Hypoglycemia, Treatment Discontinuation, and Costs in Patients with Type 2 Diabetes Mellitus on Oral Antidiabetic Drugs

Abstract

Objective: To investigate the rate and impact of hypoglycemic events among patients with type 2 diabetes mellitus (T2DM) receiving different classes of oral antidiabetic drugs (OADs). Research Design and Methods: Adult patients with T2DM were extracted from the Ingenix IMPACT claims database. The mean number of health care visits due to hypoglycemic events per patient–year was estimated. Multivariate regression models were used to: 1) assess the risk factors for experiencing a hypoglycemic event; 2) assess the effect of experiencing hypoglycemic events on antidiabetic treatment discontinuation; and 3) compare 12–month post–index date costs between patients with and without hypoglycemic events. Results: 212 061 patients with T2DM were included in the analysis. The estimated frequency of hypoglycemia–related health care visits was 0.054 per patient–year. Insulin use was associated with increased risk of developing hypoglycemia, followed by use of sulfonylureas and other OADs (eg, meglitinide and α–glucosidase inhibitors). The impacts of thiazolidinediones, metformin, and dipeptidyl peptidase–4 on hypoglycemia risk were relatively small. Having a hypoglycemic event was associated with significantly increased risk of antidiabetic treatment discontinuation. Patients with hypoglycemia showed significantly higher annual all–cause and diabetes–related health care costs than patients without hypoglycemia (adjusted δ = +$5024 and +$3747, respectively; both P < 0.0001). Conclusion: Different OAD classes were associated with different levels of risk for hypoglycemic events. Hypoglycemia was associated with a higher risk of antidiabetic treatment discontinuation and significantly increased health care costs.

Keywords:

• hypoglycemia
• type 2 diabetes mellitus
• oral antidiabetic drug
• treatment discontinuation
• health care cost