Persistence with injectable antidiabetic agents in members with type 2 diabetes in a commercial managed care organization

Cooke, Catherine E.; Lee, Helen Y.; Tong, Yvette P.; Haines, Stuart T.

doi:10.1185/03007990903421994

Cited by 70 publications

(58 citation statements)

References 19 publications

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“…et al 10 , Cooke et al 15 , and Bonafede et al 16 , but lower than some other estimates in the literature 11,12,17 percentile of the time between the first and second refills among those with at least two refills, stratified by quantity supplied. Findings from the sensitivity analyses in the current analysis also demonstrate the effects of using different criteria used to characterize persistence: allowing for gaps in basal insulin use of up to 60 days, 90 days, 120 days, or shorter than 90th percentile of the days between two consecutive fills would respectively characterize 40%, 55%, 65%, and 44% of the sample as being persistent within the year after treatment initiation.…”

Section: Factors þ Outcomes Associated With Basal Insulin Persistencementioning

confidence: 72%

“…With regards to basal insulin in particular, studies have found that approximately 55-80% of people with T2DM (identified from large commercial insurance databases) who were prescribed insulin glargine remained treatment persistent within the year after initiation [11][12][13][14] . In a separate study evaluating persistence with injectable antihyperglycemic medications among a managed care population, Cooke et al reported that 29% of patients initiating basal insulin or exenatide were persistent at 12 months after initiation 15 . In yet another study, Bonafede et al found that 27% of basal insulin initiators had uninterrupted use in the year after initiation 16 .…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, there remains an inconsistency in the findings of previous studies that evaluated factors associated with insulin persistence. For example, older age has been consistently shown to be associated with increased likelihoods of insulin persistence 10,15,17 . Two studies found a significant association between other factors such as male gender, use of multiple classes of antihyperglycemic medications, and use of multiple classes of all-cause medications during baseline with increased likelihoods of persistence 10,16 , while another study did not.…”

Section: Introductionmentioning

confidence: 99%

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Basal insulin persistence, associated factors, and outcomes after treatment initiation among people with type 2 diabetes mellitus in the US

Pérez-Nieves

Kabul

Desai

et al. 2016

Current Medical Research and Opinion

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Objective To assess basal insulin persistence, associated factors, and economic outcomes for insulin-na€ ıve people with type 2 diabetes mellitus (T2DM) in the US. Research design and methods People aged 18 years diagnosed with T2DM initiating basal insulin between April 2006 and March 2012 (index date), no prior insulin use, and continuous insurance coverage for 6 months before (baseline) and 24 months after index date (follow-up period) were selected using de-identified administrative claims data in the US. Based on whether there were 30 day gaps in basal insulin use in the first year post-index, patients were classified as continuers (no gap), interrupters (1 prescription after gap), and discontinuers (no prescription after gap). Main outcome measures Factors associated with persistence -assessed using multinomial logistic regression model; annual healthcare resource use and costs during follow-up period -compared separately between continuers and interrupters, and continuers and discontinuers. Results Of the 19,110 people included in the sample (mean age: 59 years, 60% male), 20% continued to use basal insulin, 62% had 1 interruption, and 18% discontinued therapy in the year after initiation. Older age, multiple antihyperglycemic drug use, and injectable antihyperglycemic use during baseline were associated with significantly higher likelihoods of continuing basal insulin. Relative to interrupters and discontinuers, continuers had fewer emergency department visits, shorter hospital stays, and lower medical costs (continuers: $10,890, interrupters: $13,674, discontinuers: $13,021), but higher pharmacy costs (continuers: $7449, interrupters: $5239, discontinuers: $4857) in the first year post-index (p < 0.05 for all comparisons). Total healthcare costs were similar across the three cohorts. Findings for the second year post-index were similar. Conclusions The majority of people in this study interrupted or discontinued basal insulin treatment in the year after initiation; and incurred higher medical resource use and costs than continuers. The findings are limited to the commercially insured population in the US. In addition, persistence patterns were assessed using administrative claims as opposed to actual medicationtaking behavior and did not account for measures of glycemic control. Further research is needed to understand the reasons behind basal insulin persistence and the implications thereof, to help clinicians manage care for T2DM more effectively. ARTICLE HISTORY

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Section: Factors þ Outcomes Associated With Basal Insulin Persistencementioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Basal insulin persistence, associated factors, and outcomes after treatment initiation among people with type 2 diabetes mellitus in the US

Pérez-Nieves

Kabul

Desai

et al. 2016

Current Medical Research and Opinion

View full text Add to dashboard Cite

show abstract

“…A number of studies have been performed to evaluate persistence in patients prescribed OADs, but less in patients receiving insulin therapy, although renouncement to insulin leaves the patients with limited choice of anti-diabetes therapy [13–17]. Most of these studies were conducted in the US.…”

