In our study, the treatment persistence rate was significantly higher in the GLA-C group and medication adherence was significantly higher among GLA-S patients.…”

Section: Discussionsupporting

confidence: 88%

“…In our study, however, DET-S patients had a much higher rate of RAI use than did GLA-C patients. Although dosing frequency information was not available for our data analysis, existing literature suggests that insulin detemir is more likely to be dosed more frequently than insulin glargine [15, 29]. Both higher twice-daily use and RAI use may explain the lower persistence and adherence rates and higher diabetes drug and supply costs in the DET-S group.…”

Section: Discussionmentioning

confidence: 99%

“…Using the framework of cost-effectiveness analysis, an Asian study based on data from a Korean cohort of the PREDICTIVE study reported reduced total diabetes care costs and increased life expectancy of 0.06 years after switching from insulin glargine to insulin detemir [14]. A small retrospective study recently evaluated outcomes in patients ( n = 10 with type 1 diabetes and n = 21 with T2DM) switching from insulin glargine to insulin detemir due to changes in Medicaid formulary coverage [15]. Among patients with T2DM, both insulin dose and the proportion of patients needing twice-daily dosing were significantly higher after switching to insulin detemir.…”

Section: Introductionmentioning

confidence: 99%

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Much Ado About Nothing? A Real-World Study of Patients with Type 2 Diabetes Switching Basal Insulin Analogs

et al. 2014

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IntroductionType-2 diabetes mellitus (T2DM) is a progressive disease, and many patients eventually require insulin therapy. This study examined real-world outcomes of switching basal insulin analogs among patients with T2DM.MethodsUsing two large United States administrative claims databases (IMPACT® and Humana®), this longitudinal retrospective study examined two cohorts of adult patients with T2DM. Previously on insulin glargine, Cohort 1 either continued insulin glargine (GLA-C) or switched to insulin detemir (DET-S), while Cohort 2 was previously on insulin detemir, and either continued insulin detemir (DET-C) or switched to insulin glargine (GLA-S). One-year follow-up treatment persistence and adherence, glycated hemoglobin (HbA1c), hypoglycemia events, healthcare utilization and costs were assessed. Selection bias was minimized by propensity score matching between treatment groups within each cohort.ResultsA total of 5,921 patients (mean age 60 years, female 50.0%, HbA1c 8.6%) were included in the analysis (Cohort 1: IMPACT®: n = 536 DET-S matched to n = 2,668 GLA-C; Humana®: n = 256 DET-S matched to n = 1,262 GLA-C; Cohort 2: n = 419 GLA-S matched to n = 780 DET-C), with similar baseline characteristics between treatment groups in each cohort. During 1-year follow-up, in Cohort 1, DET-S patients, when compared with GLA-C patients, had lower treatment persistence/adherence with 33–40% restarting insulin glargine, higher rapid-acting insulin use, worse HbA1c outcomes, significantly higher diabetes drug costs, and similar hypoglycemia rates, health care utilization and total costs. However, in Cohort 2 overall opposite outcomes were observed and only 19.8% GLA-S patients restarted insulin detemir.ConclusionsThis study showed contrasting clinical and economic outcomes when patients with T2DM switched basal insulin analogs, with worse outcomes observed for patients switching from insulin glargine to insulin detemir and improved outcomes when switching from insulin detemir to insulin glargine. Further investigation into the therapeutic interchangeability of insulin glargine and insulin detemir in the real-world setting is needed.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0120-1) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Much Ado About Nothing? A Real-World Study of Patients with Type 2 Diabetes Switching Basal Insulin Analogs

et al. 2014

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Understanding the Clinical Profile of Insulin Degludec, the Latest Basal Insulin Approved for Use in Canada: a Narrative Review

2020

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In recent years, the development of basal insulin therapies has focused on insulin analogues that have longer durations of action and more predictable pharmacokinetic/pharmacodynamic (PK/PD) profiles than their human insulin-based predecessors, such as neutral protamine Hagedorn (NPH) insulin. Dosed once-daily, such analogues can provide a more stable glucose-lowering action, which translates clinically into a reduced risk of hypoglycemia. Insulin degludec (degludec) became available in Canada in 2017 and is the first basal insulin analogue to have a half-life exceeding the dosing interval. As well as offering the promise of an exceptionally flat PK/PD profile when at steady state, this characteristic means that insulin degludec can be dosed with some flexibility with regard to time of day and that it need not be taken at the same time each day. However, the approximately 25-h half-life also has some implications concerning dose titration. This article provides an up-to-date review of the study data describing the clinical profile of degludec, and aims to give helpful and practical advice to prescribers about its use. While the clinical benefits of degludec are described, it is also acknowledged that further study is required to better understand how its clinical performance compares with that of insulin glargine 300 units/mL.

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Alzheimer’s Disease Drugs in Clinical Trials

Sheerin¹,

Adejare²

2017

Drug Discovery Approaches for the Treatment of Neurodegenerative Disorders

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Evaluation of Dosing and Clinical Outcomes in Patients Undergoing Conversion of Insulin Glargine to Insulin Detemir

Cited by 19 publications

References 18 publications

Much Ado About Nothing? A Real-World Study of Patients with Type 2 Diabetes Switching Basal Insulin Analogs

Much Ado About Nothing? A Real-World Study of Patients with Type 2 Diabetes Switching Basal Insulin Analogs

Understanding the Clinical Profile of Insulin Degludec, the Latest Basal Insulin Approved for Use in Canada: a Narrative Review

Alzheimer’s Disease Drugs in Clinical Trials

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