PDB32 - Comparison of Healthcare Resource Utilization and Clinical Status Among Type 2 Diabetes Patients Using Multiple-Daily Injection (MDI) Insulin Therapy Versus Non-Mdi Therapy

Abstract

To compare healthcare resource utilization and clinical status in cohorts of Type 2 Diabetes (T2DM) patients using multiple daily injections (MDI) of insulin with non-MDI therapy patients. We retrospectively analyzed health resource utilization and clinical status in MDI therapy patients compared to non-MDI therapy patients. MDI was defined as patients having at least one basal and one prandial/bolus insulin prescription during a one year period starting October 2015. We identified a cohort of T2DM with an ICD-10 code of E11, 18 years of age and older, not pregnant, with a minimum of one office visit between October 2015 and April 2016. Data such as physician office visits, emergency department (ED), hospitalizations were pooled from one hospital EMR system in the southeastern United States for MDI (n=11,742) and non-MDI (n=56,025) patients. We used t-test statistics for mean differences. All mean differences were significant (p<0.001). The average annual utilization of physician office visits, ED visits and hospitalizations for MDI patients was 4.1(SD=3.2), 0.6(SD=1.5), and 0.4(SD=1.0) vs. 3.3 (SD=2.2), 0.2 (SD=0.5), and 0.1(SD=0.5) for non-MDI patients, respectively. The percent of patients with a BMI ≥ 30 kg/m2 in the MDI cohort was 59.7% vs. 55.0% in the non-MDI cohort. MDI patients had an average HbA1c of 8.3% (SD=1.9) vs. 7.2% (SD=1.4) for non-MDI patients. The proportion of patients with average HbA1c ≥10% was 15.6% vs. 4.6%, respectively. The rate of renal disease in the MDI cohort, 30.8%, far exceeded the rate in the non-MDI cohort (13.5%). Specifically, end stage renal disease was 7.2% in the MDI cohort vs. 1.7% in the non-MDI cohort. These results suggest that MDI patients use more healthcare resources and have poorer clinical status compared to non-MDI patients within a larger healthcare system.