PDB131 INSULIN TREATMENT PATTERN, RESOURCE UTILIZATION AND COSTS IN CHINESE PATIENTS WITH TYPE 2 DIABETES MELLITUS INITIATED BASAL OR PREMIXED INSULIN ANALOGS AFTER INSULIN INTENSIFICATION

Abstract

Hospitalized insulin intensification is a common practice to achieve better glycemic control for type 2 diabetes mellitus (T2DM) patients in China. This study aimed to assess insulin treatment pattern, resource utilization and costs for Chinese patients with T2DM initiating basal or premixed insulin analogs after hospitalized insulin intensification. Data were obtained from Tianjin Urban Employee Basic Medical Insurance claims database (2012-2015). T2DM patients aged ≥18 who initiated basal or premixed insulin analogs at discharge after hospitalized insulin intensification during 2013.01.01-2014.12.31 were included. Insulin treatment pattern (discontinuation/switching/intensification/maintenance), T2DM-related and all-cause health resource utilization and direct medical costs were examined during 12-month after discharge. Logistic, poisson and quantile regression models controlling for potential confounders were used to compare differences of resource utilization and costs between two groups. 724 patients initiating basal (N=188) and premixed (N=536) insulin analogs were included (mean[SD] age: 57.9[10.4] vs. 58.0[11.1], P=0.921; female: 46.3% vs. 38.8%, P=0.073), of which 57.4% and 50.6% (P=0.104) were also prescribed oral antidiabetic drugs at discharge. Insulin treatment pattern, of basal and premixed groups represented by discontinuation (16.0% vs. 24.8%), switching (5.9% vs. 4.7%), intensification (20.7% vs. 6.3%) and maintenance (57.4% vs. 64.2%) rates was different (P<0.001). T2DM-related hospitalization rates were similar in basal and premixed groups (19.7% vs. 20.0%, P=0.934). Basal group had more T2DM-related outpatient visits compared with premixed group (mean[SD]: 53.3[31.5] vs. 42.7[30.9], P<0.001). And the total T2DM-related and all-cause costs were also significantly higher in basal group than premixed group (T2DM-related: median[IQR]: CNY 17,445[11,840-25,023] vs. 12,909[7,085-21,061], P<0.001; all-cause: CNY 21,527[13,295-30,043] vs. 16,555[9,432-26,073], P<0.001). Similar trends were found in adjusted analyses. After hospitalized insulin intensification, Chinese T2DM patients initiating basal or premixed insulin analogs differ in their insulin treatment pattern, and patients initiating basal insulin analogs are associated with more outpatient visits and higher medical costs than premixed insulin analog initiators.