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Curr Med Res Opin. 2008 Aug;24(8):2349-58. doi: 10.1185/03007990802292728. Epub 2008 Jul 4.

Direct costs and health-related resource utilisation in the 6 months after insulin initiation in German patients with type 2 diabetes mellitus in 2006: INSTIGATE study.

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Fachklinik Bad Heilbrunn, Bad Heilbrunn, Germany.



To assess direct costs and describe resource utilisation associated with the first 6 months of insulin therapy in German patients with type 2 diabetes mellitus (DM).


This is an ongoing pan-European, non-interventional, prospective study observing the normal course of diabetes therapy of adult patients with type 2 DM in a diabetologic practice setting, and initiating insulin therapy in 2006. Diabetes therapy 6 months prior to initiation of insulin therapy was assessed retrospectively. For German patients (n = 256), direct costs associated with health-care resource utilisation prior to and after the insulin initiation were assessed and compared from the German statutory health insurance perspective.


The percentage of patients using blood glucose monitoring increased from 76.4 to 99.6%; 42.1% of patients remained on oral anti-diabetic medication, with metformin used most frequently (36.5%). Total average cost of resource use related to diabetes care per patient for the 6-month period prior to and 6 months after insulin initiation increased from Euro 579 to Euro 961. Mean total costs of diabetes care during 6 months after insulin initiation in the subgroup of obese patients with worse prognosis at baseline (HbA(1c)> or = 7.5% and BMI > or = 30 kg/m(2)) were Euro 1047 [95% CI 965; 1128] vs. Euro 903 [95% CI 840; 965] in other patients.


Resource utilisation and costs related to diabetes increased in the 6 months following insulin initiation, mainly driven by specialist care resource use, insulin, and blood glucose monitoring. Total direct costs of diabetes care of the patients with a less favourable profile of BMI and HbA(1c) at baseline are higher compared to other patients.

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