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Kostev K.,IMS Health | Rathmann W.,Institute of Biometrics and Epidemiology
Primary Care Diabetes | Year: 2013

Aims To study whether the time to insulin therapy in type 2 diabetic patients in primary care in Germany and UK has increased (2005-2010). Methods Longitudinal data from general practices in Germany and UK (Disease Analyser) from 1995 to 2010 were analyzed. Patients who started their insulin treatment from 2005 to 2010 were analyzed regarding the time from the first diabetes diagnosis in the practices (index date) and the first insulin prescription, including 6368 patients (age: 68 (SD: 12) years) in Germany and 1998 patients (age: 64 (12) yrs) in UK. Results Median (interquartile range) time to insulin therapy in the practices increased from 943 (214-1994) days in 2005 to 1549 (957-2533) days in 2010 (p < 0.001). In UK, time to onset of insulin treatment increased from 1700 (649-2521) days in 2005 to 2061 (1309-2686) days in 2010 (p < 0.001). The last HbA1c values before insulin initiation were high and slightly increased during the study period (Germany: 2005: 8.2%, 2010: 8.4%; UK: 2005: 9.5%, 2010: 9.8%; both p < 0.001). Conclusions This real world data shows that the time to insulin therapy has increased in type 2 diabetes patients from 2005 to 2010 (Germany, UK). The average HbA1c values before insulin therapy also slightly increased during this period. © 2013 Primary Care Diabetes Europe.

Kostev K.,IMS Health | Dippel F.-W.,University of Leipzig | Rathmann W.,Institute of Biometrics and Epidemiology
Primary Care Diabetes | Year: 2014

Aims To investigate the frequency and predictors (diabetes care and treatment, comorbidity) of documented hypoglycaemia in primary care patients with insulin-treated type 2 diabetes. Methods Data from 32,545 patients (mean age: 70 (SD 11) years, 50.3% males) from 1072 practices were retrospectively analyzed (Disease Analyzer database Germany: 09/2011-08/2012). Logistic regression (≥1 documented hypoglyemia) was used to adjust for confounders (age, sex, practice characteristics, diabetes treatment regimen). Results The prevalence of patients (12 months) with at least one reported hypoglycaemia was 2.2% (95% CI: 2.0-2.4%). The adjusted odds of having hypoglycemia were increased for renal failure (OR; 95% CI: 1.26; 1.16-1.37), autonomic neuropathy (1.34; 1.20-1.49), and adrenocortical insufficiency (3.08; 1.35-7.05). Patients with mental disorders including dementia (1.49; 1.31-1.69), depression (1.24; 1.13-1.35), anxiety (1.18; 1.01-1.37), and affective disorders (1.80; 1.36-2.38) also showed an increased odds of having hypoglycemia. Location of the practice in an urban area was associated with a lower odds ratio (0.74; 0.68-0.80). Conclusions Both individual patient characteristics (e.g. comorbidity) and regional factors (practice location) have a substantial impact on hypoglycaemia in primary care patients with insulin therapy. © 2013 Primary Care Diabetes Europe.

Kostev K.,IMS Health | Jockwig A.,Fresenius University of Applied Sciences | Hallwachs A.,Praxis for Internal Medicine and Nephrology | Rathmann W.,Institute of Biometrics and Epidemiology
Primary Care Diabetes | Year: 2014

Aims To estimate the prevalence and risk factors of diabetic neuropathy in newly diagnosed type 2 diabetes in general practices. Methods Longitudinal data from nationwide general practices in Germany (n = 630) and UK (n = 100) (Disease Analyzer) were analyzed. Patients with newly diagnosed (<1 year) type 2 diabetes (2008-2012) were identified including 45,633 patients (age: 66, SD: 12 years) in Germany and 14,205 patients (age: 63, SD: 13 years) in UK. Neuropathy was identified by ICD code (E11.4) or the original diagnosis. Associations of potential risk factors with neuropathy were investigated using logistic regression. Results The prevalence of diagnosed neuropathy was 5.7% (95% CI: 5.5-5.9%) in Germany and 2.4% (1.9-2.9%) in UK. In Germany, factors independently associated with neuropathy in stepwise logistic regression were age (>70 years: OR; 95% CI 2.1; 1.6-2.8), retinopathy (3.0; 2.1-4.2), peripheral artery disease (PAD: 1.9; 1.4-2.5), insulin treatment (4.6; 3.5-6.2) and oral antidiabetic drugs (OAD: 1.6; 1.2-2.0). In UK, male sex (1.4; 1.01-1.9), nephropathy (1.7; 1.2-2.5), PAD (1.5; 1.1-2.1), antihypertensives (1.7; 1.1-2.5), insulin (2.1; 1.1-3.8) and OAD (1.4; 1.01-1.8) were identified. Conclusions The prevalence of diabetic neuropathy at time of type 2 diabetes diagnosis was low in primary care (Germany, UK). Neuropathy was associated with age, PAD and microvacular complications. © 2014 Primary Care Diabetes Europe.

