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

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 Gabler31IPAM, University of Wismar 23966 Wismar, Germany; 2Real-World Evidence and Health Economics, Ingress-Health HWM GmbH, Wismar 23966, Germany; 3HP Country...

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Autores principales:	Wilke T, Picker N, Mueller S, Geier S, Foersch J, Aberle J, Martin S, Riedl M, Gabler M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	T2DM antidiabetic treatment claims data chart review Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/571aed618f8a412e82bb9220ab373dee
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spelling	oai:doaj.org-article:571aed618f8a412e82bb9220ab373dee2021-12-02T02:23:11ZReal-world insulin therapy in German type 2 diabetes mellitus patients: patient characteristics, treatment patterns, and insulin dosage1178-7007https://doaj.org/article/571aed618f8a412e82bb9220ab373dee2019-07-01T00:00:00Zhttps://www.dovepress.com/real-world-insulin-therapy-in-german-type-2-diabetes-mellitus-patients-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Thomas Wilke,1 Nils Picker,2 Sabrina Mueller,2 Silke Geier,3 Johannes Foersch,4 Jens Aberle,5 Stephan Martin,6 Matthias Riedl,7 Maximilian Gabler31IPAM, 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, GermanyBackground: 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 reviewWilke TPicker NMueller SGeier SFoersch JAberle JMartin SRiedl MGabler MDove Medical PressarticleT2DMantidiabetic treatmentclaims datachart reviewSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 12, Pp 1225-1237 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	T2DM antidiabetic treatment claims data chart review Specialties of internal medicine RC581-951
spellingShingle	T2DM antidiabetic treatment claims data chart review Specialties of internal medicine RC581-951 Wilke T Picker N Mueller S Geier S Foersch J Aberle J Martin S Riedl M Gabler M Real-world insulin therapy in German type 2 diabetes mellitus patients: patient characteristics, treatment patterns, and insulin dosage
description	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 Gabler31IPAM, 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, GermanyBackground: 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
format	article
author	Wilke T Picker N Mueller S Geier S Foersch J Aberle J Martin S Riedl M Gabler M
author_facet	Wilke T Picker N Mueller S Geier S Foersch J Aberle J Martin S Riedl M Gabler M
author_sort	Wilke T
title	Real-world insulin therapy in German type 2 diabetes mellitus patients: patient characteristics, treatment patterns, and insulin dosage
title_short	Real-world insulin therapy in German type 2 diabetes mellitus patients: patient characteristics, treatment patterns, and insulin dosage
title_full	Real-world insulin therapy in German type 2 diabetes mellitus patients: patient characteristics, treatment patterns, and insulin dosage
title_fullStr	Real-world insulin therapy in German type 2 diabetes mellitus patients: patient characteristics, treatment patterns, and insulin dosage
title_full_unstemmed	Real-world insulin therapy in German type 2 diabetes mellitus patients: patient characteristics, treatment patterns, and insulin dosage
title_sort	real-world insulin therapy in german type 2 diabetes mellitus patients: patient characteristics, treatment patterns, and insulin dosage
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/571aed618f8a412e82bb9220ab373dee
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Real-world insulin therapy in German type 2 diabetes mellitus patients: patient characteristics, treatment patterns, and insulin dosage

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