The Evaluation of Clinical and Cost Outcomes Associated with Earlier Initiation of Insulin in Patients with Type 2 Diabetes Mellitus

Smolen, H.J.; Murphy, Daniel R.; Gahn, J.C.; Yu, Xingjian; Curtis, Bradley

doi:10.18553/jmcp.2014.20.9.968

Cited by 11 publications

(7 citation statements)

References 49 publications

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“…The treatment of diabetes complicated with cerebral ischemia-reperfusion injury should combine hypoglycemic drugs with drugs for cerebral ischemia-cerebral injury in a clinical setting. Moreover, adjusting insulin dosage according to the patient's blood glucose levels at any given time often lead to hypoglycemia and exacerbation of the risks of brain ischemia injury [ 37 ]. In addition, nimodipine commonly results in hypotension[ 38 ].…”

Section: Discussionmentioning

confidence: 99%

RhGLP-1 (7–36) protects diabetic rats against cerebral ischemia-reperfusion injury via up-regulating expression of Nrf2/HO-1 and increasing the activities of SOD

Fang

Liu

Zhao

et al. 2017

Korean J Physiol Pharmacol

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The present study aimed to explore the neuroprotective effect and possible mechanisms of rhGLP-1 (7–36) against transient ischemia/reperfusion injuries induced by middle cerebral artery occlusion (MCAO) in type 2 diabetic rats. First, diabetic rats were established by a combination of a high-fat diet and low-dose streptozotocin (STZ) (30 mg/kg, intraperitoneally). Second, they were subjected to MCAO for 2 h, then treated with rhGLP-1 (7–36) (10, 20, 40 µg/kg i.p.) at the same time of reperfusion. In the following 3 days, they were injected with rhGLP-1 (7–36) at the same dose and route for three times each day. After 72 h, hypoglycemic effects were assessed by blood glucose changes, and neuroprotective effects were evaluated by neurological deficits, infarct volume and histomorphology. Mechanisms were investigated by detecting the distribution and expression of the nuclear factor erythroid-derived factor 2 related factor 2 (Nrf2) in ischemic brain tissue, the levels of phospho-PI3 kinase (PI3K)/PI3K ratio and heme-oxygenase-1 (HO-l), as well as the activities of superoxide dismutase (SOD) and the contents of malondialdehyde (MDA). Our results showed that rhGLP-1 (7–36) significantly reduced blood glucose and infarction volume, alleviated neurological deficits, enhanced the density of surviving neurons and vascular proliferation. The nuclear positive cells ratio and expression of Nrf2, the levels of P-PI3K/PI3K ratio and HO-l increased, the activities of SOD increased and the contents of MDA decreased. The current results indicated the protective effect of rhGLP-1 (7–36) in diabetic rats following MCAO/R that may be concerned with reducing blood glucose, up-regulating expression of Nrf2/HO-1 and increasing the activities of SOD.

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Section: Discussionmentioning

confidence: 99%

RhGLP-1 (7–36) protects diabetic rats against cerebral ischemia-reperfusion injury via up-regulating expression of Nrf2/HO-1 and increasing the activities of SOD

Fang

Liu

Zhao

et al. 2017

Korean J Physiol Pharmacol

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“…29 In fact, a recent publication based on a Monte Carlo microsimulation model demonstrated that earlier initiation of insulin was associated with a higher proportion of patients achieving their A1c target, decreased risk of diabetes-related complications and death, and cost savings, but an increase in hypoglycemic events. 30 However, the long-term impact of insulin therapy on diabetes-related complications and associated costs remains to be determined. 31 Taken together, these clinical and economic data provide a strong argument for the need for early initiation of insulin therapy in patients with T2DM.…”

Section: ■■ Discussionmentioning

confidence: 99%

Health Outcomes Associated with Initiation of Basal Insulin After 1, 2, or ≥ 3 Oral Antidiabetes Drug(s) Among Managed Care Patients with Type 2 Diabetes

Levin

Zhou²,

Gill³

et al. 2015

JMCP

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This real-world analysis shows that there are significant baseline differences in patients with T2DM on 1 OAD, 2 OADs, or ≥3 OADs when adding insulin therapy. All 3 groups had significant improvements in clinical and economic outcomes compared with baseline, yet at different magnitudes. These data contribute to a growing body of evidence supporting the timely initiation of insulin therapy for T2DM patients not maintaining glycemic control with OADs.

