title: Different persistence on initial basal supported oral therapy in Type 2 diabetics is associated with unequal distributions of insulin treatment regimens under real-life conditions in Germany.
abstract: OBJECTIVE
  Results from a representative German database and from two German health services research studies revealed an unequal distribution between basal supported oral therapy (BOT) and basal-bolus therapy (ICT) regimens in Type 2 diabetics treated with either insulin glargine (GLA) or human insulin (Neutral Protamine Hagedorn; NPH). This study assesses whether this unequal distribution could be caused by a different persistence on the initial BOT regimen.
  
  
  METHODS
  A Markov model was developed simulating the transition from BOT to ICT during a treatment course of 10 years. Data on persistence with BOT were obtained from the IMS® Disease Analyzer database. The model cohort consisted of German statutorily insured Type 2 diabetics starting a BOT either with insulin glargine or NPH insulin at a ratio of 1 : 1.
  
  
  RESULTS
  The number of Type 2 diabetics who switched from BOT to ICT differed between the two groups: After 2 years, 53% of glargine-treated patients and 31% of NPH-treated patients continued the BOT. After 6.5 years, all NPH-treated patients had switched to ICT. However, complete transition to ICT of glargine-treated patients occurred 1.75 years later. In the first quarter of Year 3, the model simulation resulted in BOT : ICT ratios comparable to those found in the real-world settings for GLA- and NPH-treated patients.
  
  
  CONCLUSIONS
  The simulation indicates that the persistence on the initial basal supported oral therapy is associated with the resulting BOT : ICT ratio. Therefore, the unequal distribution between BOT and ICT of Type 2 diabetics treated with either insulin glargine or NPH insulin might be caused by different persistence on the initial BOT regimen.
authors.affiliation: Evangelisches Bethesda-Johanniter-Klinikum GmbH, Duisburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Pfohl
authors.forename: F-W
authors.initials: FW
authors.lastname: Dippel
authors.forename: K
authors.initials: K
authors.lastname: Kostev
authors.forename: S
authors.initials: S
authors.lastname: Fuchs
authors.forename: W
authors.initials: W
authors.lastname: Kotowa
mesh_terms: D000284:Administration, Oral; D000368:Aged; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005858:Germany; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000069036:Insulin Glargine; D007336:Insulin, Isophane / Q000008:administration & dosage / Q000627:therapeutic use*; D049528:Insulin, Long-Acting; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; D007336:Insulin, Isophane