Postprandial glucose and healthcare resource use: a cross-sectional survey of adults with diabetes treated with basal-bolus insulin

Abstract

Aims: Postprandial glucose (PPG) control is a well-known challenge for diabetes management, yet there is limited research on how PPG affects healthcare resource utilization. This study investigated the association between PPG levels and healthcare resource utilization among adults with diabetes treated with basal-bolus insulin.

Methods: A web-based, cross-sectional survey (n = 940) of adults with type 1 or type 2 diabetes and treated with basal and bolus insulins was conducted in Italy, the UK, and the US. Descriptive analyses included frequencies, cross-tabulations, and comparison of means. Incidence-rate ratios (IRR) were calculated using negative binomial regression analysis to investigate the relationship between elevated PPG and healthcare resource utilization. Models controlled for demographic characteristics, duration of diabetes, and diabetes-related complications.

Results: Among respondents who measured PPG regularly and reported their two highest PPG values in the past week (n = 691), the mean average highest PPG value was 11.9 mmol/L (SD = 4.0). On average, holding other variables constant at their means, a 1 mmol/L increase in PPG was associated with an increase in healthcare resource utilization related to diabetes and elevated PPG, including the expected number of healthcare provider (HCP) visits in the past 6 months (IRR [95% CI] = 1.14 [1.08–1.21], p < .001), the expected number of calls/emails to HCPs in the past 6 months (IRR [95% CI] = 1.12 [1.06–1.19], p < .001), and the expected number of overnight hospitalizations in the past year (IRR [95% CI] = 1.14 [1.07–1.23], p < .001).

Limitations: The study relied on self-reported data, which may be subject to recall bias. Given the cross-sectional nature of the study, results should be interpreted with caution.

Conclusions: Increased PPG levels were significantly associated with increased healthcare resource utilization among adults with diabetes. Additional education regarding PPG monitoring may help improve the day-to-day management of diabetes and reduce healthcare costs.

Keywords:

• Diabetes mellitus, type 1
• diabetes mellitus, type 2
• postprandial glucose
• postprandial hyperglycemia
• healthcare resource utilization
• diabetes management

Transparency

Declaration of funding

This research was funded by Novo Nordisk, A/S.

Declaration of financial/other relationships

MB and KP are consultants to the pharmaceutical industry, including Novo Nordisk, A/S. AS and AN are employees of Novo Nordisk, A/S.

Acknowledgments

The authors would like to acknowledge Sarah Buchs for her contributions to this project in its early stages. The authors also acknowledge Jane Beck of The Brod Group for editorial assistance.

Previous presentations

Some of the findings from this study were presented at the ISPOR 22nd Annual International Meeting, May 20–24, 2017, Boston, MA, USA, in a podium presentation entitled “Postprandial glucose control and health care resource utilization”.