美国 2 型糖尿病患者起始基础胰岛素后发生低血糖：对治疗中断以及医疗保健成本和利用的影响。
Hypoglycemia After Initiation of Basal Insulin in Patients with Type 2 Diabetes in the United States: Implications for Treatment Discontinuation and Healthcare Costs and Utilization.
机构信息
Sanofi US, Inc., Bridgewater, NJ, USA.
Global Outcomes and Epidemiology Research, Millennium Pharmaceuticals Inc., Subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA.
出版信息
Adv Ther. 2017 Sep;34(9):2083-2092. doi: 10.1007/s12325-017-0592-x. Epub 2017 Aug 4.
INTRODUCTION
Hypoglycemia and fear of hypoglycemia may contribute to basal insulin discontinuation, poor glycemic control, and increased healthcare burden in patients with type 2 diabetes (T2D). This study aimed to determine the impact of hypoglycemia soon after basal insulin initiation on treatment discontinuation and economic outcomes in patients with T2D.
METHODS
Hypoglycemic events within 6 months of basal insulin initiation were identified using retrospective cohort data from patients with T2D, at least 18 years of age, initiated on basal insulin therapy in the Clinformatics™ Data Mart for Multiplan claims database from January 1, 2008, through August 31, 2012. Data were adjusted for baseline characteristics. Discontinuation was established for patients with 12-month follow-up data, while discontinuation risk was assessed in the extended analysis (6- to 24-month follow-up) by Cox regression analysis. Healthcare use and costs were determined.
RESULTS
Of 55,608 patients, 4.5% experienced hypoglycemia within 6 months of basal insulin initiation. Patients with hypoglycemia were more likely to discontinue basal insulin within 12 months of initiation (79.0% vs. 74.2%; P < 0.001). Data, adjusted for baseline characteristics such as age, any baseline hypoglycemia, and use of oral antidiabetes drugs, showed that patients with hypoglycemia had a greater risk of discontinuation (hazard ratio 1.16; 95% confidence interval 1.03, 1.32; P = 0.0164), were more likely to have a hospitalization (41.0% vs. 24.3%; P < 0.001) or an ED visit (55.8% vs. 35.1%; P < 0.001), and had higher diabetes-related ($13,662 vs. $7506; P < 0.001) and all-cause ($30,719 vs. $19,079; P < 0.001) healthcare costs.
CONCLUSIONS
US patients with T2D who experienced hypoglycemia within 6 months of basal insulin initiation were more likely to discontinue treatment, accompanied by a greater healthcare burden.
FUNDING
Sanofi US, Inc.
简介
低血糖和对低血糖的恐惧可能导致 2 型糖尿病（T2D）患者停止使用基础胰岛素、血糖控制不佳和医疗保健负担增加。本研究旨在确定基础胰岛素起始后不久发生的低血糖对 T2D 患者治疗停药和经济结局的影响。
方法
从 2008 年 1 月 1 日至 2012 年 8 月 31 日，在 Clinformatics ™ Data Mart for Multiplan 索赔数据库中，使用至少 18 岁的 T2D 患者的回顾性队列数据，确定基础胰岛素起始后 6 个月内的低血糖事件。根据基线特征对数据进行调整。对有 12 个月随访数据的患者进行停药确定，而在扩展分析（6 至 24 个月随访）中，通过 Cox 回归分析评估停药风险。确定了医疗保健的使用和成本。
结果
在 55608 名患者中，4.5%的患者在基础胰岛素起始后 6 个月内发生低血糖。与起始后 12 个月内停药（79.0%比 74.2%；P < 0.001）相比，发生低血糖的患者更有可能在基础胰岛素起始后 12 个月内停止使用。根据年龄、任何基线低血糖和口服抗糖尿病药物使用等基线特征调整的数据显示，低血糖患者停药风险更高（风险比 1.16；95%置信区间 1.03，1.32；P = 0.0164），更有可能住院（41.0%比 24.3%；P < 0.001）或急诊就诊（55.8%比 35.1%；P < 0.001），并且糖尿病相关（13662 美元比 7506 美元；P < 0.001）和全因（30719 美元比 19079 美元；P < 0.001）医疗保健费用更高。
结论
美国 T2D 患者在基础胰岛素起始后 6 个月内发生低血糖更有可能停止治疗，并伴有更大的医疗保健负担。
基金
赛诺菲美国公司。
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