title: A real-world study of treatment patterns and outcomes in US managed-care patients with type 2 Diabetes initiating injectable therapies.
abstract: Examine real-world outcomes in patients with type 2 diabetes mellitus (T2DM) initiating injectable therapy as part of the Initiation of New Injectable Treatment Introduced after Antidiabetic Therapy with Oral-only Regimens (INITIATOR) study.
  
  
  
  Linked insurance claims and medical record data were collected from 2 large US health insurers (April 1, 2010 to March 31, 2012) of T2DM adults initiating treatment with glargine (GLA) or liraglutide (LIRA). Baseline characteristics were examined and changes in 12-month follow-up outcomes were described for both treatment groups: HbA1c, weight change, hypoglycaemia, persistence, healthcare utilisation and costs.
  
  
  
  A total of 4490 patients were included (GLA, 2116; LIRA, 2374). At baseline, GLA patients had significantly higher HbA1c vs LIRA patients (9.72% vs 8.19%; P < .001), lower likelihood of having HbA1c < 7% (7.1% vs 23.8%; P < .001), lower bodyweight (100.9 kg vs 110.9 kg, P < .001), higher Charlson Comorbidity Index score (0.88 vs 0.63; P < .001), and higher diabetes-related costs ($3492 vs $2089; P < .001), respectively. During 12-months of follow-up, treatment persistence was 64%, mean HbA1c reduction was -1.24% and weight change was + 1.17 among GLA patients, and was 49%, -0.51% and -2.74 kg, respectively, among LIRA patients. Diabetes-related costs increased significantly from baseline to follow-up for LIRA patients ($2089 vs $3258, P < .001) but not for GLA patients ($3492 vs $3550, P = .890).
  
  
  
  There were clinically relevant baseline differences in both groups, suggesting that GLA and LIRA are prescribed for different patient groups, and highlighting that efficacy results from clinical trials do not always translate into real-world practice. Significant increases in healthcare costs were observed in the LIRA group, warranting further cost-effectiveness analysis.
authors.affiliation: Sanofi US, Inc., Bridgewater, New Jersey.
authors.forename: Wenhui
authors.initials: W
authors.lastname: Wei
authors.affiliation: Optum, Eden Prairie, Minnesota.
authors.forename: Erin
authors.initials: E
authors.lastname: Buysman
authors.affiliation: HealthCore, Inc., Wilmington, Delaware.
authors.forename: Michael
authors.initials: M
authors.lastname: Grabner
authors.affiliation: STATinMED Research, Ann Arbor, Michigan.
authors.forename: Lin
authors.initials: L
authors.lastname: Xie
authors.affiliation: Optum, Eden Prairie, Minnesota.
authors.forename: Lee
authors.initials: L
authors.lastname: Brekke
authors.affiliation: HealthCore, Inc., Wilmington, Delaware.
authors.forename: Xuehua
authors.initials: X
authors.lastname: Ke
authors.affiliation: Monterey Endocrine & Diabetes Institute, Monterey, California.
authors.forename: James W
authors.initials: JW
authors.lastname: Chu
authors.affiliation: MODEL Clinical Research, Baltimore, Maryland.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Levin
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001786:Blood Glucose / Q000378:metabolism; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000378:metabolism; D017048:Health Care Costs; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D000069036:Insulin Glargine / Q000191:economics / Q000627:therapeutic use; D000069450:Liraglutide / Q000191:economics / Q000627:therapeutic use; D008329:Managed Care Programs; D055118:Medication Adherence; D016896:Treatment Outcome; D014481:United States
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human; D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; D000069450:Liraglutide
keywords: basal insulin; database research; incretin therapy; observational study; type 2 diabetes