Contribution of hypoglycemia to medical care expenditures and short-term disability in employees with diabetes
ABSTRACT 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.
Article: A Safety Net for DiabeticsScience 03/2014; 343(6175):1076-7. DOI:10.1126/science.343.6175.1076-b · 31.48 Impact Factor
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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. Methods 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. Results 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. Conclusions 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 · 1.93 Impact Factor
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ABSTRACT: Hypoglykämien stellen für einen Großteil aller Menschen mit Diabetes eine ernst zu nehmende psychische Belastung dar. In diesem Beitrag wird ein Überblick über die verschiedenen Bereiche der psychischen Beeinträchtigungen aufgrund von Hypoglykämien, über psychosoziale Risikofaktoren für schwere Unterzuckerungen und über Strategien für Patienten mit Unterzuckerungsproblemen gegeben. Hypoglycemia is a serious psychological burden for the majority of persons with diabetes. This report summarizes the various aspects of mental distress caused by hypoglycemia, psychosocial risk factors for severe hypoglycemia and strategies for patients who have problems with hypoglycemia.Der Diabetologe 02/2013; 9(1):33-40. DOI:10.1007/s11428-012-0912-3 · 0.06 Impact Factor