medwireNews: Real-world study results suggest that people with type 2 diabetes treated with insulin monotherapy have worse clinical outcomes than those given combination treatment with insulin and other antidiabetic drugs.
Nils Picker (Ingress-Health HWM GmbH, Wismar, Germany) and team used German medical claims data to evaluate treatment-related outcomes in 12,034 individuals with type 2 diabetes who initiated insulin treatment between 2013 and 2015. A total of 29% were given insulin monotherapy, while the remaining 71% received concomitant antidiabetic drugs.
As reported in Diabetes Research and Clinical Practice, the proportion of people with glycated hemoglobin (HbA1c) levels in the target range of 6.5–7.5% (48–58 mmol/mol) improved from baseline to the 1-year follow-up irrespective of whether insulin was taken alone or together with other drugs. However, Picker and team note that this improvement was “markedly lower” among people taking insulin monotherapy compared with other regimens.
Specifically, the proportion of individuals with HbA1c levels in the target range improved from 24.5% to 35.2% among the 3426 people taking insulin monotherapy, a 10.7 percentage point (pp) increase. This rose to a 13.1 pp increase for the 2863 individuals given insulin plus a non-metformin antidiabetic agent (from 22.5% to 35.6%) and an 18.4 pp increase for the 3782 taking insulin plus metformin and another antidiabetic agent (from 18.8% to 37.2%). The improvement was greatest, at 21.1 pp (from 16.3% to 37.4%), for the 1963 people on insulin plus metformin.
In a multivariate analysis, people taking insulin plus metformin and those taking insulin plus metformin and another antidiabetic agent had a significantly higher probability of achieving target HbA1c levels at the 1-year follow-up than those given insulin monotherapy, at odds ratios (ORs) of 1.18 and 1.15, respectively.
The researchers also found that all three combination treatment regimens were associated with a significantly reduced risk for weight gain (≥10% of bodyweight from baseline to 1 year) compared with insulin monotherapy, with ORs ranging from 0.50 for insulin plus metformin and another antidiabetic agent to 0.71 for insulin plus a non-metformin agent.
In addition to the limited benefits associated with insulin monotherapy, Picker and colleagues also note that costs “were by far highest” with this regimen, with all-cause costs per person–year of € 12,283 (US$ 14,615), compared with € 9,947–10,509 ($ 11,835–12,504).
Together, these findings suggest “that insulin alone is a suboptimal treatment” for type 2 diabetes, conclude the study authors.
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Diabetes Res Clin Pract 2021; doi:10.1016/j.diabres.2021.108734