Rituparna Bhattacharya1, Steve Zhou2, Wenhui Wei2, Mayank Ajmera3, Usha Sambamoorthi1. 1. Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia. 2. Sanofi US, Inc., Bridgewater, New Jersey. 3. RTI International, Research Triangle Park, North Carolina.
Abstract
OBJECTIVES: To compare clinical and economic outcomes of early insulin initiation with those of delayed initiation in older adults with type 2 diabetes mellitus (T2DM). DESIGN: Retrospective cohort study. SETTING: Humana Medicare Advantage health insurance plan. PARTICIPANTS: Older (≥65) Medicare beneficiaries with T2DM. MEASUREMENTS: Subjects were grouped according to number of classes of oral antidiabetes drugs (OADs) they had taken before initiation of insulin: one (early insulin initiators), two, or three or more (delayed insulin initiators). One-year follow-up outcomes included change in glycosylated hemoglobin (HbA1c), percentage of older adults with HbA1c less than 8.0%, hypoglycemic events, and total healthcare costs. RESULTS: Overall, 14,669 individuals were included in the analysis. Baseline and 1-year follow-up HbA1c levels were available for 4,028 (27.5%) individuals. Insulin was initiated early in 32% and delayed in 20%. At follow-up, unadjusted reduction in HbA1c was 0.9±3.7% for the group with one OAD, 0.7±2.4% for those with two, and 0.5±3.6% for those with three or more. Early insulin initiation was associated with significantly greater reduction in HbA1c (0.4%; adjusted P<.001), 30% greater likelihood of achieving HbA1c less than 8.0% (adjusted odds ratio=1.30, 95% confidence interval=1.18-1.43), and no significant differences in total costs or hypoglycemia events (11.5% of early initiators vs 10.2% of delayed initiators; P=.32). CONCLUSION: This study suggests beneficial effects of early insulin initiation in older adults with T2DM who do not have adequate glycemic control, without increasing the risk of hypoglycemia or greater total direct healthcare costs.
OBJECTIVES: To compare clinical and economic outcomes of early insulin initiation with those of delayed initiation in older adults with type 2 diabetes mellitus (T2DM). DESIGN: Retrospective cohort study. SETTING: Humana Medicare Advantage health insurance plan. PARTICIPANTS: Older (≥65) Medicare beneficiaries with T2DM. MEASUREMENTS: Subjects were grouped according to number of classes of oral antidiabetes drugs (OADs) they had taken before initiation of insulin: one (early insulin initiators), two, or three or more (delayed insulin initiators). One-year follow-up outcomes included change in glycosylated hemoglobin (HbA1c), percentage of older adults with HbA1c less than 8.0%, hypoglycemic events, and total healthcare costs. RESULTS: Overall, 14,669 individuals were included in the analysis. Baseline and 1-year follow-up HbA1c levels were available for 4,028 (27.5%) individuals. Insulin was initiated early in 32% and delayed in 20%. At follow-up, unadjusted reduction in HbA1c was 0.9±3.7% for the group with one OAD, 0.7±2.4% for those with two, and 0.5±3.6% for those with three or more. Early insulin initiation was associated with significantly greater reduction in HbA1c (0.4%; adjusted P<.001), 30% greater likelihood of achieving HbA1c less than 8.0% (adjusted odds ratio=1.30, 95% confidence interval=1.18-1.43), and no significant differences in total costs or hypoglycemia events (11.5% of early initiators vs 10.2% of delayed initiators; P=.32). CONCLUSION: This study suggests beneficial effects of early insulin initiation in older adults with T2DM who do not have adequate glycemic control, without increasing the risk of hypoglycemia or greater total direct healthcare costs.
Authors: G Papa; V Fedele; A Chiavetta; I Lorenti; C Leotta; S Luca; A M Rabuazzo; S Piro; C Alagona; L Spadaro; F Purrello; V Pezzino Journal: Acta Diabetol Date: 2008-01-08 Impact factor: 4.280
Authors: Silvio E Inzucchi; Richard M Bergenstal; John B Buse; Michaela Diamant; Ele Ferrannini; Michael Nauck; Anne L Peters; Apostolos Tsapas; Richard Wender; David R Matthews Journal: Diabetes Care Date: 2012-04-19 Impact factor: 19.112
Authors: Hsien-Yen Chang; Jonathan P Weiner; Thomas M Richards; Sara N Bleich; Jodi B Segal Journal: Am J Manag Care Date: 2012-11 Impact factor: 2.229
Authors: Xue Feng; Xi Tan; Brittany Riley; Tianyu Zheng; Thomas K Bias; James B Becker; Usha Sambamoorthi Journal: Ann Pharmacother Date: 2017-06-21 Impact factor: 3.154
Authors: Kimberly Danae Cauley Narain; Danielle Doppee; Ning Li; Gerardo Moreno; Douglas S Bell; Amanda L Do; Robert W Follett; Carol M Mangione Journal: J Gen Intern Med Date: 2020-03-06 Impact factor: 5.128
Authors: Peter Bramlage; Tobias Bluhmki; Holger Fleischmann; Matthias Kaltheuner; Jan Beyersmann; Reinhard W Holl; Thomas Danne Journal: BMJ Open Diabetes Res Care Date: 2017-01-25
Authors: Simon R Heller; Richard E Pratley; Alan Sinclair; Andreas Festa; Jacek Kiljański; Cynthia S Brusko; Ran Duan; Robert J Heine Journal: Diabetes Obes Metab Date: 2017-08-08 Impact factor: 6.577