title: Glycemic control and long-acting insulin analog utilization in patients with type 2 diabetes.
abstract: BACKGROUND
  The objective was to compare glycemic control, insulin utilization, and body weight in patients with type 2 diabetes (T2D) initiated on insulin detemir (IDet) or insulin glargine (IGlar) in a real-life setting in the Netherlands.
  
  
  METHODS
  Insulin-naïve patients with T2D, starting treatment with IDet or IGlar between January 1, 2004 and June 30, 2008, were selected from the PHARMO data network. Glycemic control (hemoglobin A1c [HbA1c]), target rates (HbA1c <7%), daily insulin dose, and weight gain were analyzed comparing IDet and IGlar for patients with available HbA1c levels both at baseline and at 1-year follow-up. Analysis of all eligible patients (AEP) and a subgroup of patients without treatment changes (WOTC) in the follow-up period were adjusted for patient characteristics, propensity scores, and baseline HbA1c.
  
  
  RESULTS
  A total of 127 IDet users and 292 IGlar users were included in the WOTC analyses. The mean HbA1c dropped from 8.4%-8.6% at baseline to 7.4% after 1 year. Patients at HbA1c goal increased from 9% at baseline to 32% for IDet and 11% to 35% for IGlar, which was not significantly different (OR 0.75, 95% CI 0.46, 1.24). Weight gain (n=90) was less among IDet users (+0.4 kg) than among IGlar users (+1.1 kg), albeit not significant. The AEP analysis (252 IDet + 468 IGlar users) showed similar results with 33%-36% at goal (OR 0.81, 95% CI 0.57, 1.16), and median daily insulin doses of 25 IU/day (P=0.70).
  
  
  CONCLUSIONS
  There was no significant difference between users of IDet and IGlar with respect to glycemic control and insulin dose in a real-life setting. The low proportion of patients on target at baseline may indicate that insulin therapy is initiated too late. Moreover, the observation that one-third of the patients reached HbA1c target at follow-up may indicate that basal insulin analogs are not titrated intensively enough.
authors.affiliation: PHARMO Institute, Utrecht, The Netherlands. edith.heintjes@pharmo.nl
authors.forename: Edith M
authors.initials: EM
authors.lastname: Heintjes
authors.forename: Trine L
authors.initials: TL
authors.lastname: Thomsen
authors.forename: Fernie J A
authors.initials: FJ
authors.lastname: Penning-van Beest
authors.forename: Torsten E
authors.initials: TE
authors.lastname: Christensen
authors.forename: Ron M C
authors.initials: RM
authors.lastname: Herings
mesh_terms: D000368:Aged; D001835:Body Weight / Q000187:drug effects; D015331:Cohort Studies; D003692:Delayed-Action Preparations; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004363:Drug Utilization; D005260:Female; D006442:Glycated Hemoglobin / Q000031:analogs & derivatives / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D003692:Delayed-Action Preparations; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; C025617:glucosylated hemoglobin A