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.
Moura et al. Rates of therapy switching is higher among initiators insulin glargine versus of insulin NPH in a population-based type 1 diabetes mellitus cohort. 2016 (ICPE abstract)
Moura et al. Treatment discontinuation and rates of hypoglycemia in type 2 diabetes patients treated with dipeptidyl peptidase-4 (DDP4) inhibitors or NPH insulin as third line therapy. 2016 (ICPE abstract)
Moura et al. Treatment discontinuation and clinical events in type 2 diabetes patients treated with dipeptidyl peptidase-4 inhibitors or NPH insulin as third-line therapy. Journal of Diabetes Research, 2018: 4817178.
Elharram M et al. The beneficial effect of novel glucose-lowering agents on cardiovascular events in type-2 diabetes at low risk: a population-based analysis. (Manuscript in preparation)