title: Clinical and Economic Outcomes Associated With the Timing of Initiation of Basal Insulin in Patients With Type 2 Diabetes Mellitus Previously Treated With Oral Antidiabetes Drugs.
abstract: OBJECTIVE
  In patients with type 2 diabetes mellitus (T2DM) not achieving glycemic targets using oral antidiabetes drugs (OADs), studies suggest that timely insulin initiation has clinical benefits. Insulin initiation at the early versus late stage of disease progression has not been explored in detail. This retrospective database analysis investigated clinical and economic outcomes associated with the timing of insulin initiation in patients with T2DM treated with ≥1 OAD in a real-world US setting.
  
  
  METHODS
  This study linked data from the Truven Health MarketScan(®) Commercial database, Medicare Supplemental database, and Quintiles Electronic Medical Records database. A total of 1830 patients with T2DM were included. Patients were grouped according to their OAD use before basal insulin initiation (1, 2, or ≥3 OADs) as a proxy for the timing of insulin initiation. Clinical and economic outcomes were evaluated over 1 year of follow-up.
  
  
  RESULTS
  During follow-up the 1 OAD group, compared with the 2 and ≥3 OADs groups, had a greater reduction in glycosylated hemoglobin A1c (-1.7% vs -1.0% vs -0.9%, respectively; P < 0.0001), greater achievement of glycemic target (38.2% vs 26.7% vs 19.6%, respectively; P < 0.0001), and a lower incidence of hypoglycemia (2.7% vs 6.6% vs 5.0%, respectively; P = 0.0002), with no difference in total health care costs ($21,167 vs $21,060 vs $20,133, respectively).
  
  
  CONCLUSIONS
  This study shows that early insulin initiation (represented by the 1 OAD group) may be clinically beneficial to patients with T2DM not controlled with OADs, without adding to costs. This supports the call for timely initiation of individualized insulin therapy in this population.
authors.affiliation: MODEL Clinical Research, Towson, Maryland. Electronic address: pal3420@yahoo.com.
authors.forename: Philip
authors.initials: P
authors.lastname: Levin
authors.affiliation: Sanofi US, Bridgewater, New Jersey.
authors.forename: Steve
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Truven Health Analytics, Ann Arbor, Michigan.
authors.forename: Emily
authors.initials: E
authors.lastname: Durden
authors.affiliation: Truven Health Analytics, Ann Arbor, Michigan.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Farr
authors.affiliation: Sanofi US, Bridgewater, New Jersey.
authors.forename: Jasvinder
authors.initials: J
authors.lastname: Gill
authors.affiliation: Sanofi US, Bridgewater, New Jersey.
authors.forename: Wenhui
authors.initials: W
authors.lastname: Wei
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects / Q000378:metabolism; D017048:Health Care Costs; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: early insulinization; economic outcomes; insulin initiation; type 2 diabetes