gms | German Medical Science

15th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

20.11. - 21.11.2008, Bonn

Basal insulins (e.g. glargine) combined with oral antidiabetics are most commonly used to initiate insulin therapy in type-2-diabetes patients in Germany

Basalinsuline in Kombination mit oralen Antidiabetika stellen den häufigsten Einstieg in die Insulintherapie bei Patienten mit Typ-2-Diabetes dar

Meeting Abstract

  • Franz-Werner Dippel - Sanofi-Aventis Deutschland, Frankfurt, Germany
  • Karel Kostev - IMS Health, Health Economics & Outcomes Research, Nürnberg, Germany
  • Christiane Kogler - IMS Health, Health Economics & Outcomes Research, Nürnberg, Germany
  • corresponding author Wioletta Kotowa - IMS Health, Health Economics & Outcomes Research, Nürnberg, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 15. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Bonn, 20.-21.11.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. Doc08gaa22

The electronic version of this article is the complete one and can be found online at:

Published: November 6, 2008

© 2008 Dippel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background and aim: It is still unknown which regimen is best for initiating insulin therapy (IT) in type-2-diabetes. Hence, the aim of this study was to compare the effectiveness of basal insulins such as glargine (GLA), detemir (DET) or human insulin (NPH) added to oral antidiabetic drugs (OAD), premixed insulin (MIX) and short-acting insulins (SHORT) to initiate IT. Furthermore, duration of medication until initiating IT (“time to insulin, TTI”) and distribution of treatment regimens in Germany were assessed in 2007 and compared to 2000/2004.

Material and method: This analysis utilizes a representative database (IMS® Disease Analyzer) based on patient consultation data from 1,004 practices. 2,303 patients with type-2-diabetes on OAD who have started IT in 2004-2007 were included. Metabolic control was determined as an averaged difference between HbA1c values before and 183-360 days after beginning IT. TTI was defined as duration of taking OAD before starting IT.

Results: Mean HbA1c values were significantly reduced by GLA (8.41% to 7.55%, p<0.001), NPH (8.03% to 7.47%, p<0.001), MIX (8.86% to 7.75%, p<0.002) and SHORT (7.99% to 7.17%, p<0.001). No significant difference was found for DET (8.20% to 7.87%, p=0.14) due to the small number of patients. Among basal insulins added to OAD GLA showed proportionally the highest HbA1c reduction (10.2%) followed by NPH (7.0%) and DET (4.0%). In regression analyses there was a significant stronger HbA1c reduction by GLA vs. NPH (p=0.002) and GLA vs. DET (p=0.003).

IT with GLA was started earlier compared to MIX and NPH in 2007 than in 2000 (-279, -111 and -68 days, respectively). In contrast, TTI with DET and SHORT was delayed (+519 and +67 days, respectively) in 2007 compared to 2004/2000. Currently the most common insulin regimen is GLA added to OAD (31.6% in 2007 vs. 5.8% in 2000). GLA added to OAD replaced MIX as a leading IT (28.8% in 2007 vs. 75.5% in 2000).

Conclusion: Adding basal insulins to OAD has been shown to be a successful insulin initiation strategy under real life conditions. Insulin glargine exerts stronger HbA1c reduction than NPH or DET and is used earlier in the medical practice.