Diabetologie und Stoffwechsel 2007; 2 - A48
DOI: 10.1055/s-2007-984794

Evaluating the clinical outcomes associated with insulin aspart versus human insulin as the bolus component of a basal bolus regimen for type 2 diabetes over patient lifetimes

W Valentine 1, G Goodall 1, C Townsend 1, S Nielsen 1, R Kotchie 1, K Erny-Albrecht 1
  • 1IMS Health Economics and Outcomes Research, Basel, Switzerland

Aim:

To evaluate the long-term clinical implications of using insulin aspart (NovoRapid®) versus human insulin (HI) as the bolus component of basal-bolus therapy in type 2 diabetes patients in Germany.

Material and Methods:

A publishedcomputer simulation model of diabetes, previously validated against real-lifedata, was used to project long-term clinical outcomes. Three-month data forpatients in the German cohort (n=920) receiving insulin aspart or HI, both incombination with insulin detemir, from the PREDICTIVE observational study wasused as the basis of the analysis (mean age 63 years, duration of diabetes 13years, HbA1c 8.17%, BMI 30.3kg.m-2). The model was used topredict life expectancy, time to onset and cumulative incidence (CI) ofdiabetes-related complications over patient lifetimes.

Results:

Treatment with insulin aspart was projected to improve undiscounted life expectancy by 0.23 years versus HI (12.79±0.13 versus 12.56±0.12 years). Mean time to onset of first complication was delayed by 0.29 years with insulin aspart (3.66 years) versus HI (3.37 years). Insulin aspart was associated with a reduced CI of most complications. For proliferative diabetic retinopathy, the CI was decreased by 10% with insulin aspart (2.11%) versus HI (1.90%). Similarly, the CI of end-stage renal disease, one of the costliest complications, was decreased by 13% (5.41% versus 4.72%). The CI of most cardiovascular complications was also reduced in the insulin aspart arm with the exception of stroke, where an increase of 3.5% was projected. This was most likely due to the survival paradox, whereby patients living longer on insulin aspart were exposed to the risk of stroke for longer than those on HI.

Conclusion:

Insulin aspart, as the bolus component of basal-bolus therapy, was projected to improve life expectancy, delay the onset and reduce the incidence of most diabetes-related complications compared to HI in German type 2 diabetes patients.