Table 1.
Baseline characteristics of the patients who received basal insulin or a TZD as a third antidiabetic agent.
| Characteristics | Full cohort before matching | Propensity score-matched (1:2) cohort | ||||
|---|---|---|---|---|---|---|
| Basal insulin (n = 6,441) | TZDs (n = 49,181) | S.D. | Basal insulin (n = 6,101) | TZDs (n = 11,823) | S.D. | |
| Age, mean ± SD | 52.6 ± 12.6 | 55.8 ± 10.8 | 0.28 | 52.9 ± 12.5 | 53.8 ± 11.6 | 0.08 |
| Male, n (%) | 4,087 (63.5) | 27,745 (56.4) | 0.15 | 3,822 (62.7) | 7,378 (62.4) | 0.01 |
| Index year, n (%) | 0.23 | 0.04 | ||||
| 2008–2009 | 1,641 (25.5) | 15,987 (32.5) | 1,613 (26.4) | 3,269 (27.7) | ||
| 2010–2011 | 1,890 (29.3) | 16,133 (32.8) | 1,837 (30.1) | 3,650 (30.9) | ||
| 2012–2013 | 1,924 (29.9) | 11,968 (24.3) | 1,768 (29.0) | 3,302 (27.9) | ||
| 2014 | 986 (15.3) | 5,093 (10.4) | 883 (14.5) | 1,602 (13.6) | ||
| First DM drug, n (%) | 0.34 | 0.05 | ||||
| Metformin | 1,076 (16.7) | 9,874 (20.1) | 1,066 (17.5) | 2,036 (17.2) | ||
| Other OHA | 1,279 (19.9) | 15,986 (32.5) | 1,271 (20.8) | 2,688 (22.7) | ||
| Dual therapy as the initial treatment | 4,086 (63.4) | 23,321 (47.4) | 3,764 (61.7) | 7,099 (60.0) | ||
| Type of OHA used with metformin for dual therapy | 0.28 | 0.05 | ||||
| Sulfonylureas | 5,826 (90.5) | 47,602 (96.8) | 5,635 (92.4) | 11,069 (93.6) | ||
| DPP-4is | 337 (5.2) | 649 (1.3) | 251 (4.1) | 395 (3.3) | ||
| Meglitinides | 249 (3.9) | 650 (1.3) | 187 (3.1) | 305 (2.6) | ||
| α-glucosidase inhibitors | 29 (0.5) | 280 (0.6) | 28 (0.5) | 54 (0.5) | ||
| Time since the first DM drug (years), mean ± SD | 2.6 ± 2.8 | 3.7 ± 2.5 | 0.43 | 2.7 ± 2.8 | 2.9 ± 2.5 | 0.07 |
| Time since the second DM drug (years), mean ± SD | 2.0 ± 2.4 | 2.9 ± 2.3 | 0.39 | 2.1 ± 2.4 | 2.2 ± 2.2 | 0.07 |
| aDCSI | 0.16 | 0.03 | ||||
| 0 | 3,119 (48.4) | 24,061 (48.9) | 2,959 (48.5) | 5,779 (48.9) | ||
| 1 | 1,247 (19.4) | 12,231 (24.9) | 1,223 (20.1) | 2,489 (21.1) | ||
| ≥2 | 2,075 (32.2) | 12,889 (26.2) | 1,919 (31.5) | 3,555 (30.1) | ||
| HbA1c order count in 1 year | 0.38 | 0.06 | ||||
| ≤2 | 3,790 (58.8) | 19,955 (40.6) | 3,465 (56.8) | 6,359 (53.8) | ||
| 3–4 | 1,790 (27.8) | 20,927 (42.6) | 1,778 (29.1) | 3,711 (31.4) | ||
| 5–6 | 655 (10.2) | 6,731 (13.7) | 653 (10.7) | 1,360 (11.5) | ||
| >6 | 206 (3.2) | 1,568 (3.2) | 205 (3.4) | 393 (3.3) | ||
| Baseline PDC of dual therapy (%) | 0.26 | 0.05 | ||||
| ≤30 | 1,048 (16.3) | 6,003 (12.2) | 1,024 (16.8) | 1,985 (16.8) | ||
