Northwestern University School of Medicine, 750 N Lake Shore Dr, Ste 680, Chicago, IL 60611. E-mail:
Am J Manag Care. 2017 Jun;23(6):353-359.
Continuous subcutaneous insulin infusion (CSII), or "insulin pump" therapy, is an alternative to multiple daily insulin injections (MDII) for management of diabetes. This study evaluates patterns of healthcare utilization, costs, and blood glucose control for patients with diabetes who initiate CSII.
Pre-post with propensity-matched comparison design involving commercially insured US adults (aged 18-64 years) with insulin-requiring diabetes who transitioned from MDII to CSII between July 1, 2009, and June 30, 2012 ("CSII initiators"; n = 2539), or who continued using MDI (n = 2539).
Medical claims and laboratory results files obtained from a large US-wide health payer were used to construct direct medical expenditures, hospital use, healthcare encounters for hypoglycemia, and mean concentration of glycated hemoglobin (A1C). We fit difference-in-differences regression models to compare healthcare expenditures for 3 years following the switch to CSII. Stratified analyses were performed for prespecified patient subgroups.
Over 3 years, mean per-person total healthcare expenditures were $1714 (95% confidence interval [CI], $1184-$2244) higher per quarter for CSII initiators compared with matched MDII patients (total mean 3-year difference of $20,565). Compared with matched controls, mean A1C concentrations became lower for CSII initiators by 0.46% in year 2 (P = .0003) and by 0.32% in year 3 (P = .047). CSII initiators also had a higher rate of hypoglycemia encounters in year 1 (P = .002).
For adults with insulin-requiring diabetes, transitioning from MDII to CSII was associated with modest improvements in A1C but more hypoglycemia encounters and increased healthcare expenditures, without significant improvement in other potentially offsetting areas of healthcare consumption.
持续皮下胰岛素输注（CSII），即“胰岛素泵”疗法，是糖尿病管理中替代多次胰岛素皮下注射（MDII）的一种方法。本研究评估了起始 CSII 治疗的糖尿病患者的医疗保健利用、成本和血糖控制模式。
本研究采用倾向匹配前后对照设计，涉及 2009 年 7 月 1 日至 2012 年 6 月 30 日期间从 MDII 转为 CSII 的美国商业保险成年（18-64 岁）胰岛素依赖型糖尿病患者（CSII 起始者，n=2539）或继续使用 MDI 的患者（n=2539）。
本研究使用来自美国大型医疗保险机构的医疗索赔和实验室结果文件，构建直接医疗支出、住院使用、低血糖医疗事件和糖化血红蛋白（A1C）平均浓度。我们使用差异-差异回归模型比较 CSII 转换后 3 年的医疗保健支出。对预先指定的患者亚组进行分层分析。
在 3 年期间，CSII 起始者每季度的人均总医疗保健支出比匹配的 MDII 患者高 1714 美元（95%置信区间[CI]，1184 美元至 2244 美元）（3 年总平均差异为 20565 美元）。与匹配对照相比，CSII 起始者的 A1C 浓度在第 2 年降低了 0.46%（P=.0003），在第 3 年降低了 0.32%（P=.047）。CSII 起始者在第 1 年的低血糖事件发生率也更高（P=.002）。
对于需要胰岛素治疗的成年糖尿病患者，从 MDII 转为 CSII 与 A1C 的适度改善相关，但低血糖事件增加和医疗保健支出增加，而其他潜在的医疗保健消耗领域没有显著改善。
