Why does diabetes therapy often fails?

Abstract

patients with type 2 diabetes (T2D) to determine if the mean daily dose in the real-world setting differs between these products. Methods: Patients with T2D (per ICD-9 code 250.x1 250.x3) were identified in the Verispan Electronic Data Warehouse (SDI, Plymouth Meeting, PA) from 7/1/2006 to 6/31/2007. Verispan data has an open architecture and does not include eligibility data, but filtering techniques were employed to eliminate cohort shrinkage. Insulin naive patients started on detemir (cases) were matched 1:1 to newly treated glargine patients (controls) for baseline characteristics that could influence dose requirements including gender, age (± 2 years), baseline antidiabetic therapy (by classes of oral agents, and exenatide), and comorbidities including cerebrovascular disease, renal failure, heart failure, heart disease/myocardial infarction, hypertension, neuropathy, and obesity. Patients were not prescribed any other insulin during the observation period. The average daily insulin dose in units was calculated as the number of units dispensed from the first to the second to last prescription in the observation period divided by the elapsed days from the first to last fill. A Wilcoxon rank sum test was used to identify differences in the average number of units per day between detemir and glargine. Changes in antidiabetic therapy by class and number of agents after insulin initiation were identified and compared between cases and controls using chi-squared tests. results: Of 2215 newly treated patients with T2D, 1581 (71.4%) were matched to a glargine patient. Mean age of this matched cohort was 59.4 years; 53.5% were female. Metformin (57.1%) and sulfonylureas (51.6%) were the most commonly used antidiabetic agents at baseline; 45% were on 1 or 2 non-insulin antidiabetic agents at baseline. The most common comorbidities were hypertension (57.6%) and heart disease/myocardial infarction (15.4%). The mean (median) of the average daily insulin dose was 35 (26) units per day for detemir and 32 (27) units per day for glargine; which was not significantly different (p=0.15). There were no differences in concomitant antidiabetic drug use from baseline to follow-up which could have influenced insulin dose requirements. conclusion: The mean daily insulin dose for detemir did not differ from glargine in patients with T2D matched on baseline characteristics that could influence insulin dose requirements.