Abstract
ABSTRACTBackground: Two alternative basal analogue insulin treatments are available in the UK: insulin glargine and insulin detemir. The purpose of this study was to compare the outcome of treatment with these two alternative products since their launch using routinely available, unselected data from general practice. Glargine was launched in the UK in 2002, whereas detemir was launched in 2004.Methods: The study used proprietary data from The Health Improvement Network – THIN (around 300 GP practices) using standard statistical methods. A detailed description of each patient was available for up to 15 years that included their diagnoses, test results and treatments. The two alternative treatments were compared for 9 months following switching to one of these treatments by quarterly periods. The primary outcome measure was change in HbA1c, whilst secondary measures were change in weight, reported hypoglycaemia and treatment discontinuation. Subjects were split by type of diabetes.Results: Data were available for 694 people treated with detemir and 5683 people treated with glargine. The demographic and clinical profiles of the respective groups were almost identical. There was a notable improvement in HbA1c following treatment switching to either glargine or detemir; however, there was a trend for improved diabetes control with glargine in both type 1 and type 2 diabetes. Glargine resulted in less hypoglycaemia (relative risk = 0.75; p < 0.05). Detemir resulted in a trend for less weight gain, but this did not achieve statistical significance. There was no convincing evidence of a difference in treatment discontinuation patterns.Conclusion: On balance, glargine showed marginal improvement over detemir in diabetes-related outcomes. There was a marked improvement in hypoglycaemia when treated with glargine over detemir.
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