INTENSIFICATION OF BASAL INSULIN TREATMENT AMONG PATIENTS WITH DIABETES MELLITUS TYPE 2 IN THE NETHERLANDS
Author(s)
Overbeek J1, Houben E1, Kring S2, Sommer J3, Penning-van Beest F1, van der Heijden A4, Nijpels G4, Herings R1
1PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands, 2Novo Nordisk Scandinavia AB, Copenhagen, Denmark, 3Novo Nordisk B.V, Alphen a/d Rijn, The Netherlands, 4EMGO Institute, VU Medical Centre, Amsterdam, The Netherlands
OBJECTIVES: To characterise type 2 diabetes (T2DM) patients in the Netherlands initiating basal insulin and those intensifying treatment. METHODS: Antidiabetic dispensing records were obtained from the Out-patient Pharmacy Database of the PHARMO Database Network. New users, i.e. first-time dispensing, of basal insulin only were selected between 2007-2012. Treatment intensification was defined as either add-on of GLP-1, bolus insulin or DPP-4i or switch to premixed insulin. Demographics and HbA1c before basal insulin start (pre-insulin), at intensification and post- intensification were assessed including time to intensification. RESULTS: A total of 15,986 T2DM patients initiating basal insulin only (median (IQR) age at start basal insulin: 65 (55-74) years, 52% male, 87%, 75% and 51% had a pre-insulin HbA1c >53, >58 and >64 mmol/mol, respectively). Overall, 4,945 patients (31%) intensified treatment during a median follow-up of 14 months (median (IQR) age at start basal insulin: 63 (53-73) years, 50% male, 88%, 78% and 54% had an HbA1c at intensification >53, >58 and >64 mmol/mol, respectively). Intensification mostly was add-on of bolus insulin (58%) or switch to premixed insulin (39%). Median (IQR) time to intensification was 8 (2-15) months. Among patients with an HbA1c >53, >58 and >64 mmol/mol at intensification, median (IQR) time to intensification was 12 (5-23), 12 (5-22) and 12 (5-22) months, respectively. Post-intensification, 32%, 52% and 73% of the patients attained an HbA1c of ≤53, ≤58 and ≤64 mmol/mol, respectively, with median reduction in HbA1c of 6 mmol/mol. CONCLUSIONS: About one third of T2DM patients initiating basal insulin intensified their treatment leading to glycemic goal attainments of HbA1c ≤53, ≤58 and ≤64 mmol/mol in 32%, 52% and 73% of patients, respectively. Further research might provide more information on the underlying reasons and potential barriers for intensifying versus not intensifying, such as patient characteristics, co-medication, treatment complexity and occurrence of hypoglycaemic events.
Conference/Value in Health Info
2015-11, ISPOR Europe 2015, Milan, Italy
Value in Health, Vol. 18, No. 7 (November 2015)
Code
PDB113
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care
Topic Subcategory
Health Care Research, Prescribing Behavior, Public Health, Treatment Patterns and Guidelines
Disease
Diabetes/Endocrine/Metabolic Disorders