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“…Alongside the medical consequences for patients with diabetes, clinical inertia also has an impact on healthcare expenditures; overcoming clinical inertia to provide a sustained reduction in HbA1c levels has been associated with significant cost savings and reduced healthcare utilization [ 15 – 17 ]. Thus, overcoming clinical inertia has the potential to improve both clinical and economic outcomes in T2D patients.…”

Section: Introductionmentioning

confidence: 99%

Treatment Intensification in Type 2 Diabetes: A Real-World Study of 2-OAD Regimens, GLP-1 RAs, or Basal Insulin

et al. 2018

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IntroductionTreatment guidelines recommend a stepwise approach to glycemia management in patients with type 2 diabetes (T2D), but this may result in uncontrolled glycated hemoglobin A1c (HbA1c) between steps. This retrospective analysis compared clinical and economic outcomes among patients with uncontrolled T2D initiating two oral antidiabetes drugs (OADs), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), or basal insulin in a real-world setting.MethodsAdults with T2D on OAD monotherapy were identified in the MarketScan claims database (2007–2014). Those initiating two OADs (simultaneously or sequentially), GLP-1 RAs, or basal insulin were selected (date of initiation was termed the ‘index date’); patients were required to have HbA1c > 7.0% in the 6 months pre-index date. HbA1c was compared from 6 months pre- to 1-year post-index. Annual all-cause healthcare utilization and costs were reported over the 1-year follow-up period.ResultsData for 6054 patients were analyzed (2-OAD, n = 4442; GLP-1 RA, n = 361; basal insulin, n = 1251). Baseline HbA1c was high in all cohorts, but highest in the basal-insulin cohort. Treatment initiation resulted in reductions in HbA1c in all cohorts, which was generally maintained throughout the follow-up period. Average HbA1c reductions from the 6 months pre- to 1 year post-index date were −1.2% for GLP-1 RA, −1.6% for OADs, and −1.8% for basal insulin. HbA1c < 7.0% at 1 year occurred in 32.6%, 47.5%, and 41.1% of patients, respectively. Annual healthcare costs (mean [SD]) were lowest for OAD (US$10,074 [$22,276]) followed by GLP-1 RA (US$14,052 [$23,829]) and basal insulin (US$18,813 [$37,332]).ConclusionDespite robust HbA1c lowering following treatment initiation, many patients did not achieve HbA1c < 7.0%. Basal insulin, generally prescribed for patients with high baseline HbA1c, was associated with a large reduction in HbA1c and with higher costs. Therapy intensification at an appropriate time could lead to clinical and economic benefits and should be investigated further.FundingSanofi U.S., Inc.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0429-x) contains supplementary material, which is available to authorized users.

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The Evaluation of Clinical and Cost Outcomes Associated with Earlier Initiation of Insulin in Patients with Type 2 Diabetes Mellitus

Cited by 11 publications

References 49 publications

RhGLP-1 (7–36) protects diabetic rats against cerebral ischemia-reperfusion injury via up-regulating expression of Nrf2/HO-1 and increasing the activities of SOD

RhGLP-1 (7–36) protects diabetic rats against cerebral ischemia-reperfusion injury via up-regulating expression of Nrf2/HO-1 and increasing the activities of SOD

Health Outcomes Associated with Initiation of Basal Insulin After 1, 2, or ≥ 3 Oral Antidiabetes Drug(s) Among Managed Care Patients with Type 2 Diabetes

Treatment Intensification in Type 2 Diabetes: A Real-World Study of 2-OAD Regimens, GLP-1 RAs, or Basal Insulin

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