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Updated: Dec 15, 2025
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Published on: June 11, 2012
Persistence with Basal Insulin and Frequency of Hypoglycemia Requiring Hospitalization in Patients with Type 2
Ronan Roussel1, Bruno Detournay2, Zahra Boultif3
1Endocrinology Department, Hôpital Bichat Claude Bernard, Centre Hospitalier Universitaire (CHU)-Paris, Paris, France.
Introduction:
A second-generation basal insulin analogue insulin glargine 300 U/mL (Gla-300) has been marketed in France since June 2016. This real-world study was designed to assess persistence with Gla-300 and the prevalence of related hypoglycemia requiring hospitalization as compared to first-generation basal insulins, in patients with type 2 diabetes mellitus (T2DM).
Methods:
A retrospective study was conducted using data in the large French comprehensive national healthcare system claims databases. Patients with T2DM newly treated with insulin in 2016 and 2017 (2-year period) were included. Three basal insulins [Gla-300, glargine 100 U/mL (Gla-100; both branded and biosimilar) and insulin detemir (IDet)] were compared for (1) persistence until treatment discontinuation using adjusted Cox models and (2) hypoglycemia requiring hospitalization over the period of insulin exposure.
Results:
During the 2-year study period, in France, 181,263 patients initiated basal insulin therapy (in a basal scheme or a more complex insulin scheme), of whom 74% initiated Gla-100, 14.2% initiated IDet and 11.8% initiated Gla-300. Patient characteristics varied according to the insulin regimen in terms of age, gender, social coverage, insulin scheme, and Charlson Comorbidity Index. Overall, 72% of patients were still treated with any basal insulin after 1 year (75% in basal scheme). In all insulin treatment regimens, patients were less likely to discontinue Gla-300 as compared to Gla-100 [adjusted odds ratio (OR) 0.39, 95% confidence interval (CI) 0.37-0.41], with similar results when only the basal scheme was considered (adjusted OR 0.38, 95% CI 0.35-0.40). Persistence with IDet was similar to that with Gla-100. Patients treated with Gla-100 had higher crude hospitalization rates for hypoglycemia than those receiving Gla-300 (1.4 for 100 patients-years; OR 0.67, 95% CI 0.55-0.81); however, this difference was not statistically significant after adjustment for patient characteristics. Emergency Room (ER) visits were less frequent in patients treated with Gla-300 versus Gla-100 with or without adjustment for patient characteristics (p < 0.0001).
Conclusion:
Real-world persistence for basal insulin therapy in patients with T2DM was significantly better in those on Gla-300 compared with those on Gla-100 and IDet. A trend to a lower frequency of hospitalization for hypoglycemia and ER visits, whatever the cause, was also observed in patients on Gla-300.
Insights
This study found that patients with type 2 diabetes mellitus (T2DM) using insulin glargine 300 U/mL (Gla-300) showed better persistence and fewer emergency room visits compared to those on glargine 100 U/mL (Gla-100) or insulin detemir (IDet).
Area of Science:
- Endocrinology
- Pharmacology
- Real-world evidence studies
Background:
- Insulin glargine 300 U/mL (Gla-300) is a second-generation basal insulin analogue.
- Type 2 diabetes mellitus (T2DM) management often involves basal insulin therapy.
- Real-world data is crucial for understanding treatment effectiveness and patient adherence.
Purpose of the Study:
- To assess real-world persistence with Gla-300 compared to first-generation basal insulins (Gla-100 and insulin detemir [IDet]).
- To evaluate the prevalence of hypoglycemia-related hospitalizations in patients treated with Gla-300 versus Gla-100 and IDet.
- To analyze emergency room (ER) visit rates across different basal insulin treatments.
Main Methods:
- Retrospective analysis of French national healthcare system claims databases.
- Inclusion of T2DM patients newly treated with basal insulin in 2016-2017.
- Comparison of Gla-300, Gla-100 (branded and biosimilar), and IDet using adjusted Cox models for persistence and hospitalization rates.
Main Results:
- Significantly higher persistence was observed with Gla-300 compared to Gla-100 (adjusted OR 0.39) and IDet.
- Crude hospitalization rates for hypoglycemia were higher with Gla-100 than Gla-300, but not statistically significant after adjustment.
- Emergency Room visits were significantly less frequent in patients treated with Gla-300 versus Gla-100 (p < 0.0001).
Conclusions:
- Real-world persistence with basal insulin therapy in T2DM patients is significantly better with Gla-300 than with Gla-100 and IDet.
- A trend towards lower hospitalization and ER visit frequency was observed for Gla-300.
- These findings support Gla-300 as a valuable option for long-term basal insulin management in T2DM.
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