title: Treatment duration (persistence) of basal insulin supported oral therapy (BOT) in Type-2 diabetic patients: comparison of insulin glargine with NPH insulin.
abstract: OBJECTIVE
  To compare the persistence (treatment duration) of basal insulin supported oral therapy (BOT) using insulin glargine (GLA) or NPH insulin (NPH) in Type-2 diabetic patients.
  
  
  METHODS
  This retrospective cohort study reports results from an analysis of claims data from prescriptions for ambulatory patients within the German Statutory Health Insurance scheme. The study is based on claims data from more than 80% of German community pharmacies. Treatment duration until switching to a basal bolus treatment regimen (intensified conventional insulin therapy: ICT) was determined in insulin-naïve patients who began treatment with BOT using GLA or NPH between 01/2003 and 12/2006.
  
  
  RESULTS
  A total of 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 from BOT to ICT. The upper quartile of probability of continuation of therapy (the 75th percentile) was reached after 769 days in GLA patients and after 517 days in NPH patients. Therefore, the risk of switching to ICT was significantly higher with NPH compared to GLA: hazard ratios were 1.34 (99% CI: 1.29-1.38; unadjusted) and 1.22 (99% CI: 1.18-1.27) after adjustment for predefined covariates. Various sensitivity analyses using modified inclusion criteria and endpoint definitions were applied and these confirmed the initial results.
  
  
  CONCLUSIONS
  Type-2 diabetic patients under BOT with GLA stayed significantly longer on the initial therapy before switching to ICT than patients on BOT using NPH.
authors.affiliation: DAPI-German Institute for Drug Use Evaluation, Eschborn, Germany. info@dapi.de
authors.forename: Renate
authors.initials: R
authors.lastname: Quinzler
authors.forename: Miriam
authors.initials: M
authors.lastname: Ude
authors.forename: Alexandra
authors.initials: A
authors.lastname: Franzmann
authors.forename: Sandra
authors.initials: S
authors.lastname: Feldt
authors.forename: Katrin
authors.initials: K
authors.lastname: Schüssel
authors.forename: Kristina
authors.initials: K
authors.lastname: Leuner
authors.forename: Walter E
authors.initials: WE
authors.lastname: Müller
authors.forename: Franz-Werner
authors.initials: FW
authors.lastname: Dippel
authors.forename: Martin
authors.initials: M
authors.lastname: Schulz
mesh_terms: D000284:Administration, Oral; D015331:Cohort Studies; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005858:Germany; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000069036:Insulin Glargine; D007336:Insulin, Isophane / Q000008:administration & dosage / Q000627:therapeutic use*; D049528:Insulin, Long-Acting / Q000008:administration & dosage / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; D007336:Insulin, Isophane