PMID- 21892858
OWN - NLM
STAT- MEDLINE
DCOM- 20120309
LR  - 20221207
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 14
IP  - 6
DP  - 2011
TI  - Clinical and economic outcomes in patients with type 2 diabetes initiating 
      insulin glargine disposable pen versus exenatide BID.
PG  - 673-80
LID - 10.3111/13696998.2011.605818 [doi]
AB  - OBJECTIVE: To evaluate clinical and economic outcomes in patients with type 2 
      diabetes mellitus (T2DM) who failed oral anti-diabetic drug (OAD) therapy and 
      initiated either insulin glargine with disposable pen (GLA-P) or exenatide BID 
      (EXE). RESEARCH DESIGN AND METHODS: This retrospective study used data from a 
      large US-managed care claims database and included adult T2DM patients initiating 
      treatment with GLA-P or EXE in 2007 or 2008. Propensity score matching was used 
      to control observed baseline differences between treatment groups. Primary study 
      end-points included treatment persistence, A1C, healthcare utilization, and 
      healthcare costs during the 1-year follow-up period. RESULTS: Two thousand three 
      hundred and thirty nine patients were included in the study (GLA-P: 381; EXE: 
      1958); 626 patients were in the 1:1 matched cohort (54% male; mean age: 54 years; 
      mean A1C: 9.2%). At follow-up, patients in the GLA-P group were significantly 
      more persistent in treatment than EXE patients (48% vs 15% in persistence rate 
      and 252 vs 144 days in persistence days; both p<0.001). GLA-P patients also had 
      significantly lower A1C at follow-up (8.02% vs 8.32%; p=0.042) and greater A1C 
      reduction from baseline (-1.23% vs -0.92%; p=0.038). There were no significant 
      differences in claims-based hypoglycemia rates and overall diabetes-related 
      healthcare utilization and cost. LIMITATIONS: Since this was a retrospective 
      analysis, causality of treatment benefits cannot be established. The study was 
      specific to two treatments and may not generalize to other models of insulin 
      administration. Some of the results, although statistically significant, may not 
      be found clinically important. CONCLUSIONS: In a real-world setting among T2DM 
      patients who failed to achieve or sustain glycemic goal with OADs, initiation of 
      GLA-P instead of EXE may be a more effective option because it was associated 
      with greater treatment persistence, greater A1C reduction without a significantly 
      higher rate of hypoglycemia, and similar healthcare costs.
FAU - Baser, Onur
AU  - Baser O
AD  - The University of Michigan, MI, USA. obaser@statinmed.com
FAU - Wei, Wenhui
AU  - Wei W
FAU - Baser, Erdem
AU  - Baser E
FAU - Xie, Lin
AU  - Xie L
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110905
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin, Long-Acting)
RN  - 0 (Peptides)
RN  - 0 (Venoms)
RN  - 2ZM8CX04RZ (Insulin Glargine)
RN  - 9P1872D4OL (Exenatide)
SB  - IM
MH  - Costs and Cost Analysis
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Drug Delivery Systems
MH  - Exenatide
MH  - Female
MH  - Glycated Hemoglobin/drug effects
MH  - Health Services/economics/statistics & numerical data
MH  - Humans
MH  - Hypoglycemic Agents/administration & dosage/*economics/*therapeutic use
MH  - Insulin Glargine
MH  - Insulin, Long-Acting/administration & dosage/*economics/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Peptides/administration & dosage/*economics/*therapeutic use
MH  - Retrospective Studies
MH  - Venoms/administration & dosage/*economics/*therapeutic use
EDAT- 2011/09/07 06:00
MHDA- 2012/03/10 06:00
CRDT- 2011/09/07 06:00
PHST- 2011/09/07 06:00 [entrez]
PHST- 2011/09/07 06:00 [pubmed]
PHST- 2012/03/10 06:00 [medline]
AID - 10.3111/13696998.2011.605818 [doi]
PST - ppublish
SO  - J Med Econ. 2011;14(6):673-80. doi: 10.3111/13696998.2011.605818. Epub 2011 Sep 
      5.