Abstract
BackgroundAlthough glargine and detemir are both FDA-approved in the U.S. as long-acting insulin analogues, inherent differences in the insulins may lead to varying outcomes. This study examined changes in clinical measures and associated costs for veterans with type 2 diabetes on insulin therapy converted from insulin glargine to insulin detemir.MethodsA retrospective before-and-after comparison study was performed at a single-site medical center located in the southwestern U.S., comprising 133 Veterans diagnosed with type 2 diabetes receiving insulin therapy with glargine and converted to insulin detemir using a 1:1 unit dosage ratio. Patients’ A1c, weight, body mass index, total daily dose, and estimated monthly insulin costs during and after conversion were compared employing Wilcoxon signed-rank tests. These measures were similarly assessed in patients at A1c goal (<7 %) prior to conversion.ResultsWhen switched from insulin glargine to insulin detemir, an increase in A1c (median of 7.7 % to 8.3 %, p < 0.01) and total daily dose (TDD: 40 to 46 units/day, p < 0.01) resulted. Monthly insulin costs decreased 19 % ($47 to $38, p < 0.01), or roughly a one-year savings of $110 per patient. An increase in A1c was similarly observed for patients at-goal prior to conversion but remained at-goal post-conversion (6.5 % to 6.7 %, p = 0.02).ConclusionThe increase in A1c and TDD following conversion from insulin glargine to insulin detemir suggests that glargine requires a smaller amount of units to reach the same glycemic-lowering ability compared to detemir. Despite the observed insulin cost savings associated with detemir, future studies should also determine overall costs (including indirect) and benefits associated with switching from glargine to detemir among Veteran with Type 2 diabetes.
Highlights
In 2011, diabetes mellitus was reported to have a prevalence rate of 8.3 % in the U.S, affecting approximately 25.8 million Americans [1]
To compare clinical and financial outcomes associated with switching from insulin glargine to insulin detemir in a veteran population with type 2 diabetes, a retrospective beforeand-after study design was performed in a large integrated veteran healthcare system located in southwestern U.S The study was approved by the local institutional review board (Central Texas Veterans Health Care System IRB) prior to study initiation
Among 133 male veterans switching from insulin glargine to insulin detemir, patients were predominantly older with a mean age of 66 years (SD = 10) and white (74 %; Table 1)
Summary
In 2011, diabetes mellitus was reported to have a prevalence rate of 8.3 % in the U.S, affecting approximately 25.8 million Americans [1]. As major risk factors for diabetes, such as obesity, are becoming more common in the population, the prevalence of diabetes in adults has risen significantly from 1.9 million in 1958 to 18.8 million in 2010 [1,2,3]. The majority of these adults have type 2 diabetes (90-95 %) [1]. This study examined changes in clinical measures and associated costs for veterans with type 2 diabetes on insulin therapy converted from insulin glargine to insulin detemir
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