Intensification of Basal Insulin Therapy with Lixisenatide in Patients with Type 2 Diabetes in a Real-World Setting: The BASAL-LIXI Study

Abstract Background Poor treatment persistence can affect the real-world effectiveness of insulin therapy. A cross-sectional online survey in 942 patients with type 2 diabetes from 7 different countries evaluated patient experience when initiating basal insulin and the reasons behind insulin persistence patterns. Here, we report the quantitative results for the subset of patients from Germany. Methods Adults with type 2 diabetes who had initiated basal insulin during the last 3–24 months, identified from market-research panels, participated in the survey. Patients were asked if they had ≥7-day gaps in basal insulin treatment, and were then classified as “continuers” (no gap since starting insulin), “interrupters” (≥1 gap within the first 6 months after starting insulin and subsequently restarted insulin), or “discontinuers” (stopped insulin within the first 6 months after starting and had not restarted at the time of the survey). For each country, 50 participants were planned per persistence category. Enrollment ended if the target quota was reached or enrollment plateaued. Data were analyzed overall and separately for each persistence cohort. Results The 131 participants from Germany included 55 (42.0%) continuers, 50 (38.2%) interrupters and 26 (19.9%) discontinuers. The most common motivations to initiate basal insulin therapy were encouragement by physician or other healthcare provider (HCP; 54.2%) and expectation to improve glycemic control (42.0%). More than 95% of participants received training before and during insulin initiation (considered as helpful by 81.7%); most (67.2%) preferred in-person training. Continuers more frequently felt that insulin would help to manage diabetes and that their own views were considered when initiating insulin, they reported less concerns and challenges before and during insulin initiation than interrupters or discontinuers. The most common motivations to continue basal insulin were improved glycemic control (72.7%), improved physical well-being (49.1%), and instruction by physician or other HCP (45.5%). The most common reasons contributing to interruption/discontinuation were perceived weight gain (52.0%/50.0%), hypoglycemia (22.0%/38.5%), and potential adverse effects (30.0%/26.9%). Conclusions Quality interactions between physicians or other HCPs and their patients before and during the initiation of basal insulin may help to manage patient expectations and to improve persistence to insulin therapy.

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PREDICTORS AND CLINICAL OUTCOMES OF TREATMENT INTENSIFICATION IN PATIENTS WITH TYPE 2 DIABETES UNCONTROLLED ON BASAL INSULIN IN A REAL-WORLD SETTING

Endocrine Practice ◽

10.4158/ep-2017-0261 ◽

2018 ◽

Vol 24 (9) ◽

pp. 805-814 ◽

Cited By ~ 2

Author(s):

Lee Kallenbach ◽

Amy M. Shui ◽

Wendy Y. Cheng ◽

Tao Fan ◽

Wenli Hu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Clinical Outcomes ◽

Real World ◽

Basal Insulin ◽

Treatment Intensification ◽

Real World Setting

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Clinical and economic outcomes among injection-naïve patients with type 2 diabetes initiating dulaglutide compared with basal insulin in a US real-world setting: the DISPEL Study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000884 ◽

2019 ◽

Vol 7 (1) ◽

pp. e000884 ◽

Cited By ~ 5

Author(s):

Reema Mody ◽

Qing Huang ◽

Maria Yu ◽

Hiren Patel ◽

Xian Zhang ◽

...

Keyword(s):

Type 2 Diabetes ◽

Real World ◽

Basal Insulin ◽

Linear Models ◽

Statistical Significance ◽

Economic Outcomes ◽

Analysis Of Covariance ◽

Real World Setting ◽

Baseline Characteristics

AimsTo report 1-year clinical and economic outcomes from the retrospective DISPEL (Dulaglutide vs Basal InSulin in Injection Naïve Patients with Type 2 Diabetes: Effectiveness in ReaL World) Study.Materials and methodsThis observational claims study included patients with type 2 diabetes (T2D) and ≥1 claim for dulaglutide or basal insulin between November 2014 and April 2017 (index date=earliest fill date). Propensity score matching was used to address treatment selection bias. Change from baseline in hemoglobin A1c (HbA1c) was compared between the matched cohorts using analysis of covariance; diabetes-related costs were analyzed using generalized linear models.ResultsMatched cohorts (903 pairs total; 523 pairs with complete cost data) were balanced in baseline characteristics with mean HbA1c 8.6%, mean age 54 years. At 1 year postindex, dulaglutide patients had significantly greater reduction in HbA1c than basal insulin (−1.12% vs −0.51%, p<0.01), lower medical costs ($3753 vs $7604, p<0.01), higher pharmacy costs ($9809 vs $6175, p<0.01), and similar total costs ($13 562 vs $13 779, p=0.76). Medical and total costs per 1% HbA1c reduction were lower for dulaglutide than basal insulin (medical: $3128 vs $12 673, p<0.01; total: $11 302 vs $22 965, p<0.01), while pharmacy costs per 1% HbA1c reduction were lower without reaching statistical significance ($8174 vs $10 292, p=0.15).ConclusionsIn this real-world study, patients with T2D initiating dulaglutide demonstrated greater HbA1c reduction compared with those initiating basal insulin. Although total diabetes-related costs were similar, the total diabetes-related costs per HbA1c reduction were lower for dulaglutide, highlighting the importance of evaluating effectiveness along with the economic impact of medications.

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