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Real-world insulin therapy in German type 2 diabetes mellitus patients: patient characteristics, treatment patterns, and insulin dosage

Authors Wilke T, Picker N, Mueller S, Geier S, Foersch J, Aberle J, Martin S, Riedl M, Gabler M

Received 3 May 2019

Accepted for publication 28 June 2019

Published 24 July 2019 Volume 2019:12 Pages 1225—1237


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Antonio Brunetti

Thomas Wilke,1 Nils Picker,2 Sabrina Mueller,2 Silke Geier,3 Johannes Foersch,4 Jens Aberle,5 Stephan Martin,6 Matthias Riedl,7 Maximilian Gabler3

1IPAM, University of Wismar 23966 Wismar, Germany; 2Real-World Evidence and Health Economics, Ingress-Health HWM GmbH, Wismar 23966, Germany; 3HP Country Commercial - Market Access, Boehringer Ingelheim Pharma GmbH & Co. Kg, Ingelheim Am Rhein 55216, Germany; 4HP Country Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co. Kg, Ingelheim Am Rhein 55216, Germany; 5Department of Internal Medicine III, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg 20246, Germany; 6German Diabetes Center, Leibniz Institute at Heinrich Heine University, Düsseldorf 40591, Germany; 7Center for Diabetology, Internal and Nutritional Medicine, Medicum Hamburg MVZ GmbH, Hamburg 20097, Germany

Background: A substantial share of type 2 diabetes mellitus (T2DM) patients receive insulin. However, little is known about the real-world treatment patterns around insulin initiation.
Methods: This was a retrospective claims data analysis. T2DM patients who initiated an insulin therapy between 01/01/2013 and 31/12/2015 were identified in the German AOK PLUS dataset. For validation of results, additional data on a similar T2DM patient population were collected in a Germany-wide medical chart review.
Results: A total of 284,878 T2DM patients were identified. Of these, 27,340 (9.6%) initiated an insulin treatment during the inclusion period (mean age: 72.2 years; 51.4% female). Mean/median weight and BMI of patients with available clinical data was 85.8/84.0 kg (SD:18.9) and 30.6/29.8 kg/m2, (SD:6.1), respectively at baseline. Mean/median HbA1c-value at baseline was 8.4/8.0% (SD: 1.8). Most commonly prescribed antidiabetic drugs (AD) within 6 months before insulin initiation were metformin (MET; 54.0%), DPP-4 inhibitors (DPP-4i; 37.6%), and sulfonylureas (SU; 29.5%). As high as 23.2% of the patients did not receive any AD prescription within 6 months before insulin initiation. A total of 10,953 of above 27,340 insulin starters (40.1%) initiated their insulin therapy without concomitant ADs (insulin monotherapy); 43% of these patients did not receive any AD before insulin initiation. Of the remaining 16,387 patients (59.9%), 4070 patients (14.9%) received MET only as concomitant AD, 6385 (23.4%) received MET plus at least one further AD, and 5932 (21.7%) received at least one further AD excluding MET. Throughout the first year of treatment, prescribed insulin dosage increased over time, resulting in approximately 43.3–77.9 IUs per observed patient day after 12 months of insulin treatment.
Conclusions: Characteristics of German T2DM patients initiating insulin deviate substantially from the average German population, especially in terms of weight. We identified an unexpectedly high number of patients without previous AD therapy receiving insulin monotherapy, which is not in line with the clinical guidelines.

Keywords: T2DM, antidiabetic treatment, claims data, chart review 

Corrigendum for this paper has been published

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