Aims: Insulin aspart has a higher ability to treat postprandial glucose than regular human insulin, which may have favourable cardiovascular effects. The aim was to collect and compare the incidence of recorded macro- and microvascular events in patients with type 2 diabetes with insulin aspart or regular human insulin in general practices. Methods: Computerized data from 3154 aspart and 3154 regular insulin users throughout Germany (Disease Analyzer, January 2000 to July 2011) were analysed after matching for age (60±10years), sex (men: 57%), health insurance (private: 5.8%) and diabetes treatment period in practice (2.2±2.5years). Hazard ratios (HR; Cox regression) for macro- or microvascular outcomes (follow-up: 3.5years) were further adjusted for diabetologist care, practice region, hypertension, hyperlipidaemia, co-medication (basal insulin, oral antidiabetics, antihypertensives, lipid-lowering agents and antithrombotic drugs), previous treatment with rapid-acting insulins, hypoglycaemia and the Charlson co-morbidity score. Furthermore, adjustment was carried out for baseline microvascular complications when analysing macrovascular outcomes and vice versa. Results: Overall, the risk of combined macrovascular outcomes was 15% lower for insulin aspart users (p=0.01). For insulin aspart there was also a decreased risk incident stroke [HR: 0.58; 95% confidence interval (CI): 0.45-0.74], myocardial infarction (HR: 0.69; 95% CI: 0.54-0.88) and peripheral vascular disease (HR: 0.80; 95% CI: 0.69-0.93). For microvascular complications (retinopathy, neuropathy and nephropathy), no significant differences were observed (HR: 0.96; 95% CI: 0.87-1.06). Conclusion: Use of the rapid-acting insulin analogue aspart was associated with a reduced incidence of macrovascular outcomes in type 2 diabetes in general practices. It is important to confirm this finding in a randomized controlled trial. © 2012 Blackwell Publishing Ltd.

Kostev K.,IMS Health | Dippel F.W.,Sanofi S.A. | Rathmann W.,Institute of Biometrics and Epidemiology
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy | Year: 2015

Background: When target glycated hemoglobin (HbA1c) levels are not reached, basal insulin therapy should be considered in type 2 diabetes. The objective of this report was to describe the predictors of glycemic control (strict criterion: HbA1c ≤6.5%) during the first year after initiating basal insulin therapy in primary care.Methods: The study applied a retrospective approach using a nationwide database in Germany (Disease Analyzer, IMS Health, January 2008 to December 2011, including 1,024 general and internal medicine practices). Potential predictors of glycemic control considered were age, sex, duration of diabetes, type of basal insulin, comedication with short-acting insulin, baseline HbA1c, previous oral antidiabetic drugs, diabetologist care, private health insurance, macrovascular and microvascular comorbidity, and concomitant medication. Multivariable logistic regression models were fitted with glycemic control as the dependent variable.Results: A total of 4,062 type 2 diabetes patients started basal insulin (mean age 66 years, males 53%, diabetes duration 4.8 years, mean HbA1c 8.8%), of whom 295 (7.2%) achieved an HbA1c ≤6.5% during the one-year follow-up. Factors positively associated with HbA1c ≤6.5% in logistic regression were male sex (odds ratio 1.59, 95% confidence interval 1.23–2.04), insulin glargine (reference neutral protamine Hagedorn; odds ratio 1.43, 95% confidence interval 1.09–1.88), short-acting insulin (odds ratio 1.33, 95% confidence interval 1.01–1.76), and prior treatment with metformin, dipeptidyl peptidase-4 inhibitors, and diuretics. Lipid-lowering drugs were associated with a lower odds of reaching the glycemic target.Conclusion: Few type 2 diabetes patients (7%) reached the glycemic target (HbA1c ≤6.5%) after one year of basal insulin therapy. Achievement of the glycemic target was associated with type of basal insulin, additional short-acting insulins, previous antidiabetic medication, and other comedication, eg, diuretics or lipid-lowering drugs. © 2015 Kostev et al.

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