According to a real-world outcomes analysis among patients with type 2 diabetes mellitus, treatment with insulin glargine and liraglutide appeared to be prescribed for different patient groups, “highlighting that efficacy results from clinical trials do not always translate into real-world practice,” stated study author Wenhui Wei, PhD, MS, MBA. Findings from the study are published in Diabetes, Obesity and Metabolism.

Dr. Wei and coauthors set out to examine real-world outcomes in patients with type 2 diabetes mellitus starting injectable therapy as part of the INITIATOR (Initiation of New Injectable Treatment Introduced after Antidiabetic Therapy with Oral-only Regimens) study. They analyzed insurance claims and medical record data among adults starting treatment with insulin glargine or liraglutide. Patients’ baseline characteristics and changes in 12-month follow-up outcomes (HbA1c, weight change, hypoglycemia, persistence, healthcare utilization and costs) were compared for both treatment groups. 

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The study included 2,116 patients in the glargine group and 2,374 patients in the liraglutide group. Patients in the glargine group exhibited significantly higher baseline HbA1c vs. liraglutide patients (9.72% vs. 8.19%; P<0.001), a lower risk of having HbA1c <7% (7.1% vs. 23.8%; P<0.001), a lower body weight (100.9kg vs. 110.9kg; P<0.001), a higher Charlson Comorbidity Index score (0.88 vs. 0.63; P<0.001). Patients treated with glargine also incurred higher diabetes-related costs vs. liraglutide-treated patients ($3,492 vs. $2,089; P<0.001).

During the 12-month follow-up period, glargine-treated patients showed greater treatment persistence (64% vs. 49%) and a greater mean HbA1c reduction vs. liraglutide-treated patients (–1.24% vs. –0.51%) . However, glargine-treated patients saw a +1.17kg weight gain whereas liraglutide-treated patients had a –2.74kg loss. Change in diabetes-related costs from baseline was increased significantly for liraglutide-patients ($2,08 vs. $3,258; P<0.001) but not for glargine-treated patients ($3,492 vs. $3,550; P=0.890). 

Clinically relevant baseline differences were seen in both treatment arms. The increases in costs among the liraglutide-treatment group calls for more cost-effectiveness analysis, concluded Dr. Wei.

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