Mazzi Silvio, Ravasio Roberto, Forlani Gabriele, Veronese Giacomo, Fabbri Andrea, Marchesini Giulio
Department of Health Economics, Health Publishing & Services Srl, Milan.
Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University of Bologna, Bologna.
Clinicoecon Outcomes Res. 2017 Nov 21;9:711-720. doi: 10.2147/CEOR.S148368. eCollection 2017.
The primary objective of this study was to estimate 1) the annual risk of undergoing a severe hypoglycemic event in Italian patients with diabetes and 2) the risk of hospitalization following such event. From the HYPOTHESIS database, powered by 46 emergency departments covering a 12-million-odd population, data were extracted of 1,922 hypoglycemic events occurring in patients with diabetes in 2011. The mean age was 71.5 (standard deviation 16.8) years, 50.1% were men, and blood glucose at the time of the event was 44.2 (26.5) mg/dL. Patients were being treated with insulin alone (55%) or in combination with oral hypoglycemic agents (OHA, 15%), or with OHA alone, either in monotherapy (14%) or in multiple therapy (16%). Comorbidities were recorded in 71.8% of the patients. Based on the rates of glucose-lowering drug use in Italian patients with diabetes, the annual risk of undergoing a serious hypoglycemic event was estimated at 1.27% for subjects treated with insulin alone, the highest (<0.00001) as compared with insulin + OHA (0.41%) or OHA alone, either in monotherapy or in multiple therapy (0.1% and 0.17%, respectively). The risk of being hospitalized following the hypoglycemic event was the least (27.6%) for subjects treated with insulin alone (<0.0083). Subjects treated with insulin + OHA showed a lower risk (34.2%) as compared with that for subjects treated with OHA (<0.02). Death occurs in 7% of hospitalized patients. Older age (<0.0001) and comorbidities (<0.0001) were risk factors for hypoglycemia-related hospitalization. Treatments with insulin alone (<0.005) or in combination (<0.049) were negatively associated with hospital admission. Severe hypoglycemic events associated with the use of oral glucose-lowering agents carry the highest risk of hospital treatment. As such, they are also likely to generate higher tangible and intangible costs.
1）意大利糖尿病患者发生严重低血糖事件的年度风险；2）此类事件后住院的风险。从由46个急诊科提供支持、覆盖1200多万人口的HYPOTHESIS数据库中，提取了2011年糖尿病患者发生的1922次低血糖事件的数据。平均年龄为71.5岁（标准差16.8），男性占50.1%，事件发生时的血糖水平为44.2（26.5）mg/dL。患者单独接受胰岛素治疗（55%）或与口服降糖药（OHA）联合治疗（15%），或仅接受OHA治疗，单药治疗（14%）或联合治疗（16%）。71.8%的患者记录有合并症。根据意大利糖尿病患者的降糖药物使用比例，单独接受胰岛素治疗的患者发生严重低血糖事件的年度风险估计为1.27%，与胰岛素+OHA（0.41%）或仅接受OHA治疗（单药治疗和联合治疗分别为0.1%和0.17%）相比，该风险最高（<0.00001）。低血糖事件后住院的风险在单独接受胰岛素治疗的患者中最低（27.6%）（<0.0083）。与接受OHA治疗的患者相比，接受胰岛素+OHA治疗的患者风险较低（34.2%）（<0.02）。7%的住院患者死亡。年龄较大（<0.0001）和合并症（<0.0001）是低血糖相关住院的危险因素。单独使用胰岛素治疗（<0.005）或联合使用胰岛素治疗（<0.049）与住院呈负相关。与使用口服降糖药相关的严重低血糖事件住院治疗风险最高。因此，它们也可能产生更高的有形和无形成本。
