+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Severe hypoglycemia rates and associated costs among type 2 diabetics starting basal insulin therapy in the United States

Severe hypoglycemia rates and associated costs among type 2 diabetics starting basal insulin therapy in the United States

Current Medical Research and Opinion 30(10): 1991-2000

To derive current real-world data on the rates and costs of severe hypoglycemia (SH) for people with type 2 diabetes mellitus (T2D) who have initiated basal insulin therapy and to examine differences in SH rates and costs stratified by history of prior SH events. We used a nation-wide electronic health records database that included encounter and laboratory data, as well as clinical notes, to estimate the rates and costs of SH events among adults with T2D who initiated basal insulin between 2008 and 2011. Unadjusted and regression-adjusted rates and quarterly costs were calculated for all patients as well as stratified by history of a SH event before starting basal insulin and history of a SH event during the basal insulin titration period. We identified 7235 incident cases of basal insulin use among patients with T2D who did not use insulin during the previous 12 months. Regression-adjusted incidence and total event rates were 10.36 and 11.21 per 100 patient-years, respectively. A history of SH events during the pre-index baseline and post-index titration periods were statistically significantly associated with both the incidence and total event rates (pā€‰<ā€‰0.01). Regression-adjusted total healthcare and diabetes-related costs were statistically significantly (pā€‰<ā€‰0.01) higher in those quarters when a SH event occurred than in those quarters without any SH events ($3591 vs. $487 and $3311 vs. $406, respectively). A history of previous SH or SH events during the titration period were not statistically significantly associated with costs. These results suggest that the real-world burden of SH is high among people with T2D who start using basal insulin and that history of previous SH events, both before starting insulin and during the insulin titration period, influences future SH. These results can also provide insights into interventions that can prevent or delay SH. These results should, however, be interpreted in light of the key limitations of our study: not all SH events may have been captured or coded in the database, data on filled prescriptions were not available, and the post-titration follow-up period could have been divided into time units other than quarters (3 month blocks) resulting in potentially different conclusions. Further real-world studies on the frequency and costs of SH, using methods to identify as many SH events as possible, can allow healthcare providers to make more informed decisions on the risks and benefits of basal insulin therapy in T2D patients.

(PDF emailed within 0-6 h: $19.90)

Accession: 055739602

Download citation: RISBibTeXText

PMID: 24945720

DOI: 10.1185/03007995.2014.936930

Related references

Hypoglycemia After Initiation of Basal Insulin in Patients with Type 2 Diabetes in the United States: Implications for Treatment Discontinuation and Healthcare Costs and Utilization. Advances in Therapy 34(9): 2083-2092, 2017

Incidence of severe nocturnal hypoglycemia in patients with type 1 diabetes treated with insulin lispro or regular human insulin in addition to basal insulin glargine. Nutrition, Metabolism, and Cardiovascular Diseases 20(7): 519-526, 2010

Economic impact of severe and non-severe hypoglycemia in patients with Type 1 and Type 2 diabetes in the United States. Journal of Medical Economics 18(6): 420-432, 2016

Association of diabetic ketoacidosis, severe hypoglycemia and glycemic control among children and young adults with type 1 diabetes mellitus treated with premixed versus basal-bolus insulin therapy. Biomedical Journal 41(6): 348-355, 2019

Glycemic control before and after starting insulin therapy in obese and other type 2 diabetics. Diabetologia Croatica 35(3): 59-62, 2007

Effect of Insulin Analogs on Frequency of Non-Severe Hypoglycemia in Patients with Type 1 Diabetes Prone to Severe Hypoglycemia: Much Higher Rates Detected by Continuous Glucose Monitoring than by Self-Monitoring of Blood Glucose-The HypoAna Trial. Diabetes Technology and Therapeutics 20(3): 247-256, 2018

Rates of Hypoglycemia Predicted in Patients with Type 2 Diabetes on Insulin Glargine 300 U/ml Versus First- and Second-Generation Basal Insulin Analogs: The Real-World LIGHTNING Study. Diabetes Therapy 2019, 2019

Prospective evaluation of the insulin infusion test to establish the adequacy of glucose counterregulation during hypoglycemia in type 1 diabetics undergoing intensive insulin therapy. Minerva Endocrinologica 9(2): 101-105, 1984

Impaired counter regulation of hypoglycemia in a group of insulin-dependent diabetics with recurrent episodes of severe hypoglycemia. Acta Medica Scandinavica 216(2): 215-222, 1984

Nocturnal hypoglycemia with reference to hormonal counterregulation in type I diabetics receiving insulin therapy. Schweizerische Medizinische Wochenschrift 119(1): 9-15, 1989

Clinical outcomes of concomitant therapy of exenatide twice daily and basal insulin in patients with type 2 diabetes mellitus: a retrospective database analysis in the United States. Endocrine Practice 18(5): 700-711, 2013

Changing basal insulin from NPH to detemir or glargine in patients with type 1 diabetes and a history of severe hypoglycemia. Vascular Health and Risk Management 5(1): 121-128, 2009

Unmet Needs in the Management of Type 2 Diabetes Mellitus Patients Starting Insulin Therapy with Basal or Premix Insulin in Routine Clinical Practice in Serbia. Diabetes Therapy 2018, 2018

Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes. JAMA 318(14): 1358-1366, 2017

Effectiveness and Tolerability of Therapy With Once-Weekly Exenatide Versus Basal Insulin Among Injectable-Naive Patients With Type 2 Diabetes in a Real-World Setting in the United States. Diabetes Spectrum 31(2): 129-137, 2018