Bonafede, MM

Curkendall, S

Kalsekar, A

Kelly, KR

McGuffie, K

Pawaskar, MD

Torres, A

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Paris Abstracts A413
questionnaire regarding their medical care and self management. Medications (within 
the last 7 days), physical examination and laboratory tests were documented. DDMP 
participation was validated by the primary physician. Only DM2s with statutory 
health insurance and validated DDMP enrolment were included in the analysis (n  
166). Regression analyses adjusting for confounders (age, sex, education, diabetes 
duration and previous diabetes complications) were conducted. RESULTS: DDMP 
enrolees (n  89) reported medical examination of eyes and feet and medical advice 
regarding diet and physical activity more frequently (p  0.005), received antidiabetic 
and antihypertensive medications more often (p  0.05) and attended diabetes educa-
tion more frequently (p  0.005). DDMP enrolees measured their blood pressure more 
frequently (p  0.05). The groups did not differ regarding Hemoglobin A1c (HbA1c), 
but of 54 DM2s with values over 7%, only 3.6% of DDMP enrolees were receiving 
no antihyperglycemic medication whereas this was true for 38.5% of those not in 
DDMP. This difference remained signiﬁcant (p  0.0129) after adjustment for diabetes 
duration. CONCLUSIONS: According to our study, health care quality in DDMPs is 
improved. However, patient self-management of all diabetics must be improved.
PDB61
DIABETES REGIMEN UTILIZATION IN A LARGE MANAGED CARE 
SETTING; A COMPARISON WITH ADA/EASD CONSENSUS STATEMENT 
GUIDELINES
Palmer L1, Conner C2, Hammer M3, Bouchard JR4, Anderson JA5
1Thomson Reuters, Washington , DC, USA, 2Novo Nordisk, Seattle, WA, USA, 3Novo 
Nordisk A/S, Bagsværd, Denmark, 4Novo Nordisk, Inc., Princeton, NJ, USA, 5Thomson 
Reuters, Ann Arbor, MI, USA
OBJECTIVES: Diabetes extracts a considerable economic toll on the US health care 
system. An analysis conducted in 2007, indicated that the economic burden of diabetes 
was $174 billion, with direct medical expenditures accounting for $116 billion. Origi-
nally published in 2006 and updated yearly, the American Diabetes Association 
(ADA)/European Association for the Study of Diabetes (EASD) Consensus Algorithm 
for the Initiation and Adjustment of Therapy, stands to guide health care practitioners 
in determining the most appropriate lifestyle and pharmacotherapeutic interventions 
for patients with Type 2 diabetes. We conducted an analysis to compare medication 
regimens from claims adjudicated by patients with Type 2 diabetes to treatment regi-
mens outlined in the ADA/EASD guidelines. METHODS: This retrospective claims 
analysis utilized data from the 2007 MarketScan® Commercial Claims and Encoun-
ters and the Medicare Supplemental and Coordination of Beneﬁts databases from 
Thomson Reuters. Medication regimens were evaluated for patients with Type-2 dia-
betes and at least one prescription claim for the fourth quarter of 2007. In order to 
be considered as part of a treatment regimen all medications must have had an over-
lapping 45 day period of utilization in the quarter. All identiﬁed medication regimens 
were compared to 2008 ADA/EASD consensus guidelines RESULTS: A total of 
191,535 patients were included in the analysis. In rank order, the top ﬁve treatment 
regimens by utilization frequency were as follows: biguanide monotherapy (27.9%), 
sulfonylurea monotherapy (14.53%), sulfonylureabiguanide combination therapy 
(12.01%), thiazolidinedione monotherapy (9.21%), thiazolidinedionebiguanide 
combination therapy (6.97%). CONCLUSIONS: As expected, following ADA/EASD 
guidelines, monotherapy with biguanide and a regimen of biguanidesulfoylurea were 
among the most frequently utilized regimens. The high degree of sulfonylurea mono-
therapy utilization may suggest that many patients may not tolerate monotherapy with 
biguanide. In all cases treatment must be individualized requiring the use of other 
agents to control blood glucose levels.
PDB62
ECONOMIC IMPACT OF COMPLIANCE AND PERSISTENCE TO 
