gms | German Medical Science

16th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

19.11. - 20.11.2009, Berlin

Persistence with basal supported oral therapy – comparison of insulin glargine versus NPH insulin

Meeting Abstract

  • corresponding author Renate Quinzler - GIDE – German Institute for Drug Use Evaluation (DAPI), Eschborn, Germany
  • Miriam Ude - Department of Pharmacology, Goethe-University, Frankfurt, Germany
  • Alexandra Franzmann - GIDE – German Institute for Drug Use Evaluation (DAPI), Eschborn, Germany
  • Sandra Feldt - GIDE – German Institute for Drug Use Evaluation (DAPI), Eschborn, Germany
  • Katrin Schüssel - GIDE – German Institute for Drug Use Evaluation (DAPI), Eschborn, Germany
  • Kristina Leuner - Department of Pharmacology, Goethe-University, Frankfurt, Germany
  • Walter E. Mueller - Department of Pharmacology, Goethe-University, Frankfurt, Germany
  • F. W. Dippel - Sanofi-Aventis Germany, Berlin, Germany
  • Martin Schulz - ABDA – Federal Union of German Associations of Pharmacists, Berlin, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 16. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Berlin, 19.-20.11.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09gaa02

DOI: 10.3205/09gaa02, URN: urn:nbn:de:0183-09gaa021

Published: November 5, 2009

© 2009 Quinzler et al.
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Outline

Text

Background and aim: To assess the persistence of type 2 diabetic patients treated with basal supported oral therapy with insulin glargine (GLA) compared to NPH insulin (NPH).

Material and method: We performed a retrospective cohort study using claims data for ambulatory prescriptions within the German statutory health-insurance scheme (GKV), based on a representative sample of more than 80% of German community pharmacies. Insulin-naive patients treated with oral antidiabetic drugs (OAD) who were additionally initiating therapy with GLA or NPH between 01/2003 and 12/2006 were included and followed up until 12/2007. Persistence was defined as the duration of time from initiation of GLA or NPH until switching to intensified conventional insulin therapy (ICT). A switch to ICT was assumed whenever a short-acting insulin was prescribed for the first time followed by at least one prescription of a long-acting insulin within six months. Univariate and multivariate proportional hazards models were used to compare both cohorts.

Results: In total, 97,998 patients (61,070 GLA and 36,928 NPH) were included. Within the observation period, 23.5% of GLA patients and 28.0% of NPH patients switched to ICT. On average, these patients stayed 388 days on GLA and 313 days on NPH, respectively (p<0.001, log-rank test). The risk of switching to ICT was significantly higher for NPH patients compared to GLA patients (unadjusted hazard ratio [HR] 1.34 (99% CI: 1.29–1.38)). After adjustment for predefined covariables i.e., type of physician (general practitioner vs. specialist), region, insurance status (member, family member, retired), health insurance company, comedication, number of OAD, dose of basal insulin, the risk for NPH patients remained significantly higher (adjusted HR: 1.22 (99% CI: 1.18–1.27)).

Conclusions: Type 2 diabetic patients under basal supported oral therapy treated with GLA stay significantly longer on initial therapy until they switch to ICT when compared to NPH.