title: Patient characteristics, drug adherence patterns, and hypoglycemia costs for patients with type 2 diabetes mellitus newly initiated on exenatide or insulin glargine.
abstract: OBJECTIVE
  Examine real-world effectiveness and hypoglycemia cost burden in patients with type 2 diabetes newly initiated on exenatide or insulin glargine.
  
  
  METHODS
  Retrospective cohort study describing patient characteristics, drug adherence patterns, and 1-year hypoglycemia rates with associated costs using an administrative claims database. Adult subjects with type 2 diabetes had an initial claim for exenatide or insulin glargine between May 1, 2005 and June 30, 2007, and had continuous eligibility for >or= 6 months pre- and >or= 12 months post-initiation.
  
  
  RESULTS
  The exenatide cohort (n = 3262) was 53 +/- 10 years (+/-SD); 54% female. The insulin glargine cohort (n = 3038) was 56 +/- 12 years; 41% female. The mean Deyo-Charlson comorbidity index score was 1.45 for exenatide versus 1.82 for insulin glargine (p < 0.001). Baseline OAD use rates for exenatide and insulin glargine, respectively, were 77% versus 69% metformin; 47% versus 65% sulfonylurea; 50% versus 49% thiazolidinedione; 56% versus 60% multiple OAD. For patients with two or more pharmacy claims for exenatide or insulin glargine, the 12-month medication possession ratio (MPR) was 68 +/- 29% for exenatide and 58 +/- 28% for insulin glargine (p < 0.001). MPR >or= 80% was higher for exenatide (p < 0.001) and fewer patients discontinued therapy (p < 0.001). The probability of a hypoglycemic event was significantly lower for exenatide (p < 0.005), resulting in lower associated annual costs.
  
  
  CONCLUSIONS
  This study provides the first real-world observational comparison of type 2 diabetes patients newly initiated on exenatide or insulin glargine. Exenatide patients had a lower comorbidity burden, better drug adherence, and a lower rate of hypoglycemic events with associated costs. Retrospective database analyses examine medical care utilization in large populations using a relatively inexpensive and expedient approach. However, data are only representative of a commercial health-care plan with limited information on multiple variables usually collected during clinical trials.
authors.affiliation: Amylin Pharmaceuticals Inc, San Diego, CA, USA.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Fabunmi
authors.forename: Loretta L
authors.initials: LL
authors.lastname: Nielsen
authors.forename: Ralph
authors.initials: R
authors.lastname: Quimbo
authors.forename: Brock
authors.initials: B
authors.lastname: Schroeder
authors.forename: Derek
authors.initials: D
authors.lastname: Misurski
authors.forename: Matthew
authors.initials: M
authors.lastname: Wintle
authors.forename: Ron
authors.initials: R
authors.lastname: Wade
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D000077270:Exenatide; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000191:economics*; D007328:Insulin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D008297:Male; D010349:Patient Compliance; D010455:Peptides / Q000627:therapeutic use*; D012189:Retrospective Studies; D014688:Venoms / Q000627:therapeutic use*
chemical_list: D007328:Insulin; D049528:Insulin, Long-Acting; D010455:Peptides; D014688:Venoms; D000069036:Insulin Glargine; D000077270:Exenatide