Outcomes and healthcare resource utilization associated with medically attended hypoglycemia in older patients with type 2 diabetes initiating basal insulin in a US managed care setting

Figures & data

Table 1. Pre-index characteristics of the HG and non-HG groups.

Pre-index characteristic	HG group (n = 3066)	Non-HG group (n = 27,969)	p-value	Total cohort (N = 31,035)
Age, years (mean [SD])	73 (9.6)	72 (9.1)	0.0015	72 (9.2)
Female, %	54	52	0.0448	53
Charlson comorbidity index excluding diabetes (mean [SD])	2.64 (2.32)	1.72 (2.03)	<0.0001	1.81 (2.07)
Mean HbA1c, %^a (mean [SD])	8.28 (1.82)	8.37 (1.69)	0.2546	8.36 (1.71)
Mean HbA1c, mmol/mol^a (mean [SD])	70.9 (19.9)	68.0 (18.5)	0.25546	67.9 (18.7)
Mean FPG, mg/dL^b (mean [SD])	181.8 (79.1)	180.9 (65.5)	0.9266	181.0 (67.3)
ADs
Metformin, %	67.9	71.1	0.0002	70.8
Sulfonylurea, %	79.9	77.9	0.0109	78.1
Thiazolidinedione, %	26.8	29.9	0.0003	29.6
DPP-4 inhibitor, %	17.6	21.3	<0.0001	21.0
GLP-1 analog, %	3.6	5.1	0.0003	4.9
Number of OADs (mean [SD])	1.96 (0.83)	2.04 (0.87)	<0.0001	2.04 (0.86)
High-risk ADs^c, %	80.9	78.9	0.0110	79.1
Low-risk ADs^d, %	81.9	85.8	<0.0001	85.4
Hypoglycemia^e, % patients	15.8	3.5	<0.0001	4.7

AD, antihyperglycemic drug; BI, basal insulin; DPP-4, dipeptidyl peptidase-4; FPG, fasting plasma glucose; GLP-1, glucagon-like peptide-1; OADs, oral antihyperglycemic drugs.

^a Data available for 5926 patients in the total cohort, 646 in the HG group and 5280 patients in the non-HG group.

^b Data available for 587 patients in the total cohort, 76 patients in the HG group and 511 patients in the non-HG group.

^c Antihyperglycemic drugs with a high risk of inducing hypoglycemia: insulin secretagogues (sulfonylureas, meglitinides).

^d Antihyperglycemic drugs with a low risk of inducing hypoglycemia: biguanides (metformin), thiazolidinediones, GLP-1 analogs, DPP-4 inhibitors.

^eHypoglycemia during the first three-quarters of the pre-index period.

HG group defined as those experiencing a hypoglycemic event during 1 year following BI initiation (3066/31,035, 9.9%). Non-HG group defined as those who did not experience a hypoglycemic event during 1 year following BI initiation (27,969/31,035, 90.1%).

Figure 1. Comorbidity prevalence during the pre- and post-index periods in (A) the HG group and (B) the non-HG group. White bars, during 1 year pre-index; dark grey bars, during 1 year post-index. (C) Change in comorbidity prevalence from the pre-index to the post-index period in both HG and non-HG groups. White bars, HG group; dark grey bars, non-HG group. *p < 0.05; **p < 0.01; ***p < 0.001; ****p < 0.0001. BI, basal insulin; HG, hypoglycemia. Only the comorbidities that are significant factors in the baseline models are shown. Microvascular disease comprises retinopathy, neuropathy and nephropathy. HG group defined as those experiencing a hypoglycemic event during 1 year following BI initiation (3066/31,035, 9.9%). Non-HG group defined as those who did not experience a hypoglycemic event during 1 year following BI initiation (27,969/31,035, 90.1%).

Table 2. Antihyperglycemic medication during the follow-up period.

AD	HG group, n (%)	Non-HG group, n (%)	p-value	Total cohort, n (%)
Any BI	3066 (100.0)	27,969 (100.0)	—	31,035 (100.0)
Any OAD	2541 (82.8)	24,002 (85.8)	<0.0001	26,543 (85.5)
High-risk AD^a	1904 (62.1)	16,857 (60.2)	0.0491	18,761 (60.4)
Low-risk AD^b	1909 (62.2)	19,034 (68.0)	<0.0001	20,943 (67.4)
GLP-1 analog	84 (2.7)	898 (3.2)	0.1573	982 (3.1)
Prandial insulin	1508 (49.1)	9354 (33.4)	<0.0001	10,862 (34.9)
Rapid-acting insulin	1061 (34.6)	6196 (22.1)	<0.0001	7257 (23.3)
Regular insulin	568 (18.5)	3629 (12.9)	<0.0001	4197 (13.5)
Premix	84 (2.7)	518 (1.8)	0.0007	602 (1.9)

AD, antihyperglycemic drug; BI, basal insulin; GLP-1, glucagon-like peptide-1; OAD, oral antihyperglycemic drug.

^a Drugs with a high risk of inducing hypoglycemia: insulin secretagogues (sulfonylureas, meglitinides).

^b Drugs with a low risk of inducing hypoglycemia: biguanides (metformin), thiazolidinediones, GLP-1 analogs, DPP-4 inhibitors.

HG group defined as those experiencing a hypoglycemic event during 1 year following BI initiation (3066/31,035, 9.9%). Non-HG group defined as those who did not experience a hypoglycemic event during 1 year following BI initiation (27,969/31,035, 90.1%).

Figure 2. HR analysis for all-cause hospitalization and death. *Hypoglycemia: indicator of a medically attended hypoglycemic event occurring before hospitalization or death. Endo, endocrinologist.

Figure 3. Unadjusted annual treatment costs for the HG group and the non-HG group, during 1 year pre-index and during 1 year follow-up post-BI initiation. (A) Total costs by healthcare setting. Dark grey bars, inpatient; white bars, outpatient; cross-hatched, emergency room; hatched, pharmacy. (B) Pharmacy costs. Black bars, diabetes-related medication; white bars, non-diabetes-related medication. HG group defined as those experiencing a hypoglycemic event during 1 year following BI initiation (3066/31,035, 9.9%). Non-HG group defined as those who did not experience a hypoglycemic event during one year following BI initiation (27,969/31,035, 90.1%). ****p < 0.0001. BI, basal insulin; HG, hypoglycemia; ns, non-significant.