title: Are insulin analogues detemir or glulisine used preferentially in overweight/obese subjects? A German multicentre analysis of 38560 type 2 diabetic patients from the DPV registry.
abstract: OBJECTIVE
  Several studies suggest benefits of insulin analogues detemir or glulisine in overweight and obese patients with type 2 diabetes. The present multicentre study therefore examines, whether these insulin analogues are used more frequently in patients with increased body mass index.
  
  
  METHODS
  Data of 38 560 adult type 2 diabetic patients using insulin analogues, from 150 centres in Germany, registered in a standardized, prospective, computer-based documentation program (DPV), were included. Patients were classified into body mass index categories according to World Health Organization. Analysis was stratified by 3 time periods. To adjust for confounding effects, multivariable logistic regression models were created.
  
  
  RESULTS
  Detemir was preferentially used in overweight (OR 1.36, 95%-CI 1.20-1.53) and obese patients (OR 2.06, 95%-CI 1.84-2.31) compared to normal-weight patients. These effects remained significant after adjusting for sex, age, new/old federal state of Germany, size of centre, treatment in university clinic and clinic/specialized private practice. Models were additionally adjusted for time period and interaction of BMI category with age or sex. For glulisine, a minor effect was present when comparing obese to normal-weight patients (OR 1.26, 95%-CI 1.06-1.50). After adjustment, this finding was no longer significant. Stratified by obesity grade, class III obese patients more frequently used detemir or glulisine compared to class I obese patients. Comparing time periods, odds ratios did not differ, neither for detemir nor for glulisine.
  
  
  CONCLUSIONS
  Detemir is used more often in overweight and obese patients compared to normal-weight patients. For glulisine, the relationship is less pronounced.
authors: Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
authors: B
authors: B
authors: Bohn
authors: Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
authors: N
authors: N
authors: Scheuing
authors: Department of Internal Medicine, Academic Hospital Paul Gerhardt Stift, Lutherstadt Wittenberg, Martin- Luther-University Halle-Wittenberg, Germany.
authors: P M
authors: PM
authors: Jehle
authors: Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Freiburg, Germany.
authors: K
authors: K
authors: Laubner
authors: Department of Diabetology and Infectiology, Medical Clinic I, Reutlingen, Germany.
authors: B
authors: B
authors: Born
authors: Division of Endocrinology, Diabetes and Metabolism, Graduate School of Molecular Diabetology and Endocrinology, Ulm University, Ulm, Germany.
authors: S
authors: S
authors: Merger
authors: Specialized Diabetes Practice, Rosenheim, Germany.
authors: M
authors: M
authors: Hummel
authors: Diabetes Centre Forchheim, Germany.
authors: D
authors: D
authors: Krakow
authors: Specialized Diabetes Practice, Traunstein, Germany.
authors: A
authors: A
authors: Voll
authors: Specialized Diabetes Practice, Bad Aibling, Germany.
authors: A
authors: A
authors: Zimmermann
authors: Department for General Internal Medicine, Endocrinology and Diabetes, HELIOS Kliniken Schwerin, Schwerin, Germany.
authors: S
authors: S
authors: Zimny
authors: Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
authors: R W
authors: RW
authors: Holl
mesh_terms: D000368:Aged; D001835:Body Weight; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D011307:Drug Prescriptions; D005260:Female; D005858:Germany; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000069057:Insulin Detemir; D049528:Insulin, Long-Acting / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D010818:Practice Patterns, Physicians'; D012042:Registries
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069057:Insulin Detemir; C479079:insulin glulisine