Cost and co-morbidities associated with hypoglycemic inpatients in Belgium

Figures & data

Table 1. List of codes used for patient selection.

Indication	ICD-9 code	ICD-9 label
Diabetes	250	Diabetes mellitus
Hypoglycemia	250.3	Diabetes with other coma (including hypoglycemic coma)
	250.8	Diabetes with other specified manifestations (including hypoglycemic shock)
	E932.3	Poisoning with insulins and anti-diabetic agents
Fractures	800-829	Traumatic fractures
Falls	E880-E889	Accidental falls
Accidents	E800-E807	Railways accidents
	E810-E819	Motor vehicle traffic accidents
	E820-E825	Motor vehicle non-traffic accidents
	E826-E829	Other road vehicles accidents
	E930-E838	Water transports accidents
Cardiovascular events	410	Myocardial infarction
	411.1	Intermediate coronary syndrome (including unstable angina)
	413.0	Angina decubitus
Ischemic stroke	45 (APRDRG)	Cerebrovascular accident and pre-cerebral occlusion with infarction
	46 (APRDRG)	Cerebrovascular accident and pre-cerebral occlusion without infarction
Depression	311	Depressive disorders, not elsewhere classified

Table 2. Distribution of documented use of insulin and oral anti-diabetic drugs in the eligible population over the course of the whole study period.

Type of anti-diabetic drugs	Hypoglycemic patients (n = 2196)	Non-hypoglycemic patients (n = 28 514)
1. Insulin + oral	25.7%	15.5%
incl. Sulphonylureas	7.9%†	3.7%
Biguanides	20.4%	12.8%
Sulphonylureas + biguanides	0.8%	0.3%
Alpha-glucosidase inhibitors	0.0%	0.0%
Other oral anti-diabetics	3.2%	1.5%
2. Oral anti-diabetic only	17.2%	23.9%
incl. Sylphonylureas	5.6%	5.7%
Biguanides	13.0%	19.5%
Sulphonylureas + biguanides	0.6%	0.4%
Alpha-glucosidase inhibitors	<0.1%	<0.1%
Other oral anti-diabetics	2.1%	2.3%
3. Insulin only	36.6%	18.3%
4. No anti-diabetic drug documented	20.5%	42.4%

†Percentages in italic do not add up to the total due to the fact that patients may have been administered more than one type of oral anti-diabetic medication over the course of the study period.

Figure 1. Split of hypoglycemia-related hospitalization cost between the main cost components.

Table 3. Average cost and length of stay (LOS) associated with hypoglycemia-related hospitalizations.

Age group	All hospitalizations			With accidental fall			Without accidental fall			p-values††
	n stays	Cost (€)	LOS (days)	n stays	Cost (€)	LOS (days)	n stays	Cost (€)	LOS (days)	Cost	LOS
20–29	20	1845 (361)†	2.6 (0.5)	1	1286 (NA)	2.0 (NA)	19	1875 (379)	2.6 (0.5)	0.862	0.928
30–39	34	4980 (1 173)	7.6 (1.9)	3	16,335 (9 112)	25.7 (16.0)	31	3881 (818)	5.8 (1.3)	0.078	0.091
40–54	232	7351 (671)	11.7 (1.1)	19	8596 (3 781)	16.2 (6.3)	213	7240 (652)	11.3 (1.1)	0.518	0.926
55–64	390	10,331 (1 255)	15.0 (1.2)	24	16,673 (3 969)	27.2 (6.0)	366	9916 (1 277)	14.2 (1.2)	0.207	0.048
65–74	611	9769 (571)	15.3 (0.9)	48	14,347 (2 498)	24.4 (4.4)	563	9379 (580)	14.5 (0.9)	0.068	0.007
≥75	1338	11,223 (438)	18.2 (0.7)	199	16,786 (1 567)	27.2 (2.3)	1139	10,251 (429)	16.6 (0.6)	<0.001	<0.001
Overall	2625	10,258 (324)	16.2 (0.4)	294	15,792 (1 212)	25.9 (1.8)	2331	9559 (329)	15.0 (0.4)	<0.001	<0.001

†Mean (standard-error).

††Wilcoxon non-parametrical test.

Figure 2. In-hospital mortality in hypoglycemic vs other diabetic patients split per age band.

Table 4. Distribution of number of morbid events in patients with and without a history of hypoglycemia-related hospitalizations over the calendar year.

	n events/year	With hypoglycemia (n = 2196)	Without hypoglycemia (n = 28 514)	p-value
Hospitalizations with traumatic fractures	No event	2023 (92.12%)	26,773 (93.89%)
	At least one event (risk rate)	173 (7.88%)	1741 (6.11%)
	OR [95% CI]†	1.247 [1.057–1.470]	–	0.009
	Event rate††	0.085	0.064	<0.001
Hospitalizations with cardiovascular event	No event	2034 (92.62%)	26,424 (92.67%)
	At least one event (risk rate)	162 (7.38%)	2090 (7.33%)
	OR [95% CI]†	0.979 [0.829–1.157]	–	0.801
	Event rate††	0.090	0.080	<0.001
Hospitalizations with depression	No event	2094 (95.36%)	27,807 (97.52%)
	At least one event (risk rate)	102 (4.64%)	707 (2.48%)
	OR [95% CI]†	1.900 [1.536–2.351]	–	<0.001
	Event rate††	0.054	0.028	<0.001

†Odd-ratios, adjusted for age and sex.

††In number of events/patient-calendar year.