title: Real-world outcomes of initiating insulin glargine-based treatment versus premixed analog insulins among US patients with type 2 diabetes failing oral antidiabetic drugs.
abstract: BACKGROUND
  In patients with type 2 diabetes mellitus, basal-bolus strategies can improve treatment by offering dosing flexibility, and improved satisfaction, adherence, and clinical outcomes. The purpose of this study was to compare real-world outcomes between US patients initiating analog insulin therapy with insulin glargine and those initiating with a premixed analog insulin (PMX).
  
  
  METHODS
  This was a retrospective study of data from patients (≥18 years) with type 2 diabetes mellitus in the IMPACT® database who initiated insulin treatment with insulin glargine (GLA) or a PMX. Clinical and economic outcomes were measured over one year, including persistence and adherence, consumption of insulin, glycemic outcomes, incident hypoglycemia, and health care resource utilization and cost.
  
  
  RESULTS
  Data from 2,502 patients were included in the analyses (n = 834 for PMX, n = 1,668 for GLA). Compared with PMX, persistence was higher and consumption of insulin was lower for GLA (both P < 0.0001). Adherence, glycemic outcomes, and hypoglycemia-related events were similar between groups, as were health care utilization and total health care costs. Diabetes-related drug and supply costs were lower for GLA than for PMX (P < 0.0001 and P = 0.046, respectively).
  
  
  CONCLUSIONS
  In US patients with type 2 diabetes mellitus, initiating insulin with once-daily GLA, rather than a PMX, is associated with increased treatment persistence and similar clinical and hypoglycemic outcomes, but lower diabetes pharmacy and supply costs. GLA may be a more flexible option than PMX. However, these results also show suboptimal glycemic control in the real-world setting despite change in treatment regimens and call for optimization in management of patients with type 2 diabetes mellitus.
authors.affiliation: STATinMED Research Inc, Ann Arbor, MI, NJ, USA ; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, NJ, USA.
authors.forename: Onur
authors.initials: O
authors.lastname: Baser
authors.forename: Krishna
authors.initials: K
authors.lastname: Tangirala
authors.forename: Wenhui
authors.initials: W
authors.lastname: Wei
authors.forename: Lin
authors.initials: L
authors.lastname: Xie
keywords: clinical outcomes; insulin glargine; premixed insulin; rapid acting insulin; treatment persistence; type 2 diabetes mellitus