TREATMENT WITH ANTIDIABETES MEDICATION IN T2DM— 
A SYSTEMATIC REVIEW
Breitscheidel L1, Stamenitis S1, Dippel FW2, Schöffski O3
1Kendle GmbH, Munich, Germany, 2Sanoﬁ-Aventis, Berlin, Germany, 3Universität Erlangen-
Nürnberg, Nürnberg, Germany
OBJECTIVES: Suboptimal compliance and failure to persist with antidiabetes thera-
pies are of potential economic signiﬁcance. The present research aims to review the 
recent literature regarding the impact of poor compliance and persistence with antidi-
abetes medications on the cost of health care or its components for patients with type 
2 diabetes mellitus (T2DM). METHODS: Systematic literature search was conducted 
in pubmed for relevant articles published in the period between January 1, 2000 and 
April 30, 2009. Studies describing economic consequence of compliance and/or per-
sistence with pharmaceutical antidiabetes treatment were identiﬁed. RESULTS: Of 
449 articles corresponding to the primary search algorithm, 12 studies (all conducted 
in USA) fulﬁlled inclusion criteria regarding the economic impact of compliance and/or 
persistence with treatment on the overall cost of T2DM care or its components. 
Compliance was assessed via medication possession ratio (MPR) in 10 studies, and 
ranged from 0.52 to 0.93 depending on regimen. Persistence was assessed in one study. 
Mean total annual costs per patient having T2DM varied between the studies, ranging 
from $4,570 to $17,338. In 7 studies medication compliance was inversely associated 
with total health care costs, while in four other studies inverse associations between 
medication compliance and hospitalisation costs were reported. In one study increased 
adherence did not change overall health care costs. CONCLUSIONS: Improved com-
pliance can lead to reductions of the total health care costs in T2DM, mainly through 
decrease in hospitalisations. Studies assessing economic impact of persistence with 
pharmacotherapy in T2DM are limited, and studies investigating cost consequences 
of compliance are predominantly using MPR as a measure of compliance. Further 
research is needed in countries other than USA to assess impact of compliance and 
persistence to pharmacotherapy on T2DM costs in country-speciﬁc settings. Research-
ers should follow deﬁnitions of compliance and persistence proposed by the ISPOR 
Medication Compliance and Persistence Special Interest Group.
PDB63
THE UTILIZATION OF ROSIGLITAZONE AND PIOGLITAZONE AFTER 
THE CARDIOVASCULAR RISK-WARNINGS: WAS THERE A 
DIFFERENTIAL EFFECT?
Jain R1, Mullins CD2, Lee H3, Wong W3
1University of Georgia, Athens, , GA, USA, 2University of Maryland, Baltimore, MD, USA, 
3CareFirst BlueCross BlueShield, Baltimore, MD, USA
OBJECTIVES: Meta-Analyses of oral hypoglycemic agents (OHA) revealed that Rosi-
glitazone (Rosi) increased the risk of Myocardial Infarction (MI) and Heart Failure 
(HF), and Pioglitazone (Pio) increased the risk of HF and decreased the risk of MI. 
The objective of this research is to compare OHA utilization patterns, before and after 
these publications. METHODS: CareFirst BlueCross BlueShield’s claims were ana-
lyzed for patients continuously enrolled from January 2005 through December 2007 
who started on mono-Rosi or mono-Pio. The “pre-publication” period (November 1, 
2006—March 31, 2007) was compared to the “post-publication” period (July 1, 
2007—December 1, 2007) using a difference-in-difference approach. Multinomial 
logistic regression (MLR) explored discontinuation; continuation with monotherapy 
or adding another drug; and switching after adjusting for gender, age, type of insur-
ance, history of MI or HF and risk factors for MI and HF. RESULTS: The number 
of monotherapy Rosi users decreased from the pre (N  368, 5.94%) to post (N  
170, 2.87%) period, while monotherapy Pio use was stable across the two periods. 
The proportion who switched from Rosi to non-Rosi drugs changed from 2.17% in 
pre-period to 5.88% in post period. Adjusted relative risk was 2.66 (95 % CI 1.0569, 
6.7689). Pio to non-pio drugs switching was 1.48% in pre-period and 1.16% in post-
