...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Journal of Managed Care & Specialty Pharmacy >Persistence with Basal-Bolus Insulin Therapy in Patients with Type 2 Diabetes Mellitus and Effect on Clinical and Economic Outcomes: A Retrospective Claims Database Study
【24h】

Persistence with Basal-Bolus Insulin Therapy in Patients with Type 2 Diabetes Mellitus and Effect on Clinical and Economic Outcomes: A Retrospective Claims Database Study

机译：持久性与2型糖尿病患者的基底推注胰岛素治疗和对临床和经济结果的影响：回顾性声明数据库研究

获取原文
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

BACKGROUND: Persistence with multiple daily insulin injections (MDI) may be challenging for patients with type 2 diabetes (T2DM). However, limited information is available regarding the effect of persistence with MDI on outcomes. OBJECTIVE: To evaluate persistence with basal and bolus insulin therapy and assess its relationship with clinical and economic outcomes in a real-world setting. METHODS: This retrospective matched cohort study used 2012-2015 data from multiple U.S. commercial health plans (IBM MarketScan). Patients with T2DM aged 18-64 years with ≥ 2 basal and ≥ 2 bolus insulin claims during a 12-month period were eligible for inclusion if they had 18 months of continuous health plan enrollment (6-month baseline and 12-month post-index). Persistence during 12 months post-index was defined using 2 methods: (a) method 1, ≤ 90-day gaps in both basal and bolus insulin claims and (b) method 2, ≥ 1 basal and ≥ 1 bolus insulin claim every quarter (every 90 days) for 4 consecutive quarters after index bolus claim. Propensity score matching was used to match persistent and nonpersistent method 2 cohorts. Mean per-patient all-cause and diabetes-related medical costs (2015 U.S. dollars, excluding outpatient drugs) and health care resource use (HCRU) were calculated. For patients with hemoglobin A1c (A1c) values during baseline and post-index months 10-12, treatment success was defined as (a) A1c decrease from baseline of ≥ 1% and/or (b) baseline A1c ≥ 7% with post-index A1c 7%. Baseline characteristics of matched cohorts were compared using standardized mean differences (SMDs). Outcome variables were compared using t-tests, chi-square tests, and generalized linear models. RESULTS: Characteristics of 12,882 eligible patients and 12-month persistence rates were similar as defined by method 1 (22.4%) and method 2 (21.1%). After matching, the method 2 cohorts included 2,723 and 8,169 persistent and nonpersistent patients, respectively, with well-balanced baseline characteristics (mean age 53 years; 58% men; all SMDs 0.1). All-cause annual medical costs were lower for the persistent cohort (mean $13,499 vs. $17,362; P 0.0001), as were annual diabetes-related costs (mean $6,392 vs. $8,376; P 0.0001). In persistent versus nonpersistent cohorts, 11% versus 15% of patients, respectively, experienced ≥ 1 hospitalization; 21% versus 24%, respectively, had ≥ 1 ED visit; 9% versus 12%, respectively, experienced ≥ 1 diabetes-related hospitalization; and 13% versus 15%, respectively, had ≥ 1 diabetes-related ED visit ( P ≤ 0.005 for all). Mean baseline A1c was similar in persistent and nonpersistent cohorts (9.7% vs. 9.6%, respectively; P = 0.63). Persistence with MDI was associated with greater mean reduction in A1c (–1.3% vs. –0.8%, respectively; P = 0.006) and greater percentages of patients achieving treatment success (55% vs. 39%, respectively, for nonpersistent; P = 0.009). CONCLUSIONS: Poor persistence with basal-bolus insulin therapy over 12 months of follow-up was prevalent and was associated with greater medical costs, greater HCRU, and poorer glycemic control than for patients who were persistent. Interventions are needed to improve persistence with insulin therapy and aid patients with T2DM to achieve glycemic control. DISCLOSURES: Funding for this study was provided by Becton, Dickinson and Company (BD). All authors except Edelman are employees and stockholders of BD. Edelman reports board membership at Senseonics and participation in advisory board/speakers bureau at Lilly USA, MannKind, Novo Nordisk, Sanofi-Aventis U.S., Merck, and AstraZeneca, all unrelated to this study. A poster for this study was presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2018; April 23-26, 2018; Boston MA.
机译：背景：持久性与多种日常胰岛素注射（MDI）可能对2型糖尿病（T2DM）的患者有挑战性。但是，有关持久性与MDI在结果的效果提供有限的信息。目的：评价基础和推注胰岛素治疗的持久性，并评估其与现实世界环境中的临床和经济结果的关系。方法：该回顾性匹配队列研究使用了来自多个美国商业健康计划的2012-2015数据（IBM Marketscan）。 18-64岁患者18-64岁，≥2天基和≥2升胰岛素声明在12个月期间有资格包含18个月的持续卫生计划入学（6个月基线和12个月的指数后12个月）。使用2种方法定义了12个月期间的持久性：（a）方法1，≤9天间隙，≤10天间隙在基底和推注胰岛素索赔和（b）方法2中，≥1个基础和≥1μl≥1μl胰岛素主张（每90天）在索引推注索赔后连续4个季度。倾向得分匹配用于匹配持久性和非携带方法2队列。计算平均患者的全患者和糖尿病相关的医疗费用（2015年美国，不包括门诊药物）和医疗资源使用（HCRU）。对于基线和指数后月10-12期间血红蛋白A1C（A1C）值的患者，治疗成功定义为（a）a1c从≥1％和/或（b）基线A1c≥7％的基线下降≥7％索引A1C＆ 7％。使用标准化平均差异（SMD）进行比较匹配队列的基线特征。使用T-Tests，Chi-Square测试和广义的线性模型进行比较结果变量。结果：12,882名符合条件的患者和12个月持久性的特点如方法1（22.4％）和方法2（21.1％）相似。在匹配后，方法2队列分别包括2,723和8,169名持续和非球形患者，具有良好平衡的基线特征（平均53岁; 58％的男性;所有SMD <0.1）。持久性群组的全部导致年度医疗费用降低了（意味着13,499美元，比17,362美元; 0.0001美元），与年度糖尿病相关费用（平均$ 8,376; P <0.0001）。在持续存在与非持股队列中，11％与15％的患者分别经历≥1住院; 21％与24％分别有≥1次访问; 9％对12％，分别经历了≥1糖尿病相关住院治疗;和15％的13％分别与15％有关≥1-糖尿病相关的ED访问（P≤0.005）。平均基线A1C在持续和非持续的队列中相似（分别为9.7％，分别为9.6％; P = 0.63）。与MDI的持久性与A1C的更大平均降低有关（分别为-1.3％，分别为-0.8％; p = 0.006），更高百分比的患者分别实现治疗成功的患者（分别为39％，因为不持续; p = 0.009）。结论：与基础推注胰岛素治疗持续12个月的后续随访较差，与持续存在的患者相比，与较高的医疗成本，更高的肝脏和较差的血糖控制有关。需要干预措施来改善胰岛素治疗的持续性，并辅助T2DM患者实现血糖控制。披露：本研究提供资金由Becton，Dickinson和公司（BD）提供。除Edelman以外的所有作者都是BD的员工和股东。 Edelman在Lilly USA，Mannkind，Novo Nordisk，Sanofi-Aventis U.，Serck和Astrazeneca举行的Senseonics和参与咨询委员会/发言者局的咨询委员会/发言局的报告委员会成员资格。 2018年AMCP管理护理和专业药物年会提出了这项研究的海报; 2018年4月23日至26日;波士顿马。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号