Javier Escalada1, Laura Liao2, Chunshen Pan3, Hongwei Wang2, Mohan Bala4. 1. a Department of Endocrinology and Nutrition , Clínica Universidad de Navarra , Pamplona , Spain ; 2. b Sanofi , Bridgewater , NJ , USA ; 3. c Pro Unlimited , Boca Raton , FL , USA ; 4. d Sanofi , Cambridge , MA , USA.
Abstract
OBJECTIVE: To assess health outcomes and the economic burden of hypoglycemia in older patients with type 2 diabetes initiating basal insulin (BI). RESEARCH DESIGN AND METHODS: Medicare Advantage claims data were extracted for patients with type 2 diabetes initiating BI and patients were stratified into two groups: those with medically attended hypoglycemia during the first year of BI treatment (HG group) and those without (non-HG group). Main outcome measures were hospitalization, mortality, healthcare utilization and costs 1 year before and 1 year after BI initiation. RESULTS: Of 31,035 patients included (mean age 72 years [SD 9.2]), 3066 (9.9%; HG group) experienced hypoglycemia during 1 year post-BI initiation. After adjustment for demographic, comorbidity and medication history, hypoglycemia was associated with risk of hospitalization (HR 1.59; 95% CI: 1.53-1.65) and death (HR 1.50; 95% CI: 1.40-1.60). Healthcare utilization was higher pre-index and showed greater increases post-BI initiation in the HG vs. the non-HG group. Per-patient healthcare costs were substantially higher for the HG group than the non-HG group, both pre-index ($54,057 vs. $30,249, respectively) and post-BI initiation ($75,398 vs. $27,753, respectively). CONCLUSIONS: Based on available claims data, hypoglycemia during the first year of BI treatment is associated with risk of hospitalization or death in older people, increasing healthcare utilization and costs. Due to the observational nature of this study, causality cannot be attributed, and further prospective studies into the effect of hypoglycemia on health outcomes in this population are warranted.
OBJECTIVE: To assess health outcomes and the economic burden of hypoglycemia in older patients with type 2 diabetes initiating basal insulin (BI). RESEARCH DESIGN AND METHODS: Medicare Advantage claims data were extracted for patients with type 2 diabetes initiating BI and patients were stratified into two groups: those with medically attended hypoglycemia during the first year of BI treatment (HG group) and those without (non-HG group). Main outcome measures were hospitalization, mortality, healthcare utilization and costs 1 year before and 1 year after BI initiation. RESULTS: Of 31,035 patients included (mean age 72 years [SD 9.2]), 3066 (9.9%; HG group) experienced hypoglycemia during 1 year post-BI initiation. After adjustment for demographic, comorbidity and medication history, hypoglycemia was associated with risk of hospitalization (HR 1.59; 95% CI: 1.53-1.65) and death (HR 1.50; 95% CI: 1.40-1.60). Healthcare utilization was higher pre-index and showed greater increases post-BI initiation in the HG vs. the non-HG group. Per-patient healthcare costs were substantially higher for the HG group than the non-HG group, both pre-index ($54,057 vs. $30,249, respectively) and post-BI initiation ($75,398 vs. $27,753, respectively). CONCLUSIONS: Based on available claims data, hypoglycemia during the first year of BI treatment is associated with risk of hospitalization or death in older people, increasing healthcare utilization and costs. Due to the observational nature of this study, causality cannot be attributed, and further prospective studies into the effect of hypoglycemia on health outcomes in this population are warranted.
Entities:
Keywords:
Health care delivery; hypoglycemia; insulin therapy; macrovascular disease; microvascular disease
Authors: Jason I Chiang; Bhautesh Dinesh Jani; Frances S Mair; Barbara I Nicholl; John Furler; David O'Neal; Alicia Jenkins; Patrick Condron; Jo-Anne Manski-Nankervis Journal: PLoS One Date: 2018-12-26 Impact factor: 3.240
Authors: Jun Jie Benjamin Seng; Amelia Yuting Monteiro; Yu Heng Kwan; Sueziani Binte Zainudin; Chuen Seng Tan; Julian Thumboo; Lian Leng Low Journal: BMC Med Res Methodol Date: 2021-03-11 Impact factor: 4.615