Healthcare Utilisation and Costs in Adults with Type 2 Diabetes Treated with First- or Second-Generation Basal Insulins in England

Holden, Neil; Diribe, Onyinye; Palmer, Karen; Puttanna, Amar; Mahieu, Aymeric; Nicholls, Charlie; Li Marston, Xiaocong; Denholm, Nick; Saberi Hosnijeh, Fatemeh; Idris, Iskandar

Abstract

Introduction: The prevalence of people with type 2 diabetes (T2D) on basal insulin (BI) is rising to improve glucose control and minimize minimise complications. However, limited evidence exists regarding the economic impact of second-generation BI analogues compared with first-generation BI in the United Kingdom.

Research Design and Methods: In this comparative retrospective, observational study, adults with T2D who initiated treatment with a first-generation BI (e.g., glargine 100 U/mL, detemir) and switched to another first-generation or a second-generation BI (glargine 300 U/mL [Gla-300] or degludec) (index date) between 01/07/2014 and 31/03/2021 were analysed using the Clinical Practice Research Datalink (CPRD) Aurum linked to Hospital Episode Statistics. Subjects were followed from the index date until the end of observation period, deregistration in CPRD, or death. Propensity score weighting balanced baseline characteristics, and healthcare resource utilisation (HCRU) and costs were compared using standardised differences and zero-inflated regression models.

Results: A total of 13,975 people with T2D (mean [standard deviation, SD] age: 62.45 [13.59] years) treated with a first-generation BI who switched to another first-generation BI (n=5,654), Gla-300 (n=4,737), or degludec (n=3,584) were included. Mean (SD) follow-up time was 4.98 (4.27), 1.96 (1.62), and 2.05 (1.92) years for the first-generation BI, Gla-300, and degludec groups, respectively. Overall, people who switched to Gla-300 had significantly lower HCRU. Fewer people in the Gla-300 group received hypoglycaemia-related healthcare compared with those in the first-generation BI group (9.1% vs. 16.4%, incident rate ratio [IRR]=0.41, P<0.001) and the degludec group (9.2% vs. 11.7%, IRR=0.51, P<0.001). During follow-up, diabetes- and diabetic ketoacidosis–related total direct costs were lower for the Gla-300 group compared with the first-generation BI group by 17% and the degludec group by 60%, respectively.

Conclusions: These findings suggest that Gla-300 may offer clinical and economic benefits by reducing hypoglycaemia incidents and lowering healthcare costs compared with first-generation BI.

Citation

Holden, N., Diribe, O., Palmer, K., Puttanna, A., Mahieu, A., Nicholls, C., Li Marston, X., Denholm, N., Saberi Hosnijeh, F., & Idris, I. (in press). Healthcare Utilisation and Costs in Adults with Type 2 Diabetes Treated with First- or Second-Generation Basal Insulins in England. BMJ Open Diabetes Research and Care,

• Journal Article Type: Article
• Acceptance Date: Apr 26, 2025
• Deposit Date: Apr 28, 2025
• Journal: BMJ Open Diabetes Research & Care
• Print ISSN: 2052-4897
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Public URL: https://nottingham-repository.worktribe.com/output/48352693