Authors: Levin P, Lin J, Wei W, Vlajnic A, Pan C, Xie L, Baser O.
Objective: To examine treatment patterns and outcomes of initiation of injectable pen therapy with either insulin glargine or liraglutide, and to evaluate comparative effectiveness.
Study Design: Retrospective analysis of information from the national managed care IMPACT database. Adults with type 2 diabetes mellitus initiating injectable pen therapy with insulin glargine or liraglutide were evaluated.
Methods: Clinical and economic measures were compared between cohorts at baseline and over 1 year. Those patients with poor glycemic control (glycated hemoglobin target glycated A1c [A1c] >7.0%) were matched using propensity score matching for comparative effectiveness analysis.
Results: A total of 1574 patients were identified; 756 and 818 initiated therapy with insulin glargine and liraglutide, respectively. There were significant differences in demographics and clinical characteristics at baseline; insulin glargine initiators were sicker, had longer hospitalizations, had a higher mean A1C (9.7% vs 7.9%; P <.0001), and had higher baseline costs. In patients who had poorer glycemic control, 698 with comparable baseline characteristics were matched. During 1-year follow-up of this subset, there was little difference in utilizations and clinical outcomes between cohorts. However, compared with liraglutide initiators, insulin glargine initiators had significantly lower diabetes-related pharmacy costs ($2832 vs $4027; P <.0001) and total diabetes-related costs ($5305 vs $7501; P = .0005).
Conclusions: Significant real-world differences, particularly in A1C level, existed at baseline between those initiating injectable therapy with insulin glargine vs liraglutide. The matched-cohort analysis suggests that the use of the insulin glargine pen was associated with clinical outcomes similar to those with liraglutide, but with lower diabetes-related costs.
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