Section: Introductionmentioning

confidence: 99%

Persistence with Insulin Therapy in Patients with Type 2 Diabetes in France: An Insurance Claims Study

et al. 2016

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IntroductionThe objective of this study was to document the initiation of insulin therapy in patients with type 2 diabetes mellitus (T2DM) and its maintenance as a function of time after initiation in a French nationwide representative cohort.MethodsA retrospective cohort study was conducted on a random sample of ~600,000 beneficiaries registered in the French national health insurance database. Newly insulin treated T2DM patients were selected. Persistence was defined as remaining on insulin without discontinuation (defined over a 6 or a 12-month period).ResultsAmong 1909 initiations identified in 2012/2013 (basal scheme: 61.8%, basal/rapid: 15%, other schemes: 23.2%) the average age (standard deviation) at initiation was, respectively, 67.5 (14.2), 61.8 (18.1) and 63.2 (18.4) years. Insulin was initiated by general practitioners in 39.3% and prescribed without other antidiabetic drugs in 32.0%. Persistence was studied in 1969 patients initiating insulin in 2011/2012. Among survivors, nearly 25% stopped insulin during the first year (18.4% for basal scheme). Patients discontinuing insulin were younger [64.7 years (18.5) vs 67.3 years (14.3) p = 0.0003] and less often male (45.8% vs 55.7%, p < 0.0001). A proportion of 20.2% did not receive any antidiabetic drug over 12 months after discontinuation. These high percentages were only partly explained by transient intensive insulin regimens in acutely ill patients identifiable in the database.ConclusionWe observed a high rate of early discontinuation of insulin in T2DM patients (but lower with basal insulin scheme). Further real world studies are warranted to identify factors associated with this poor persistence.FundingThis study was supported by Sanofi-France.

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“…[20][21][22] In reality, patients taking insulin glargine have been shown to be more likely to persist with their medication than those taking NPH insulin. 23 In general, treatment complexity for chronic conditionsincluding, though not limited to the need to administer more than one injection daily-correlates with poor adherence. 24 Although there are data in support of the clinical benefits of basal insulins, there is currently a paucity of realworld information about the impact of different basal insulin regimens on healthcare utilisation, employee disability and their associated costs from an employer's perspective.…”

Section: Introductionmentioning

confidence: 99%

Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: a comparative retrospective database study

et al. 2013

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ObjectivesTo compare real-world outcomes of initiating insulin glargine (GLA) versus neutral protamine Hagedorn (NPH) insulin among employees with type 2 diabetes mellitus (T2DM) who had both employer-sponsored health insurance and short-tem-disability coverages.DesignRetrospective cohort study.SettingMarketScan Commercial Claims and Encounters/Health and Productivity Management Databases 2003–2009.ParticipantsAdult employees with T2DM who were previously treated with oral antidiabetic drugs and/or glucagon-like-peptide 1 receptor agonists and initiated GLA or NPH were included if they were continuously enrolled in healthcare and short-term-disability coverages for 3 months before (baseline) and 1 year after (follow-up) initiation. Treatment selection bias was addressed by 2:1 propensity score matching. Sensitivity analyses were conducted using different matching ratios.Primary and secondary outcome measuresOutcomes during 1-year follow-up were measured and compared: insulin treatment persistence and adherence; hypoglycaemia rates and daily average consumption of insulin; total and diabetes-specific healthcare resource utilisation and costs and loss in productivity, as measured by short-term disability, and the associated costs.ResultsA total of 534 patients were matched and analysed (GLA: 356; NPH 178) with no significant differences in baseline characteristics. GLA patients were more persistent and adherent (both p<0.05), had lower rates of hospitalisation (23% vs 31.4%; p=0.036) and endocrinologist visits (19.1% vs 26.9%; p=0.038), similar hypoglycaemia rates (both 4.4%; p=1.0), higher diabetes drug costs ($2031 vs $1522; p<0.001), but similar total healthcare costs ($14 550 vs $16 093; p=0.448) and total diabetes-related healthcare costs ($4686 vs $5604; p=0.416). Short-term disability days and costs were numerically lower in the GLA cohort (16.0 vs 24.5 days; p=0.086 and $2824 vs $4363; p=0.081, respectively). Sensitivity analyses yielded similar findings.ConclusionsInsulin GLA results in better persistence and adherence, compared with NPH insulin, with no overall cost disadvantages. Better persistence and adherence may lead to long-term health benefits for employees with T2DM.

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Persistence with injectable antidiabetic agents in members with type 2 diabetes in a commercial managed care organization

Cited by 70 publications

References 19 publications

Basal insulin persistence, associated factors, and outcomes after treatment initiation among people with type 2 diabetes mellitus in the US

Basal insulin persistence, associated factors, and outcomes after treatment initiation among people with type 2 diabetes mellitus in the US

Persistence with Insulin Therapy in Patients with Type 2 Diabetes in France: An Insurance Claims Study

Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: a comparative retrospective database study

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