period (relative risk not signiﬁcant). Therefore, the impact of the new studies on Rosi 
users to switch to non-Rosi drug, relative to Pio users before and after the publication 
was 3.6189 (90%CI 1.051, 12.457). CONCLUSIONS: Consistent with prior research, 
the utilization of Rosi declined by more than half in the post-period. Additionally, 
Rosi users were three times more likely to switch to a non-Rosi drug in the post period, 
relative to Pio users. Therefore, our results show that the publications about safety 
risks had differential impact between the two drugs within therapeutic class.
PDB64
A RETROSPECTIVE DATABASE ANALYSIS OF PERSISTENCE WITH 
INSULIN IN PATIENTS WITH TYPE 2 DIABETES ADDING MEALTIME 
INSULIN TO A BASAL REGIMEN
Kalsekar A1, Bonafede MM2, Pawaskar MD1, McGufﬁe K3, Torres A4, Kelly KR1,  
Curkendall S4
1Eli Lilly and Company, Indianapolis, IN, USA, 2Thomson Reuters, Cambridge, MA, USA, 
3Thomson Reuters, Washington, DC, USA, 4Thomson Reuters, Washington DC , DC, USA
OBJECTIVES: Following a commitment to an intensive glucose-lowering regimen that 
includes mealtime insulin is eventually required by patients taking basal insulin to 
maintain good glycemic control. The objective of this study was to characterize and 
examine factors associated with persistence to mealtime insulin. METHODS: Patients 
with diagnosed type-2 diabetes, with at least 2 prescriptions for mealtime insulin 
(index medication) between July 2001 and Sept 2006, were identiﬁed from a US 
managed care claims database. Patients were required to have 6 months pre- and 15 
months post-index continuous eligibility and at least 2 basal insulin prescriptions in 
pre-index period. Persistence measure #1 was deﬁned by the absence of prescription 
gap of greater than 90 days, with non-persistence effective the date of the last prescrip-
tion prior to the 90 day gap. Persistence measure #2 required one prescription per 
quarter to be persistent at 12 months; persistence at 3 and 6 months were deﬁned 
similarly. Logistic regression models were used to examine predictors of persistence 
to mealtime insulin at 12 months. RESULTS: Patients adding mealtime insulin to their 
basal regimen (n  4,752; 51% male, mean age  60.3 years) mostly used insulin 
analogs (60%) and vial/syringe (87%). The median number of mealtime insulin pre-
scription claims ﬁlled per patient was 2, 3 and 4 at 3, 6 and 12 months respectively, 
with the median time between reﬁlls being 75.5 days. Persistence to mealtime insulin 
was 40.7%, 30.2% and 19.1% using measure #1 and 74.3%, 55.3% and 42.2% using 
measure # 2 at 3, 6 and 12 months, respectively. Patients initiating with human insulin 
were less likely to be persistent across measures of persistence (OR  0.80, p  0.01). 
Additional predictors of persistence at 12 months included age, copayment, mental 
health comorbidity and polypharmacy. CONCLUSIONS: Persistence to insulin 
therapy is poorer than one would anticipate and is signiﬁcantly lower for human 
insulin compared to analogs.
PDB65
REAL-LIFE PRESCRIPTION PATTERNS SHOW FEWER TREATMENT 
CHANGES WITH BASAL INSULIN ANALOGS COMPARED TO NPH IN 
TYPE 2 DIABETES IN THE NETHERLANDS
Thomsen TL1, Heintjes EM2, Penning-van Beest FJA2, Christensen TE1, Herings RM2
1Novo Nordisk A/S, Virum, Denmark, 2PHARMO Institute, Utrecht, The Netherlands
OBJECTIVES: Using the Dutch PHARMO database, the aim was to 1) determine the 
percentage of type 2 diabetes (T2D) patients starting on long-acting insulin analogues 
versus NPH; 2) compare previous insulin experience in patients; and 3) establish the 
number of patients changing treatment within one year. METHODS: The PHARMO 
database includes community pharmacy drug dispensing and hospitalisation records 


PDB64 A RETROSPECTIVE DATABASE ANALYSIS OF PERSISTENCE WITH INSULIN IN PATIENTS WITH TYPE 2 DIABETES ADDING MEALTIME INSULIN TO A BASAL REGIMEN 

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PDB64 A RETROSPECTIVE DATABASE ANALYSIS OF PERSISTENCE WITH INSULIN IN PATIENTS WITH TYPE 2 DIABETES ADDING MEALTIME INSULIN TO A BASAL REGIMEN

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