The burden of severe hypoglycemia in type 1 diabetes

Abstract

Aims: Approximately 1.25 million people in the US have type 1 diabetes mellitus (T1DM), a chronic metabolic disease that develops from the body’s inability to produce insulin, and requires life-long insulin therapy. Poor insulin adherence may cause severe hypoglycemia (SHO), leading to hospitalization and long-term complications; these, in turn, drive up costs of SHO and T1DM overall. This study’s objective was to estimate the prevalence and costs of SHO-related hospitalizations and their additional longer-term impacts on patients with T1DM using basal-bolus insulin.

Methods: Using Truven MarketScan claims, we identified adult T1DM patients using basal-bolus insulin regimens who were hospitalized for SHO (inpatient SHO patients) during 2010–2015. Two comparison groups were defined: those with outpatient SHO-related encounters only, including emergency department (ED) visits without hospitalization (outpatient SHO patients), and those with no SHO- or acute hyperglycemia-related events (comparison patients). Lengths of stay and SHO-related hospitalization costs were estimated and propensity score and inverse probability weighting methods were used to adjust for baseline differences across the groups to evaluate longer-term impacts.

Results: We identified 8,734 patients, of which 4.2% experienced at least one SHO-related hospitalization. Among those who experienced SHO (i.e. of those in the inpatient and outpatient SHO groups), 31% experienced at least one SHO-related hospitalization, while 9% were treated in the ED without subsequent hospitalization. Approximately 79% of patients were admitted directly to the hospital; the remainder were first assessed or treated in the ED. The inpatient SHO patients stayed in the hospital, including time in the ED, for 1.7 days and incurred $3551 in costs. About one-third of patients were hospitalized again for SHO. Inpatient SHO patients incurred significantly higher monthly costs after their initial SHO-related hospitalization than patients in the two other groups ($2084 vs $1313 and $1372), corresponding to 59% or 52% higher monthly costs for inpatient SHO patients.

Limitations: These analyses excluded patients who did not seek ED or hospital care when faced with SHO; events may have been miscoded; and we were not able to account for clinical characteristics associated with SHO, such as insulin dose and duration of diabetes, or unmeasured confounders.

Conclusions: The burden associated with SHO is not negligible. About 4% of T1DM patients using basal-bolus insulin regimens are hospitalized at least once due to SHO. Not only did those patients incur the costs of their SHO hospitalization, but they also incur red at least $712 (52%) more in costs per month after their hospitalization than outpatient SHO or comparison patients. Reducing SHO events can help decrease the burden associated with SHO among patients with T1DM.

Keywords:

• Type 1 diabetes mellitus
• burden of illness
• severe hypoglycemia
• costs
• hospitalization
• basal-bolus insulin

Transparency

Declaration of funding

Novo Nordisk Inc., a pharmaceutical company that manufactures, markets, and/or distributes more than a dozen drugs for diabetes in the US, provided the funding for this study and article.

Declaration of financial/other relationships

JL and MLG are employed by Evidera Inc., an independent research company that provides consulting and other research services to the biopharmaceutical industry. In their salaried positions, they work with a variety of client companies and are precluded from receiving payment or honoraria directly from these organizations for services rendered. Evidera received payment from Novo Nordisk Inc. for the conduct of this study and the development of this manuscript. RW was an employee of Evidera Inc. when this manuscript was written. YP is an employee of Novo Nordisk Inc. JW was an employee of Novo Nordisk Inc. when this manuscript was written; he is a minor shareholder of Novo Nordisk Inc. DS has served on advisory boards for, and received honoraria from, Novo Nordisk Inc. and Intarcia Therapeutics, Inc.

Previous presentation

Liu J, Wang R, Ganz ML, Paprocki Y, Weatherall J. The Burden of Severe Hypoglycemia in Type 1 Diabetes. Poster presented at the AMCP Managed Care Specifically Pharmacy Annual Meeting 2017; March 27–30, 2017; Denver, Colorado.