Diabetes is the third-most expensive physical health condition among US employees. We sought to evaluate the contribution of hypoglycemia to these costs.
We studied 2664 employees using insulin for whom medical encounters and short-term disability (STD) records were available.
Among these employees, 442 (16.6%) had a diagnosis of hypoglycemia during an average follow-up of 2.5 years. The risk of hospitalization and emergency room visits was increased twofold in this group. Much of this excess was associated with hypoglycemia. The annualized medical cost of hypoglycemia was $3241. Patients with hypoglycemia had 77% more STD days annually. The risk of STD in the week after hypoglycemia was increased fivefold.
These data suggest that hypoglycemia contributes substantially to medical care utilization and to disability-related work absence among employees using insulin.
"Implementation of therapy with long-acting insulin analogues, such as glargine, has been shown to decrease the rate of hypoglycemic events, as well as the costs associated with their occurrence (Bullano, Al-Zakwani, Fisher, Menditto, & Willey, 2005; Bullano et al., 2006; Leichter, 2008; McEwan, Poole, Tetlow, Holmes, & Currie, 2007; Rhoads et al., 2005; Zhang & Menditto, 2005). Moderateto-severe hypoglycemia, in particular, is associated with significant expenditure on a per-patient basis and was estimated to incur costs in excess of US$ 3000 per year, or a mean cost per event of US$ 1087 (Bullano et al., 2005; Rhoads et al., 2005). Given the low NNH with NPH in the present analysis, further studies might examine whether this translates into lower treatment costs for glargine relative to NPH, which has a much higher risk of hypoglycemia, during long-term therapy. "
[Show abstract][Hide abstract] ABSTRACT: Aims
This analysis evaluated HbA1c-adjusted hypoglycemia risk with glargine versus neutral protamine Hagedorn (NPH) over a 5-year study in patients with Type 2 diabetes mellitus (T2DM). Clinical significance was assessed using number needed to harm (NNH) to demonstrate the risk of one additional patient experiencing at least one hypoglycemic event.
Individual patient-level data for symptomatic documented hypoglycemia and HbA1c values from a 5-year randomized study comparing once-daily glargine (n = 513) with twice-daily NPH (n = 504) were analyzed. Symptomatic hypoglycemia was categorized according to concurrent self-monitoring blood glucose levels and need for assistance. Hypoglycemic events per patient-year as a function of HbA1c were fitted by negative binomial regression using treatment and HbA1c at endpoint as independent variables. An estimate of NNH was derived from logistic regression models.
The cumulative number of symptomatic hypoglycemia events was consistently lower with glargine compared with NPH over 5 years. Compared with twice-daily NPH, once-daily glargine treatment resulted in significantly lower adjusted odds ratios (OR) for all daytime hypoglycemia (OR 0.74; p = 0.030) and any severe event (OR 0.64; p = 0.035), representing a 26% and 36% reduction in the odds of daytime and severe hypoglycemia, respectively. Our model predicts that, if 25 patients were treated with NPH instead of glargine, then one additional patient would experience at least one severe hypoglycemic event.
This analysis of long-term insulin treatment confirms findings from short-term studies and demonstrates that glargine provides sustained, clinically meaningful reductions in risk of hypoglycemia compared with NPH in patients with T2DM.
Journal of Diabetes and its Complications 09/2014; 28(5). DOI:10.1016/j.jdiacomp.2014.04.003 · 3.01 Impact Factor
"Indirect costs that are often overlooked such as productivity and time lost should be considered when evaluating the costs of severe hypoglycemia. Patients with hypoglycemia had 77% more short-term disability days annually . Reviriego et al.  reported that the overall mean cost of hypoglycemia is comprised of 65.4% direct costs and 34.6% indirect costs. "
[Show abstract][Hide abstract] ABSTRACT: The prevalence of hypoglycemia is increasing due to the growing incidence of diabetes and the latest strict guidelines for glycated hemoglobin (HbA1c) levels under 7%. This study examined the clinical characteristics, causal factors, and medical costs of severely hypoglycemic patients in an emergency room (ER) of Uijeongbu St. Mary's Hospital.
The study consisted of a retrospective analysis of the characteristics, risk factors, and medical costs of 320 severely hypoglycemic patients with diabetes who presented to an ER of Uijeongbu St. Mary's Hospital from January 1, 2006 to December 31, 2009.
Most hypoglycemic patients (87.5%, 280/320) were over 60 years old with a mean age of 69.5±10.9 years and a mean HbA1c level of 6.95±1.46%. Mean serum glucose as noted in the ER was 37.9±34.5 mg/dL. Renal function was decreased, serum creatinine was 2.0±2.1 mg/dL and estimated glomerular filtration rate (eGFR) was 48.0±33.6 mL/min/1.73 m(2). In addition, hypoglycemic patients typically were taking sulfonylureas or insulin and a variety of other medications, and had a long history of diabetes.
Severe hypoglycemia is frequent in older diabetic patients, subjects with low HbA1c levels, and nephropathic patients. Therefore, personalized attention is warranted, especially in long-term diabetics with multiple comorbidities who may not have been properly educated or may need re-education for hypoglycemia.
"Despite recent advances in diabetes treatment, hypoglycemia emerges as an important issue in the management of diabetes. In 2005, the excess annualized cost related to hypoglycemia among insulin users in the U.S. was reported to be $3,241 per patient who had experienced hypoglycemia, with the risk of short-term disability increasing fivefold in the week after a hypoglycemic event (2). In addition, the risk of hospitalization and emergency room visits was increased twofold among the patients with hypoglycemia (2). "
[Show abstract][Hide abstract] ABSTRACT: Hypoglycemia is associated with failure to show cardiovascular benefit and increased mortality of intensive glycemic control in randomized clinical trials. This retrospective cohort study aimed to examine the impact of hypoglycemia on vascular events in clinical practice.
Patients with type 2 diabetes were identified by ICD-9-CM codes (250.xx except for 250.x1 and 250.x3) between 1 January 2004 and 1 September 2010 from the Veterans Integrated Service Network 16. Index date was defined as the first date of new antihyperglycemic medications (index treatment). Patients with 1-year preindex records of hypoglycemia, cardiovascular, and microvascular diseases were excluded. The hypoglycemia group was identified by ICD-9-CM codes (250.8, 251.0, 251.1, and 251.2) within the index treatment period. A propensity score-matched group was used as control subjects. Cardiovascular events, microvascular complications, and all-cause death were compared using Kaplan-Meier analysis and Cox proportional hazards regression model.
Among the unmatched sample (N = 44,261), the hypoglycemia incidence rate was 3.57/100 patient-years. The matched sample (hypoglycemia group: n = 761; control group: n = 761) had a median follow-up of 3.93 years, mean age of 62.6 ± 11.0 years, and preindex HbA(1c) of 10.69 ± 2.61%. The 1-year change in HbA(1c) was similar (hypoglycemia group -0.51 vs. control group -0.32%, P = 0.7244). The hypoglycemia group had significantly higher risks of cardiovascular events (hazard ratio 2.00 [95% CI 1.63-2.44]) and microvascular complications (1.76 [1.46-2.11]) but no statistical mortality difference. Patients with at least two hypoglycemic episodes were at higher risks of vascular events than those with one episode (1.53 [1.10-1.66]).
Hypoglycemia is associated with higher risks of incident vascular events. Patients with hypoglycemia should be monitored closely for vascular events.
Diabetes care 03/2012; 35(5):1126-32. DOI:10.2337/dc11-2048 · 8.42 Impact Factor
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