| 30–50 | 838 (13.0) | 9,522 (19.4) | 837 (13.7) | 1,756 (14.9) | ||
| 50–80 | 999 (15.5) | 10,508 (21.4) | 993 (16.3) | 2,077 (17.6) | ||
| >80 | 3,556 (55.2) | 23,148 (47.1) | 3,247 (53.2) | 6,005 (50.8) | ||
| Hypoglycemia history, n (%) | 52 (0.8) | 127 (0.3) | 0.08 | 44 (0.7) | 72 (0.6) | 0.01 |
| Number of outpatients visits in 1 year | 0.37 | 0.03 | ||||
| ≤12 | 2,087 (32.4) | 8,449 (17.2) | 1,827 (30.0) | 3,406 (28.8) | ||
| 13–24 | 2,017 (31.3) | 20,525 (41.7) | 1,984 (32.5) | 3,898 (33.0) | ||
| 25–36 | 1,176 (18.3) | 11,219 (22.8) | 1,154 (18.9) | 2,316 (19.6) | ||
| 37–48 | 581 (9.0) | 4,708 (9.6) | 569 (9.3) | 1,114 (9.4) | ||
| >48 | 580 (9.0) | 4,280 (8.7) | 567 (9.3) | 1,089 (9.2) | ||
| Number of hospitalizations in 1 year | 0.32 | 0.03 | ||||
| 0 | 1,483 (23.0) | 17,439 (35.5) | 1,472 (24.1) | 2,981 (25.2) | ||
| 1–2 | 2,359 (36.6) | 18,105 (36.8) | 2,208 (36.2) | 4,191 (35.5) | ||
| ≥3 | 2,599 (40.4) | 13,637 (27.7) | 2,421 (39.7) | 4,651 (39.3) | ||
| Number of ER admissions in 1 year | 0.40 | 0.04 | ||||
| 0 | 4,036 (62.7) | 39,481 (80.3) | 3,973 (65.1) | 7,918 (67.0) | ||
| 1 | 1,512 (23.5) | 6,765 (13.8) | 1,340 (22.0) | 2,463 (20.8) | ||
| ≥2 | 893 (13.9) | 2,935 (6.0) | 788 (12.9) | 1,442 (12.2) | ||
| Cardiovascular history, n (%) | 1,929 (30.0) | 16,516 (33.6) | 0.08 | 1,891 (31.0) | 3,710 (31.4) | 0.01 |
| Comorbidities, n (%) | ||||||
| Myocardial infarction | 115 (1.8) | 755 (1.5) | 0.02 | 112 (1.8) | 204 (1.7) | 0.01 |
| Other coronary artery disease | 1,021 (15.9) | 9,700 (19.7) | 0.10 | 1,011 (16.6) | 1,981 (16.8) | 0.00 |
| Cerebrovascular disease | 735 (11.4) | 4,909 (10.0) | 0.05 | 712 (11.7) | 1,329 (11.2) | 0.01 |
| Hypertension | 3,410 (52.9) | 31,667 (64.4) | 0.23 | 3,338 (54.7) | 6,532 (55.3) | 0.01 |
| Dyslipidemia | 3,756 (58.3) | 35,373 (71.9) | 0.29 | 3,667 (60.1) | 7,383 (62.5) | 0.05 |
| Heart failure | 392 (6.1) | 2,845 (5.8) | 0.01 | 385 (6.3) | 706 (6.0) | 0.01 |
| Peripheral vascular disease | 227 (3.5) | 2,115 (4.3) | 0.04 | 226 (3.7) | 402 (3.4) | 0.02 |
| Dysrhythmia | 402 (6.2) | 3,542 (7.2) | 0.04 | 389 (6.4) | 757 (6.4) | 0.00 |
| Valvular heart disease | 178 (2.8) | 1,299 (2.6) | 0.01 | 174 (2.9) | 319 (2.7) | 0.01 |
| Depression | 301 (4.7) | 1,406 (2.9) | 0.10 | 276 (4.5) | 518 (4.4) | 0.01 |
| Bipolar disorder | 107 (1.7) | 443 (0.9) | 0.07 | 97 (1.6) | 174 (1.5) | 0.01 |
| Schizophrenia | 118 (1.8) | 570 (1.2) | 0.06 | 113 (1.9) | 226 (1.9) | 0.00 |
