Effects of patient-reported non-severe hypoglycemia on healthcare resource use, work-time loss, and wellbeing in insulin-treated patients with diabetes in seven European countries

Abstract

Purpose:

Hypoglycemia is a frequent side effect induced by insulin treatment of type 1 (T1DM) and type 2 diabetes (T2DM). Limited data exist on the associated healthcare resource use and patient impact of hypoglycemia, particularly at a country-specific level. This study investigated the effects of self-reported non-severe hypoglycemic events (NSHE) on use of healthcare resources and patient wellbeing.

Methods:

Patients with T1DM or insulin-treated T2DM diabetes from seven European countries were invited to complete four weekly questionnaires. Data were collected on patient demographics, NSHE occurrence in the last 7 days, hypoglycemia-related resource use, and patient impact. NSHE were defined as events with hypoglycemia symptoms, with or without blood glucose measurement, or low blood glucose measurement without symptoms, which the patient could manage without third-party assistance.

Results:

Three thousand, nine hundred and fifty-nine respondents completed at least one wave of the survey, with 57% completing all four questionnaires; 3827 respondents were used for data analyses. Overall, 2.3% and 8.9% of NSHE in patients with T1DM and T2DM, respectively, resulted in healthcare professional contact. Across countries, there was a mean increase in blood glucose test use of 3.0 tests in the week following a NSHE. Among respondents who were employed (48%), loss of work-time after the last hypoglycemic event was reported for 9.7% of NSHE. Overall, 10.2% (daytime) and 8.0% (nocturnal) NSHE led to work-time loss, with a mean loss of 84.3 (daytime) and 169.6 (nocturnal) minutes among patients reporting work-time loss. Additionally, patients reported feeling tired, irritable, and having negative feelings following hypoglycemia.

Limitations:

Direct comparisons between studies must be interpreted with caution because of different definitions of hypoglycemia severity, duration of the studies, and methods of data collection.

Conclusions:

NSHE were associated with use of extra healthcare resources and work-time loss in all countries studied, suggesting that NSHE have considerable impact on patients/society.

Keywords::

• Hypoglycemia
• Diabetes mellitus
• Quality of life
• Health economics

Transparency

Declaration of funding

Funding for this study was provided by Novo Nordisk. The sponsor was involved in the study design, data collection, data review, and data analysis. All authors had full access to the data and were involved in data interpretation and manuscript writing. P. Geelhoed-Duijvestijn had the final decision to submit the manuscript for publication and takes responsibility for its content.

Declaration of financial/other relationships

P. Geelhoed-Duijvestijn has received honoraria for lectures from Novo Nordisk and as a member of Advisory Boards of Medtronic, Sanofi Aventis, and Eli Lilly. U. Pedersen-Bjergaard has received honoraria for lectures from Novo Nordisk, Sanofi Aventis, and BMS, and has served as a member of Advisory Boards for Novo Nordisk and AstraZeneca. R. Weitgasser has received honoraria for lectures and as a member of Advisory Boards for Novo Nordisk, Eli Lilly, Sanofi Aventis, Novartis, Medtronic, MSD, Takeda, Astra Zeneca/BMS, Boehringer-Ingelheim, and Roche Diagnostics. J. Lahtela has received honoraria for the preparation of educational material and lecture from Novo Nordisk, Sanofi Aventis, Eli Lilly, Novartis, and Merck. M. M. Jensen is an employee at Novo Nordisk Scandinavia. C. Östenson has received honoraria as a symposium speaker for Novo Nordisk Scandinavia. JME Peer Reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors take full responsibility for the content of this manuscript. Adele Norman at Watermeadow Medical (supported by Novo Nordisk) provided medical writing support.