Abstract
IntroductionHypoglycemia and fear of hypoglycemia may contribute to basal insulin discontinuation, poor glycemic control, and increased healthcare burden in patients with type 2 diabetes (T2D). This study aimed to determine the impact of hypoglycemia soon after basal insulin initiation on treatment discontinuation and economic outcomes in patients with T2D.MethodsHypoglycemic events within 6 months of basal insulin initiation were identified using retrospective cohort data from patients with T2D, at least 18 years of age, initiated on basal insulin therapy in the Clinformatics™ Data Mart for Multiplan claims database from January 1, 2008, through August 31, 2012. Data were adjusted for baseline characteristics. Discontinuation was established for patients with 12-month follow-up data, while discontinuation risk was assessed in the extended analysis (6- to 24-month follow-up) by Cox regression analysis. Healthcare use and costs were determined.ResultsOf 55,608 patients, 4.5% experienced hypoglycemia within 6 months of basal insulin initiation. Patients with hypoglycemia were more likely to discontinue basal insulin within 12 months of initiation (79.0% vs. 74.2%; P < 0.001). Data, adjusted for baseline characteristics such as age, any baseline hypoglycemia, and use of oral antidiabetes drugs, showed that patients with hypoglycemia had a greater risk of discontinuation (hazard ratio 1.16; 95% confidence interval 1.03, 1.32; P = 0.0164), were more likely to have a hospitalization (41.0% vs. 24.3%; P < 0.001) or an ED visit (55.8% vs. 35.1%; P < 0.001), and had higher diabetes-related ($13,662 vs. $7506; P < 0.001) and all-cause ($30,719 vs. $19,079; P < 0.001) healthcare costs.ConclusionsUS patients with T2D who experienced hypoglycemia within 6 months of basal insulin initiation were more likely to discontinue treatment, accompanied by a greater healthcare burden.FundingSanofi US, Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-017-0592-x) contains supplementary material, which is available to authorized users.
Highlights
Hypoglycemia and fear of hypoglycemia may contribute to basal insulin discontinuation, poor glycemic control, and increased healthcare burden in patients with type 2 diabetes (T2D)
A total of 71,470 patients who were initiated on treatment with basal insulin for the first time with follow-up periods ranging from 6 to 24 months were identified in the ClinformaticsTM Data Mart for Multiplan (IMPACTTM) claims database, and a subset of 55,608 patients with a 12-month follow-up was used for the primary analysis of this study
A greater proportion had their first hypoglycemia event diagnosed within the first month after starting basal insulin therapy
Summary
Hypoglycemia and fear of hypoglycemia may contribute to basal insulin discontinuation, poor glycemic control, and increased healthcare burden in patients with type 2 diabetes (T2D). Compared to Gla-100, Gla-300 is associated with a lower incidence of a severe or confirmed nocturnal hypoglycemic episode (blood glucose B70 mg/dL [B3.9 mmol/L]) [9, 10], and a lower occurrence of a severe or confirmed hypoglycemic event at any time of the day [9]. These results were reported throughout the clinical trial periods, including during the first 8 weeks of treatment when the greatest insulin dose titration occurs [9, 10]
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