Yi Yingping, Li Yawei, Hou Anran, Ge Yanqiu, Xu Yuan, Xiong Gang, Yang Xinlei, Acevedo Stephanie Ann, Shi Lizheng, Xu Hua
Department of Science and Education, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, People's Republic of China.
Department of Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA.
Diabetes Ther. 2018 Jun;9(3):1073-1082. doi: 10.1007/s13300-018-0409-1. Epub 2018 Apr 5.
This study aimed to examine the associations of hypoglycemia with health care resource utilization (HCRU) and health care costs among patients with type 2 diabetes mellitus (T2DM) in China.
This retrospective cohort study was conducted with 23,680 T2DM patients >18 years old who visited the Second Affiliated Hospital of Nanchang University between 1 January 2011 and 31 December 2015. Univariate descriptive statistics were used to relate the HCRU and associated costs to patient characteristics, and regression analysis was used to examine the association between hypoglycemia and HCRU, controlling for other confounding factors.
In the T2DM patients with or without insulin treatment, when compared with nonhypoglycemic patients, hypoglycemia was associated with more medical visits (all T2DM patients 19.48 vs. 10.46, insulin users 23.45 vs. 14.12) and higher diabetes-related medical costs (all T2DM patients ¥5187.54 vs. ¥3525.00, insulin users ¥6948.84 vs. ¥3401.15) and medication costs (T2DM patients ¥1349.40 vs. ¥641.92, insulin users: ¥1363.87 vs. ¥853.96). Controlling for age, gender, and Charlson comorbidity index (CCI) score, hypoglycemia and insulin intake were associated with greater health care resource utilization. As compared to nonhypoglycemic patients, hypoglycemic T2DM patients and those on insulin therapy performed more outpatient visits (proportions of hypoglycemic vs nonhypoglycemic T2DM patients performing 3+ visits: 72.69% vs. 65.49%; proportions of hypoglycemic vs nonhypoglycemic patients on insulin therapy performing 3+ visits: 78.26% vs. 71.73%) and were hospitalized more often (proportions of hypoglycemic vs nonhypoglycemic T2DM patients with 3+ admissions 75.90% vs. 50.24%; proportions of hypoglycemic vs nonhypoglycemic patients on insulin therapy with 3+ admissions: 83.19% vs. 58.51%).
Hypoglycemia in diabetes patients was associated with increased healthcare resource utilization and health-related expenditure, especially for patients on insulin treatment. Insulin treatment regimens should be more individualized and account for hypoglycemia risk.
本研究旨在探讨中国2型糖尿病（T2DM）患者低血糖与医疗资源利用（HCRU）及医疗费用之间的关联。
本回顾性队列研究纳入了2011年1月1日至2015年12月31日期间就诊于南昌大学第二附属医院的23680例年龄大于18岁的T2DM患者。采用单因素描述性统计分析HCRU及相关费用与患者特征的关系，并运用回归分析在控制其他混杂因素的情况下检验低血糖与HCRU之间的关联。
在接受或未接受胰岛素治疗的T2DM患者中，与非低血糖患者相比，低血糖与更多的就诊次数相关（所有T2DM患者：19.48次对10.46次；胰岛素使用者：23.45次对14.12次），以及更高的糖尿病相关医疗费用（所有T2DM患者：5187.54元对3525.00元；胰岛素使用者：6948.84元对3401.15元）和药物费用（T2DM患者：1349.40元对641.92元；胰岛素使用者：1363.87元对853.96元）。在控制年龄、性别和Charlson合并症指数（CCI）评分后，低血糖和胰岛素使用与更高的医疗资源利用相关。与非低血糖患者相比，低血糖T2DM患者及接受胰岛素治疗的患者门诊就诊更多（低血糖与非低血糖T2DM患者进行3次及以上就诊的比例：72.69%对65.49%；接受胰岛素治疗的低血糖与非低血糖患者进行3次及以上就诊的比例：78.26%对71.73%），住院也更频繁（低血糖与非低血糖T2DM患者住院3次及以上的比例：75.90%对50.24%；接受胰岛素治疗的低血糖与非低血糖患者住院3次及以上的比例：83.19%对58.51%）。
糖尿病患者的低血糖与医疗资源利用增加及健康相关支出增加有关，尤其是接受胰岛素治疗的患者。胰岛素治疗方案应更加个体化，并考虑低血糖风险。
