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Impact of Switching Insulin Glargine to Insulin Detemir in T2 Patients

Many people are unaware about the health outcome associated with switching from glargine to detemir…

Type 2 diabetes is often managed by antidiabetic oral agents. As the disease progresses, it creates a need for insulin therapy. Insulin has significant impact on patients’ quality of life as well as financial circumstance. Both glargine and detemir are FDA-approved long-acting (basal) insulin for diabetes. Even though both glargine and detemir are in the same class of medication, studies have found differences in clinical outcomes between the two agents. Previous studies suggested that detemir is associated with less weight gain and hypoglycemic events compared to glargine in patients with type 2 diabetes. There is a lack of information about the effects of switching to detemir from glargine.

The purpose of this present study is to investigate the differences in clinical measures and associated costs for veterans with type 2 diabetes on insulin therapy converted from insulin glargine to insulin detemir. The trial was designed as a retrospective before-and-after comparison study. It was conducted at a single-site medical center located in the southwestern U.S. The study included 133 veterans diagnosed with type 2 diabetes getting insulin treatment with glargine and switched to insulin detemir utilizing a 1:1 unit dosage ratio. Data that was collected included patients’ HbA1c, weight, body mass index, total daily dose, and estimated monthly insulin costs during and after conversion. Wilcoxon signed-rank test was used to compare the differences.

The results showed that the conversion from glargine to detemir was associated with an increase in HbA1c (median of 7.7 % to 8.3 %, p < 0.01) and total daily dose (TDD: 40 to 46 units/day, p < 0.01). Patients experienced a decrease in monthly cost of insulin 19 % ($47 to $38, p < 0.01), or roughly a one-year savings of $110/patient. A rise in HbA1c was also noted for patients at-goal before switching, but remained at-goal post-conversion (6.5 % to 6.7 %, p = 0.02).

To conclude, switching from glargine to detemir is associated with an increase in HbA1c and TDD. These results suggest the need for a reduced quantity of units to reach similar glycemic-lowering ability compared to detemir. Also, the study showed that there is a cost saving associated with detemir. Future studies should be conducted to determine the overall saving and benefits of switching from glargine to detemir.

Practice Pearls:

  • Switching from glargine to detemir is associated with an increase in HbA1c and TDD.
  • Detemir is associated with a decrease in monthly cost of insulin in patients with type 2 diabetes.
  • Patients taking detemir requires more insulin to obtain glycemic control compared to patients taking glargine.

Asias BD, Stock EM, Small NL, et al. Clinical and financial outcomes of switching insulin glargine to insulin detemir in a veteran population with type 2 diabetes. J Diabetes Metab Disord. 2015;14:53.