Clinical and economic outcomes among patients with diabetes mellitus initiating insulin glargine pen versus vial.

Abstract

BACKGROUND:

Insulin pens may help patients reach glycated hemoglobin (HbA1c) target levels, but a substantial proportion of patients continue to use insulin vials/syringes. The objective of the current study was to evaluate real-world clinical and economic outcomes of patients with type 2 diabetes mellitus (T2DM) initiating insulin glargine via pen delivery (pen) or vial/syringe (vial) within a large managed-care population in the United States.

METHODS:

This retrospective administrative claims study used data on adult, insulin-naïve patients with T2DM treated with ≥ 1 oral antidiabetic or glucagon-like peptide-1 receptor agonist at baseline. The index date was the earliest pen or vial prescription date. Propensity score matching (1:1) of patients in the pen and vial cohorts was used when comparing 1-year outcomes, including treatment persistence and adherence, HbA1c levels, hypoglycemia rates, and all-cause and diabetes-related health care costs (computed as paid amounts on claims).

RESULTS:

Patients in the matched cohorts (n = 733 per cohort) were well balanced with regard to demographics (mean age 52 years; 43% women), clinical measures (mean HbA1c level, 9.4%; mean Quan-Modified Charlson Comorbidity Index score, 0.9), and health care utilization at baseline. Following initiation of insulin glargine, pen patients were more persistent (60.6% vs 50.1%; P < 0.001) and adherent (medication possession ratio, 0.73 vs 0.57; P < 0.001), with lower HbA1c levels during follow-up (mean adjusted change, -1.05 vs -0.73; P < 0.001), compared with vial patients. Hypoglycemic events occurred at similar rates across pen and vial cohorts (3.8% vs 5.2%, respectively; P = 0.21). Study drug costs were higher among pen users ($1164 vs $762, respectively; P < 0.001), but this did not translate into higher total all-cause or diabetes-related costs.

CONCLUSION:

For patients with diabetes newly initiating insulin glargine, using an insulin pen device was associated with increased therapy persistence and adherence, and lower HbA1c levels relative to vial/syringe, without increasing total all-cause or diabetes-related costs.

• Authors: Michael Grabner, James Chu, Swetha Raparla, Ralph Quimbo, Steve Zhou, Joseph Conoshenti
• Journal: Postgraduate medicine (Postgrad Med) Vol. 125 Issue 3 Pg. 204-13 (May 2013) ISSN: 1941-9260 [Electronic] England
• PMID: 23748521 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin, Long-Acting
• hemoglobin A1c protein, human
• Insulin Glargine

Topics

• Adolescent
• Adult
• Aged
• Delivery of Health Care (statistics & numerical data)
• Diabetes Mellitus, Type 2 (drug therapy, economics)
• Drug Costs (statistics & numerical data)
• Female
• Glycated Hemoglobin (analysis)
• Health Care Costs (statistics & numerical data)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Insulin Glargine
• Insulin, Long-Acting (administration & dosage, economics, therapeutic use)
• Logistic Models
• Male
• Medication Adherence
• Middle Aged
• Propensity Score
• Retrospective Studies
• Young Adult