학술논문
Treatment Patterns and Outcomes Before and After Humulin R U-500 Initiation Among US Patients with Type 2 Diabetes Previously Prescribed [less than or equal to] 200 Units/day of U-100 Insulin
Original Research
Original Research
Document Type
Report
Source
Diabetes Therapy. March 2022, Vol. 13 Issue 3, p465, 15 p.
Subject
Language
English
ISSN
1869-6953
Abstract
Author(s): Jieling Chen [sup.1] , Sujana Borra [sup.2] , Ahong Huang [sup.2] , Ludi Fan [sup.1] , Roy Daniel Pollom [sup.1] , Robert C. Hood [sup.3] Author Affiliations: (1) grid.417540.3, [...]
Introduction Humulin R U-500 (U-500R) utilization has increased in the past few years, raising concerns as U-500R is indicated only for patients requiring > 200 units of insulin. Thus, evidence of dispensed total daily dose (dTDD) > 200 units of prior U-100 insulin based on pharmacy claims is increasingly used as a criterion to determine appropriate switching to U-500R by payers. The study compared the treatment patterns and outcomes before and after U-500R initiation among patients who were identified with [less than or equal to] 200 units/day U-100 insulin fill in order to understand the appropriateness of switching. Methods Patients with type 2 diabetes who initiated U-500R (index date = first fill) with [less than or equal to] 200 units/day pre-index dTDD and > 200 units/day post-index dTDD were identified in a Veterans Health Administration dataset between 1 January 2014 and 30 June 2017. Descriptive analysis was conducted on treatment patterns (dTDD, insulin dosage [units/kg], adherence, number of prescription fills) and clinical outcomes (HbA1c, symptomatic hypoglycemic events). Associations between U-500R exposure and outcomes were evaluated using mixed-effects models. Subgroups of U-500R syringe and KwikPen users were analyzed separately. Results Among 1191 U-500R initiators identified in the study the mean dTDD increased from the pre- to post-index periods (147.2 vs 346.3; p < 0.0001). The mean HbA1c decreased from pre- to post-initiation (9.6% vs 8.6%; p < 0.0001), and symptomatic hypoglycemia events per patient per year increased (2.0 vs 3.3, p < 0.0001). Mixed-effects models confirmed the significance of the changes (p 200 units before switching to U-500R criterion could hurt the opportunities for patients who need a simplified regimen for better outcomes.
Introduction Humulin R U-500 (U-500R) utilization has increased in the past few years, raising concerns as U-500R is indicated only for patients requiring > 200 units of insulin. Thus, evidence of dispensed total daily dose (dTDD) > 200 units of prior U-100 insulin based on pharmacy claims is increasingly used as a criterion to determine appropriate switching to U-500R by payers. The study compared the treatment patterns and outcomes before and after U-500R initiation among patients who were identified with [less than or equal to] 200 units/day U-100 insulin fill in order to understand the appropriateness of switching. Methods Patients with type 2 diabetes who initiated U-500R (index date = first fill) with [less than or equal to] 200 units/day pre-index dTDD and > 200 units/day post-index dTDD were identified in a Veterans Health Administration dataset between 1 January 2014 and 30 June 2017. Descriptive analysis was conducted on treatment patterns (dTDD, insulin dosage [units/kg], adherence, number of prescription fills) and clinical outcomes (HbA1c, symptomatic hypoglycemic events). Associations between U-500R exposure and outcomes were evaluated using mixed-effects models. Subgroups of U-500R syringe and KwikPen users were analyzed separately. Results Among 1191 U-500R initiators identified in the study the mean dTDD increased from the pre- to post-index periods (147.2 vs 346.3; p < 0.0001). The mean HbA1c decreased from pre- to post-initiation (9.6% vs 8.6%; p < 0.0001), and symptomatic hypoglycemia events per patient per year increased (2.0 vs 3.3, p < 0.0001). Mixed-effects models confirmed the significance of the changes (p 200 units before switching to U-500R criterion could hurt the opportunities for patients who need a simplified regimen for better outcomes.