Real‐world evidence concerning clinical and economic outcomes of switching to insulin glargine 300 units/mL vs other basal insulins in patients with type 2 diabetes using basal insulin

Abstract

This retrospective cohort study compared real‐world clinical and healthcare‐resource utilization (HCRU) data in patients with type 2 diabetes using basal insulin (BI) who switched to insulin glargine 300 units/mL (Gla‐300) or another BI. Data from the Predictive Health Intelligence Environment database 12 months before (baseline) and 6 months after (follow‐up) the switch date (index date, March 1, 2015 to May 31, 2016) included glycated haemoglobin A1c (HbA1c), hypoglycaemia, HCRU and associated costs. Baseline characteristics were balanced using propensity score matching. Change in HbA1c from baseline was similar in both matched cohorts (n = 1819 in each). Hypoglycaemia incidence and adjusted event rate were significantly lower with Gla‐300. Patients switching to Gla‐300 had a significantly lower incidence of HCRU related to hypoglycaemia. All‐cause and diabetes‐related hospitalization and emergency‐department HCRU were also favourable for Gla‐300. Lower HCRU translated to lower costs in patients using Gla‐300. In this real‐world study, switching to Gla‐300 reduced the risk of hypoglycaemia in patients with type 2 diabetes when compared with those switching to another BI, resulting in less HCRU and potential savings of associated costs.

Hypoglycaemia and treatment patterns among insulin‐treated patients with type 2 diabetes who switched to insulin glargine 300 units/mL versus other basal insulin in a real‐world setting

“…Patients in this cohort who switched to Gla‐300 were less likely to experience hypoglycaemia both at 3‐ and at 6‐month follow‐up compared with those who switched to other basal insulins. Similar results were found in a real‐world study that used propensity matching to harmonize baseline characteristics between groups, controlling for baseline confounders of hypoglycaemia …”

“…There is a growing body of real‐world evidence (RWE) for use of Gla‐300 in patients with T2D . Real‐world data arising from routine clinical care and healthcare service operations, when applied to research questions and analysed using rigorous scientific standards, become RWE and can help in the understanding of how the efficacy and safety data from randomized controlled trials translate in real‐world clinical practice settings and patient populations.…”

A comparative effectiveness study of degludec and insulin glargine 300 U/mL in insulin‐naïve patients with type 2 diabetes

“…Although the financial impact of insulins is also considered to be a major driver of treatment discontinuation because of access to insurance schemes requiring reduced or no copayments, in terms of differentiation among insulins, hypoglycaemia may be a more important driver. For example, despite the higher prescription costs of analogue insulins as compared to NPH, analogue insulins are associated with a lower rate of discontinuation compared with that with NPH, potentially explained by their lower rates of hypoglycaemia and the associated healthcare resource utilization and costs …”

“…By contrast with the aforementioned DELIVER D+ study, a strength of the present study from the CONFIRM trial was the use of an insulin‐naïve population to ensure that comparison of degludec and glargine U300 is not clouded by inclusion of other insulin analogues, either before or after propensity‐score matching, or by different populations of patients that may subsequently introduce bias . In addition, the utilization of 1:1 propensity‐score matching of treatment groups helped to minimize confounding by indication by producing well‐balanced treatment groups after matching, illustrated by the standardized mean differences of baseline characteristics.…”

Switching to insulin glargine 300 units/mL in real‐world older patients with type 2 diabetes (DELIVER 3)

“…Although the observed glycaemic control is poorer in real‐world settings than in RCTs, real‐world evidence is useful to support decision‐making . Therefore, the outcomes of switching to Gla‐300 or another basal insulin among adults with T2D in real‐world clinical practice have been investigated in the DELIVER studies . In DELIVER 2, which compared adults who switched basal insulin to Gla‐300 or another basal insulin, Gla‐300 was associated with less hypoglycaemia and lower healthcare resource utilization, while providing similar glycaemic control .…”