| Anxiety | 1,208 (18.8) | 9,160 (18.6) | 0.00 | 1,143 (18.7) | 2,259 (19.1) | 0.01 |
| Chronic kidney disease | 126 (2.0) | 1,011 (2.1) | 0.01 | 123 (2.0) | 266 (2.3) | 0.02 |
| Malignancy | 469 (7.3) | 2,330 (4.7) | 0.11 | 437 (7.2) | 821 (6.9) | 0.01 |
| Autoimmune disease | 868 (13.5) | 5,841 (11.9) | 0.05 | 835 (13.7) | 1,594 (13.5) | 0.01 |
| Transplantation | 12 (0.2) | 42 (0.1) | 0.03 | 12 (0.2) | 21 (0.2) | 0.00 |
| Asthma/COPD | 1,108 (17.2) | 8,416 (17.1) | 0.00 | 1,069 (17.5) | 2,005 (17.0) | 0.01 |
| Comedications, n (%) | ||||||
| α-blockers | 190 (3.0) | 1,425 (2.9) | 0.00 | 182 (3.0) | 340 (2.9) | 0.01 |
| β-blockers | 1,565 (24.3) | 13,345 (27.1) | 0.06 | 1,517 (24.9) | 2,944 (24.9) | 0.00 |
| ACEIs/ARBs | 2,574 (40.0) | 23,864 (48.5) | 0.17 | 2,514 (41.2) | 4,964 (42.0) | 0.02 |
| Calcium channel blockers | 2,205 (34.2) | 20,232 (41.1) | 0.14 | 2,141 (35.1) | 4,183 (35.4) | 0.01 |
| Diuretics | 1,176 (18.3) | 7,798 (15.9) | 0.06 | 1,103 (18.1) | 2,062 (17.4) | 0.02 |
| Renin inhibitors | 9 (0.1) | 86 (0.2) | 0.01 | 9 (0.2) | 20 (0.2) | 0.01 |
| Statins | 2,428 (37.7) | 23,664 (48.1) | 0.21 | 2,375 (38.9) | 4,824 (40.8) | 0.04 |
| Fibrates | 1,103 (17.1) | 10,652 (21.7) | 0.11 | 1,076 (17.6) | 2,184 (18.5) | 0.02 |
| Other lipid-lowering agents | 189 (2.9) | 1,172 (2.4) | 0.03 | 178 (2.9) | 345 (2.9) | 0.00 |
| Aspirin | 1,521 (23.6) | 12,416 (25.3) | 0.04 | 1,471 (24.1) | 2,878 (24.3) | 0.01 |
| P2Y12 inhibitors | 173 (2.7) | 1,000 (2.0) | 0.04 | 170 (2.8) | 287 (2.4) | 0.02 |
| Other antiplatelets | 359 (5.6) | 3,273 (6.7) | 0.05 | 351 (5.8) | 715 (6.1) | 0.01 |
| Anticoagulants | 97 (1.5) | 360 (0.7) | 0.07 | 88 (1.4) | 154 (1.3) | 0.01 |
| Nitrates | 472 (7.3) | 3,146 (6.4) | 0.04 | 452 (7.4) | 871 (7.4) | 0.00 |
| Digoxin | 129 (2.0) | 598 (1.2) | 0.06 | 125 (2.1) | 212 (1.8) | 0.02 |
| Atypical antipsychotics | 385 (6.0) | 1,788 (3.6) | 0.11 | 357 (5.9) | 658 (5.6) | 0.01 |
| Systemic steroids | 1,701 (26.4) | 11,443 (23.3) | 0.07 | 1,600 (26.2) | 3,041 (26.7) | 0.01 |
Abbreviations: ACEIs, angiotensin-converting enzyme inhibitors; aDCSI, adapted diabetes complication severity index; ARBs, angiotensin receptor blockers; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; DPP-4is, dipeptidylpeptidase-4 inhibitors; ER, emergency room; OHA, oral hypoglycemic agent; PDC, proportion of days covered; S.D., standardized difference; SUs, sulfonylureas; TZD, thiazolidinedione.