title: Treatment persistence after initiating basal insulin in type 2 diabetes patients: A primary care database analysis.
abstract: OBJECTIVE
  To compare persistence and its predictors in type 2 diabetes patients in primary care, initiating either basal supported oral therapy (BOT) or intensified conventional therapy (ICT) with glargine, detemir, or NPH insulin.
  
  
  METHODS
  In the BOT cohort, 1398 glargine (mean age: 68 years), 292 detemir (66 years), and 874 NPH (65 years) users from 918 practices were retrospectively analyzed (Disease Analyzer, Germany: 2008-2012). The ICT group incorporated 866 glargine (64 years), 512 detemir (60 years), and 1794 NPH (64 years) new users. Persistence was defined as proportion of patients remaining on the initial basal insulin (glargine, detemir and NPH insulin) over 2 years. Persistence was evaluated by Kaplan-Meier curves (log-rank tests) and Cox regression adjusting for age, sex, diabetes duration, antidiabetic co-therapy, comorbidities, specialist care, and private health insurance.
  
  
  RESULTS
  In BOT, two-year persistence was 65%, 53%, and 59% in glargine, detemir, and NPH users, respectively (p<0.001). In ICT, persistence was higher without differences between groups: 84%, 85%, 86% in glargine, detemir, and NPH, respectively (p=0.536). In BOT, detemir and NPH users were more likely to discontinue basal insulin compared with glargine (detemir vs. glargine: adjusted Hazard Ratio; 95% CI: 1.56; 1.31-1.87; NPH vs. glargine: 1.22; 1.07-1.38). Heart failure (1.39; 1.16-1.67) was another predictor of non-persistence, whereas higher age (per year: 0.99; 0.98-0.99), metformin (0.61; 0.54-0.69), and sulfonylurea co-medication (0.86; 0.77-0.97) were associated with lower discontinuation.
  
  
  CONCLUSIONS
  In BOT, treatment persistence among type 2 diabetes patients initiating basal insulin is influenced by type of insulin, antidiabetic co-medication, and patient characteristics.
authors.affiliation: Klinisches Diabeteszentrum Süd-Ostbayern, Traunstein, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Pscherer
authors.affiliation: Sanofi-Aventis, NJ, USA.
authors.forename: Engels
authors.initials: E
authors.lastname: Chou
authors.affiliation: Sanofi-Aventis Deutschland GmbH, Berlin, Germany.
authors.forename: Franz-Werner
authors.initials: FW
authors.lastname: Dippel
authors.affiliation: Institute of Biometrics and Epidemiology, German Diabetes Center, Duesseldorf, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rathmann
authors.affiliation: IMS HEALTH, Frankfurt, Germany. Electronic address: kkostev@de.imshealth.com.
authors.forename: Karel
authors.initials: K
authors.lastname: Kostev
mesh_terms: D000284:Administration, Oral; D000368:Aged; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005858:Germany; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D000069057:Insulin Detemir / Q000008:administration & dosage*; D000069036:Insulin Glargine / Q000008:administration & dosage*; D007336:Insulin, Isophane / Q000008:administration & dosage*; D053208:Kaplan-Meier Estimate; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D011320:Primary Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; D000069057:Insulin Detemir; D007336:Insulin, Isophane
keywords: Basal insulin; Insulin initiation; Persistence; Primary care; Type 2 diabetes