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低血糖严重程度与美国使用基础胰岛素的 2 型糖尿病患者的临床、患者报告和经济结局的相关性。

Association of hypoglycaemia severity with clinical, patient-reported and economic outcomes in US patients with type 2 diabetes using basal insulin.

机构信息

Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas, Texas.

Kantar Health, San Mateo, California.

出版信息

Diabetes Obes Metab. 2018 May;20(5):1156-1165. doi: 10.1111/dom.13208. Epub 2018 Feb 7.

Abstract

AIMS

To evaluate the clinical and patient-reported outcomes and healthcare utilization and costs associated with patient-reported hypoglycaemia in US adults with type 2 diabetes (T2D) treated with basal insulin.

MATERIALS AND METHODS

This was an observational, cross-sectional, survey-based study of adults with T2D on basal insulin ± oral antidiabetes drugs (OADs) or rapid-acting/premixed insulin, who had in the past ever experienced hypoglycaemia, using US data from the National Health and Wellness Survey. Eligible patients were categorized as having no hypoglycaemia (38.7%), non-severe hypoglycaemia (55.1%), or severe hypoglycaemia (6.2%) in the preceding 3 months. Outcomes included health-related quality of life (HRQoL), work productivity and activity impairment, healthcare resource utilization, and estimated direct and indirect costs. Multivariable regression models were performed to control for patient characteristics.

RESULTS

Patients who experienced severe hypoglycaemia had significantly (P < .05) lower HRQoL scores, greater overall impairment of work productivity and activity, greater healthcare resource utilization, and higher costs compared with those who experienced non-severe or no hypoglycaemia. Patients with non-severe hypoglycaemia also reported an impact on the number of provider visits, indirect costs, and HRQoL.

CONCLUSIONS

Patients with T2D using basal insulin ± OADs or rapid-acting/premixed insulin in the United States who experienced severe hypoglycaemia had greater impairment of activity and work productivity, utilized more healthcare resources, and incurred higher associated costs than those with non-severe or no hypoglycaemia. The study also demonstrated the impact that non-severe hypoglycaemic events have on economic and HRQoL outcomes. Reducing the incidence and severity of hypoglycaemia could lead to clinically meaningful improvements in HRQoL and may result in lower healthcare utilization and associated costs.

摘要

目的

评估与美国接受基础胰岛素治疗的 2 型糖尿病(T2D)成人患者报告的低血糖相关的临床和患者报告结局以及医疗保健利用和成本。

材料和方法

这是一项观察性、横断面、基于调查的研究,纳入了正在接受基础胰岛素±口服抗糖尿病药物(OAD)或速效/预混胰岛素治疗且过去曾经历过低血糖的 T2D 成人患者,该研究使用了美国全国健康和健康调查的数据。符合条件的患者在前 3 个月被归类为无低血糖(38.7%)、非严重低血糖(55.1%)或严重低血糖(6.2%)。结局包括健康相关生活质量(HRQoL)、工作生产力和活动障碍、医疗资源利用情况以及估计的直接和间接成本。采用多变量回归模型来控制患者特征。

结果

与经历非严重或无低血糖的患者相比,经历严重低血糖的患者 HRQoL 评分显著降低(P <.05),工作生产力和活动的总体受损程度更大,医疗资源利用更多,成本更高。经历非严重低血糖的患者也报告了对就诊次数、间接成本和 HRQoL 的影响。

结论

在美国使用基础胰岛素±OAD 或速效/预混胰岛素的 T2D 患者中,经历严重低血糖的患者活动和工作生产力受损程度更大,医疗资源利用更多,相关成本更高,而非严重或无低血糖的患者则更轻。该研究还表明,非严重低血糖事件对经济和 HRQoL 结局有影响。降低低血糖的发生率和严重程度可能会导致 HRQoL 有临床意义的改善,并且可能会导致医疗保健利用率和相关成本降低。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e505/5947635/8cf2e9921c31/DOM-20-1156-g002.jpg

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