Query 11-04: How does real world use of insulin glargine compare to NPH insulin in terms of effectiveness and safety (and ideally cost-effectiveness) for the management of type 1 diabetes mellitus? What is the comparative effectiveness and safety of sitagliptan and NPH insulin for the management of type 2 diabetes (T2D) not controlled by metformin plus sulfonylurea?
This project was originated with a query by British Columbia Ministry of Health in 2013 and funded for 3 years.
Final analysis using Marketscan for both parts of this query were finalized. With T1DM, we found that initiators of NPH insulin were more likely to switch to another insulin therapy after discontinuation (HR: 1.51; 95% CI 1.27-1.79) when compared to initiators of insulin glargine. The risk of hypoglycemia, DKA, and microvascular complications was not significant different among NPH and glargine initiators. With T2DM analysis, we found that initiators of NPH insulin discontinued earlier and have three times higher risk of hypoglycemia when compared to DPP-4 users. A manuscript detailing the results of part “b” (T2DM) was submitted to Diabetes Care and is currently under review. A second manuscript, describing the results of part “a” was submitted to the Pharmacoepidemiology and Drug Safety journal.