title: Direct healthcare costs and clinical outcomes after insulin initiation in patients with type 2 diabetes mellitus in Spain: 24-month follow-up data from the INSTIGATE study.
abstract: OBJECTIVE
  The INSTIGATE study assessed healthcare costs and clinical outcomes in patients with type 2 diabetes mellitus starting insulin therapy in Spain over a 24-month follow up period.
  
  
  METHODS
  This was an observational, non-interventional, prospective, multicenter study. Costs incurred in the previous 6 months were assessed at each visit.
  
  
  RESULTS
  A total of 172 patients with a mean body mass index of 29.6 kg/m2, a mean [standard deviation] duration of diabetes of 10.9 [7.0] years and a hemoglobin A1c value of 9.2% [1.5%] were followed up for at least 12 and up to 24 months. Direct costs were assessed from the perspective of the Spanish healthcare system. Long/intermediate-acting insulin alone was started in 116 patients (67.4%). After 6, 12, and 24 months of insulin treatment, mean [SD] intraindividual changes from baseline in hemoglobin A1c were -1.9% [1.65%], -1.6 [1.73%], and -1.5% [1.76%] respectively. Mean (median) total diabetes-related healthcare costs per patient increased from €659 (€527) to €1.085 (€694) 6 months after insulin initiation, decreased to €646 (€531) after 12 months, and increased again after 24 months to €667(€539). Insulin/oral antidiabetics, primary/specialized care, and blood glucose monitoring accounted for 41%, 26%, and 19% of total cost at 24 months respectively.
  
  
  CONCLUSIONS
  Clinical parameters of these patients with type 2 diabetes mellitus improved following insulin initiation. After a temporary increase, direct healthcare costs of diabetes care returned to baseline values at the end of the follow-up period.
authors.affiliation: Departamento de Investigación de Resultados Sanitarios, Lilly, S.A. Alcobendas, Madrid, Spain. dilla_tatiana@lilly.com
authors.forename: Tatiana
authors.initials: T
authors.lastname: Dilla
authors.forename: Claudia
authors.initials: C
authors.lastname: Nicolay
authors.forename: María
authors.initials: M
authors.lastname: Alvarez
authors.forename: Jesús
authors.initials: J
authors.lastname: Reviriego
authors.forename: Alberto
authors.initials: A
authors.lastname: Goday
authors.forename: Conxa
authors.initials: C
authors.lastname: Castell
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics*; D004180:Direct Service Costs; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use*; D007328:Insulin / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin