Method: This longitudinal retrospective study examined two independent cohorts from two large national healthcare administrative databases (commercial [IMPACT®] and Medicare [Humana]). Included were adult patients with T2DM (aged ≥ 18 years for IMPACT and ≥ 65years for Humana) previously treated with insulin glargine and either switched to insulin detemir (DET-S) or continuing on insulin glargine (GLA-C). One-year follow-up outcomes were compared between DET-S and GLA-C patients, including treatment persistence and adherence, hemoglobin A1c (A1C), hypoglycemia, healthcare utilization and costs. Selection bias was minimized by propensity score matchings with 1: up to 5 ratios, balancing the two groups’ baseline demographic, clinical, and economic characteristics in each cohort.
Result: A total of 13,882 eligible patients were identified (IMPACT cohort: DET-S 581, GLA-C 8,094; Humana cohort: DET-S 277, GLA-C 4,930), with 4,722 patients included after matching (IMPACT cohort: DET-S 536, GLA-C 2,668; Humana cohort: DET-S 256, GLA-C 1,262). Baseline characteristics were similar between matched groups in each cohort. During 1-year follow-up GLA-C showed significantly higher persistence and adherence rates in both cohorts (P<0.001). A significant portion (33–40%) of DET-S patients restarted insulin glargine and more DET-S patients were on rapid-acting insulin (P<0.01). At end of 1-year follow-up, GLA-C patients had significantly lower A1C and were more likely to achieve A1C <7% or <8% (P<0.05). Overall hypoglycemia rates were higher for GLA-C than for DET-S in the Humana cohort (16% vs 11% , P<0.05), but similar in the IMPACT cohort (11% vs 12%). Severe (hospital/emergency department-related) hypoglycemia rate was low for GLA-C and DET-S in both cohorts, with no significant differences. Healthcare utilization and total costs were similar between groups, but GLA-C had significantly lower diabetes drug costs.
Conclusion: This real-world study suggested that among patients with T2DM previously treated with insulin glargine, compared with switching to insulin detemir, continuing on insulin glargine was associated with better persistence and adherence and improved clinical outcomes. Additionally, a significant portion of DET-S patients restarted insulin glargine and more of them added rapid acting insulin. These findings need to be further validated by randomized pragmatic trials but also need to be considered when implementing therapeutic interchange programs.
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