Outcomes and Healthcare Resource Utilisation Associated with Medically Attended Hypoglycaemia in Older Patients with Type 2 Diabetes Initiating Basal Insulin in a US Managed Care Setting

OBJECTIVE:
To assess health outcomes and the economic burden of hypoglycaemia 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 hypoglycaemia during the first year of BI treatment (HG group) and those without (non-HG group). Main outcome measures were hospitalisation, mortality, healthcare utilisation and costs 1 year before and 1 year after BI initiation.

RESULTS:
Of 31,035 patients included (mean age 72 years [SD 9.2]), 3,066 (9.9%; HG group) experienced hypoglycaemia during 1 year post-BI initiation. After adjustment for demographic, comorbidity and medication history, hypoglycaemia was associated with risk of hospitalisation (HR 1.59; 95% CI: 1.53-1.65) and death (HR 1.50; 95% CI: 1.40-1.60).

Healthcare utilisation 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, hypoglycaemia during the first year of BI treatment is associated with risk of hospitalisation or death in older people, increasing healthcare utilisation and costs. Due to the observational nature of this study, causality cannot be attributed, and further prospective studies into the effect of hypoglycaemia on health outcomes in this population are warranted.

CITA DEL ARTÍCULO  Curr Med Res Opin. 2016 Sep;32(9):1557-65. doi: 10.1080/03007995.2016.1189893.  Epub 2016 Jun 13.