REAL-WORLD INSULIN THERAPY IN GERMAN TYPE 2 DIABETES MELLITUS PATIENTS- PATIENT CHARACTERISTICS, TREATMENT PATTERNS AND INSULIN DOSAGE
Author(s)
Gabler M1, Geier S2, Försch J2, Picker N3, Müller S3, Aberle J4, Martin S5, Riedl M6, Wilke T7
1Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany, 2Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany, 3Ingress-Health HWM GmbH, Wismar, Germany, 4Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany, 5Westdeutsches Diabetes- und Gesundheitszentrum (WDGZ), Düsseldorf, Germany, 6medicum Hamburg MVZ GmbH, Hamburg, Germany, 7IPAM, University of Wismar, Wismar, Germany
OBJECTIVES A substantial share of type 2 diabetes mellitus (T2DM) patients receives insulin. However, little is known about the real-world treatment patterns around insulin initiation. METHODS This was a retrospective claims data analysis. T2DM patients who initiated an insulin therapy between 01/01/2013 and 31/12/2015 were identified in the German AOK PLUS dataset. For validation of results, additional data on a similar T2DM patient population were collected in a Germany-wide medical chart review. RESULTS 284,878 T2DM patients were identified. 27,340 (9.6%) of these initiated an insulin treatment during the inclusion period (mean age: 72.2 years; 51.4% female). Mean/median weight | BMI of patients with available clinical data was 85.8/84.0 kg (SD:18.9) | 30.6/29.8 kg/m2 (SD:6.1) at baseline. Mean/median HbA1c-value at baseline was 8.4/8.0% (SD: 1.8). Most commonly prescribed antidiabetic drugs (AD) within 6 months before insulin initiation were metformin (MET; 54.0%), DPP-4 inhibitors (DPP-4i; 37.6%) and sulfonylureas (SU; 29.5%). 23.2% of patients did not receive any AD prescription within 6 months before insulin initiation. 10,953 of above 27,340 insulin starters (40.1%) initiated their insulin therapy without concomitant ADs (insulin monotherapy); 43% of these patients did not receive any AD before insulin initiation. Of the remaining 16,387 patients (59.9%), 4,070 patients (14.9%) received MET only as concomitant AD, 6,385 (23.4%) received MET plus at least one further AD, and 5,932 (21.7%) received at least one further AD excluding MET. Throughout the first year of treatment, prescribed insulin dosage increased over time, resulting in approximately 43.3-77.9 IUs per observed patient day after 12 months of insulin treatment. CONCLUSIONS Characteristics of German T2DM patients initiating insulin deviate substantially from the average German population, especially in terms of weight. We identified an unexpectedly high number of patients without previous AD therapy receiving insulin monotherapy, which is not in line with the clinical guidelines.
Conference/Value in Health Info
2019-11, ISPOR Europe 2019, Copenhagen, Denmark
Code
PDB122
Topic
Clinical Outcomes, Health Service Delivery & Process of Care
Topic Subcategory
Clinician Reported Outcomes, Treatment Patterns and Guidelines
Disease
Diabetes/Endocrine/Metabolic Disorders