Total costs of basal or premixed insulin treatment in 5077 insulin-naïve type 2 diabetes patients: register-based observational study in clinical practice.

BACKGROUND: To investigate the costs of treatment with basal insulin (insulin NPH [NPH], insulin glargine [IG], insulin determir [IG]), and premixed insulin (PM) in routine clinical care. METHODS: Cohort study based on data from the Swedish National Diabetes Register, including 5077 insulin-naïve men and women with type 2 diabetes, resident in a distinct geographical region of Sweden. Patients were included between 1 July 2006 and 31 December 2009 and followed for 12 months. All drug- and healthcare-related costs, stratified by diabetes-related or non-diabetes care contacts, were quantified and compared to baseline. RESULTS: Initiation of insulin treatment generally entails increased diabetes-related health care contacts and treatment costs, and decrease in health care costs. The median changes in costs were generally smaller than the mean changes, reflecting great variations between patients. The treatment costs were higher for IG, ID and PM compared with NPH, although higher age, history cardiovascular disease and diabetes complications as well as higher diabetes-related and other treatment costs were independent predictors. Overall, only PM (but not IG or ID) were associated with higher diabetes-related health care costs, although these were also independently predicted by cardiovascular morbidity and markers of complicated diabetes. CONCLUSIONS: This study demonstrates that the initiation of insulin in patients with type 2 diabetes in clinical practice leads to increased health care contacts, overall and treatment costs, but also generally results in a decrease in health care costs. The diabetes-related treatment cost was lowest using NPH insulin but only premixed insulin was associated with higher diabetes-related health care costs than NPH.

Metabolic effects of Basal or premixed insulin treatment in 5077 insulin-naïve type 2 diabetes patients: registry-based observational study in clinical practice.

INTRODUCTION: To investigate the clinical effects associated with premixed insulin (PM) and basal insulin [insulin NPH (NPH), insulin glargine (IG), insulin detemir (ID)], in insulin-naïve patients with type 2 diabetes in routine clinical care. MATERIALS AND METHODS: Cohort study based on data from the Swedish National Diabetes Register, including 5,077 patients, resident in the Western region of Sweden. Patients were included between 1 July 2006 and 31 December 2009 and followed for 12 months. Changes in HbA1c, body mass index (BMI) and required insulin doses were compared between the different insulin types. Covariance adjustments were performed to adjust for differences between the groups. RESULTS: NPH, IG, ID and PM were all associated with significant reductions in HbA1c, mean ± standard deviation ranged between 6.6 ± 17.4 mmol/mol (IG) and 8.9 ± 17.7 mmol/mol (NPH), during the 12 months of follow-up. There were no statistically significant differences in the magnitude of HbA1c reduction between the insulin types. PM required 59% higher and ID 25% higher insulin doses to achieve a similar HbA1c reduction as NPH. PM was associated with a significantly greater increase in BMI compared with NPH (p = 0.016), while IG and ID did not differ significantly from NPH. The number of patients experiencing severe hypoglycemia was low, but highest in patients treated with PM (p = 0.023). CONCLUSIONS: NPH, IG, ID and PM were found to be equally effective in lowering HbA1c in insulin-naïve patients with type 2 diabetes in routine clinical care in Sweden. The effects on weight, dose and treatment persistence support the recommendation of NPH or IG as first and second choices in this group of patients requiring initiation of insulin treatment.