Persistence with Basal Insulin and Frequency of Hypoglycemia Requiring Hospitalization in Patients with Type 2 Diabetes

• Published in: Diabetes therapy Vol. 11; no. 8; pp. 1861 - 1872
• Main Authors: Roussel, Ronan, Detournay, Bruno, Boultif, Zahra, Bahloul, Amar, Teissier, Clement, Charbonnel, Bernard
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.08.2020; Springer; Springer Nature B.V
• Subjects: Cardiology; Diabetes; Drug therapy; Endocrinology; Hospital patients; Hospitalization; Hypoglycemia; Insulin; Insulin glargine; Internal Medicine; Medicine; Medicine & Public Health; Original Research; Patient outcomes; Patients; Risk factors; Statistics; Type 2 diabetes; France; Medication persistence; Basal insulin; Type 2 diabetes mellitus; Hypoglycemia; Claims analyses
• ISSN: 1869-6953; 1869-6961
• DOI: 10.1007/s13300-020-00874-2

Introduction A second-generation basal insulin analogue insulin glargine 300 U/mL (Gla-300) has been marketed in France since June 2016. This real-world study was designed to assess persistence with Gla-300 and the prevalence of related hypoglycemia requiring hospitalization as compared to first-generation basal insulins, in patients with type 2 diabetes mellitus (T2DM). Methods A retrospective study was conducted using data in the large French comprehensive national healthcare system claims databases. Patients with T2DM newly treated with insulin in 2016 and 2017 (2-year period) were included. Three basal insulins [Gla-300, glargine 100 U/mL (Gla-100; both branded and biosimilar) and insulin detemir (IDet)] were compared for (1) persistence until treatment discontinuation using adjusted Cox models and (2) hypoglycemia requiring hospitalization over the period of insulin exposure. Results During the 2-year study period, in France, 181,263 patients initiated basal insulin therapy (in a basal scheme or a more complex insulin scheme), of whom 74% initiated Gla-100, 14.2% initiated IDet and 11.8% initiated Gla-300. Patient characteristics varied according to the insulin regimen in terms of age, gender, social coverage, insulin scheme, and Charlson Comorbidity Index. Overall, 72% of patients were still treated with any basal insulin after 1 year (75% in basal scheme). In all insulin treatment regimens, patients were less likely to discontinue Gla-300 as compared to Gla-100 [adjusted odds ratio (OR) 0.39, 95% confidence interval (CI) 0.37–0.41], with similar results when only the basal scheme was considered (adjusted OR 0.38, 95% CI 0.35–0.40). Persistence with IDet was similar to that with Gla-100. Patients treated with Gla-100 had higher crude hospitalization rates for hypoglycemia than those receiving Gla-300 (1.4 for 100 patients-years; OR 0.67, 95% CI 0.55–0.81); however, this difference was not statistically significant after adjustment for patient characteristics. Emergency Room (ER) visits were less frequent in patients treated with Gla-300 versus Gla-100 with or without adjustment for patient characteristics ( p  < 0.0001). Conclusion Real-world persistence for basal insulin therapy in patients with T2DM was significantly better in those on Gla-300 compared with those on Gla-100 and IDet. A trend to a lower frequency of hospitalization for hypoglycemia and ER visits, whatever the cause, was also observed in patients on Gla-300.