Different persistence on initial basal supported oral therapy in Type 2 diabetics is associated with unequal distributions of insulin treatment regimens under real-life conditions in Germany

Objectives Results from a representative German database and from two German health services research studies revealed an unequal distribution between basal supported oral therapy (BOT) and basal-bolus therapy (ICT) regimens in Type 2 diabetics treated with either insulin glargine (GLA) or human insulin (Neutral Protamine Hagedorn, NPH) This study assesses whether this unequal distribution could be caused by a different persistence on the initial BOT regimen Methods A Markov model was developed simulating the transition from BOT to ICT during a treatment course of 10 years Data on persistence with BOT were obtained from the IMS (R) Disease Analyzer database The model cohort consisted of German statutorily insured Type 2 diabetics starting a BUT either with insulin glargine or NPH insulin at a ratio of 1 1 Results The number of Type 2 diabetics who switched from BUT to ICT differed between the two groups After 2 years, 53% of glargine-treated patients and 31% of NPH-treated patients continued the BUT After 6 5 years, all NPH-treated patients had switched to ICT However, complete transition to ICT of glargine-treated patients occurred 1 75 years later In the first quarter of Year 3, the model simulation resulted in BUT ICT ratios comparable to those found in the real-world settings for GLA- and NPH-treated patients Conclusions The simulation indicates that the persistence on the initial basal supported oral therapy is associated with the resulting BUT ICT ratio Therefore, the unequal distribution between BUT and ICT of Type 2 diabetics treated with either insulin glargine or NPH insulin might be caused by different persistence on the initial BUT regimen