TY - JOUR
T1 - Impact of delaying treatment intensification with a glucagon-like peptide-1 receptor agonist in patients with type 2 diabetes uncontrolled on basal insulin
T2 - A longitudinal study of a US administrative claims database
AU - Tong, Liyue
AU - Pan, Chunshen
AU - Wang, Hongwei
AU - Bertolini, Monica
AU - Lew, Elisheva
AU - Meneghini, Luigi F.
N1 - Funding Information:
The authors received writing/editorial support during the preparation of this manuscript from Bilge Yoruk, PhD of Excerpta Medica, which was funded by Sanofi US, Inc. L. T. and C. P. were employees of PRO Unlimited, supporting Sanofi projects at the time of this analysis. H. W. was an employee of Sanofi US, Inc. at the time of this analysis. M. B. and E. L. are employees and stock-/shareholders of Sanofi France. L. M. is a consultant and member of scientific advisory boards for Sanofi and Novo Nordisk. The study was designed by L.T., C.P., H.W., M.B. and E.L. and was conducted by L.T. C.P. and H.W. All authors contributed to the analysis and interpretation of the results, and to drafting and critically revising of the manuscript. All authors confirm that they meet the International Committee of Medical Journal Editors uniform requirements for authorship; they have read, reviewed and approved the final version and agree to be accountable for all aspects of the work.
Funding Information:
This study was funded by Sanofi US, Inc.
Publisher Copyright:
© 2017 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.
PY - 2018/4
Y1 - 2018/4
N2 - Aim: To evaluate the effect of delaying treatment intensification with a glucagon-like peptide-1 receptor agonist (GLP-1 RA) on clinical and economic outcomes in patients with type 2 diabetes (T2D). Methods: We conducted a retrospective observational claims study using IMPACT (Impact National Managed Care Benchmark Database) in adult patients with T2D who initiated basal insulin between January 1, 2005 and December 31, 2012, with or without OADs, who remained uncontrolled (glycated haemoglobin [HbA1c] ≥7.0%). Patients were categorized into 3 groups: early, delayed, and no intensification with a GLP-1 RA. We evaluated changes from baseline to follow-up at 12 months for HbA1c level, rate of hypoglycaemic events, and healthcare costs, and we assessed the association between baseline patient characteristics and subsequent treatment intensification. Results: A total of 139 patients (9.0% of 1552 eligible patients) met criteria for inclusion in the early intensification group, 588 patients (37.9%) met criteria for inclusion in the delayed intensification group, and 825 patients (53.2%) met criteria for inclusion in the no intensification group. Mean baseline HbA1c values were 9.16%, 9.07%, and 9.34%, respectively. At follow-up, delayed intensification was associated with significantly smaller decreases in HbA1c from baseline (−0.68%) compared with early intensification (−1.01%). Rates of overall hypoglycaemia were numerically greater in the delayed intensification group than in the early intensification group (0.26 vs 0.06 events/patient-years of exposure, respectively). Change in semi-annual total healthcare costs was greater in the no intensification group (+5266 USD) compared with the early intensification group (−560 USD) and the delayed intensification group (+1943 USD). Conclusions: Timely addition of a GLP-1 RA to therapy for patients with T2D who were not adequately controlled with basal insulin is associated with better clinical and economic outcomes.
AB - Aim: To evaluate the effect of delaying treatment intensification with a glucagon-like peptide-1 receptor agonist (GLP-1 RA) on clinical and economic outcomes in patients with type 2 diabetes (T2D). Methods: We conducted a retrospective observational claims study using IMPACT (Impact National Managed Care Benchmark Database) in adult patients with T2D who initiated basal insulin between January 1, 2005 and December 31, 2012, with or without OADs, who remained uncontrolled (glycated haemoglobin [HbA1c] ≥7.0%). Patients were categorized into 3 groups: early, delayed, and no intensification with a GLP-1 RA. We evaluated changes from baseline to follow-up at 12 months for HbA1c level, rate of hypoglycaemic events, and healthcare costs, and we assessed the association between baseline patient characteristics and subsequent treatment intensification. Results: A total of 139 patients (9.0% of 1552 eligible patients) met criteria for inclusion in the early intensification group, 588 patients (37.9%) met criteria for inclusion in the delayed intensification group, and 825 patients (53.2%) met criteria for inclusion in the no intensification group. Mean baseline HbA1c values were 9.16%, 9.07%, and 9.34%, respectively. At follow-up, delayed intensification was associated with significantly smaller decreases in HbA1c from baseline (−0.68%) compared with early intensification (−1.01%). Rates of overall hypoglycaemia were numerically greater in the delayed intensification group than in the early intensification group (0.26 vs 0.06 events/patient-years of exposure, respectively). Change in semi-annual total healthcare costs was greater in the no intensification group (+5266 USD) compared with the early intensification group (−560 USD) and the delayed intensification group (+1943 USD). Conclusions: Timely addition of a GLP-1 RA to therapy for patients with T2D who were not adequately controlled with basal insulin is associated with better clinical and economic outcomes.
KW - GLP-1 receptor agonist
KW - basal insulin
KW - database research
KW - glycaemic control
KW - type 2 diabetes
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U2 - 10.1111/dom.13156
DO - 10.1111/dom.13156
M3 - Article
C2 - 29119712
AN - SCOPUS:85037329698
SN - 1462-8902
VL - 20
SP - 831
EP - 839
JO - Diabetes, Obesity and Metabolism
JF - Diabetes, Obesity and Metabolism
IS - 4
ER -