Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, New Jersey.
Epidemiology, Medical Devices, Johnson & Johnson, Titusville, New Jersey.
Diabetes Obes Metab. 2019 Jun;21(6):1419-1428. doi: 10.1111/dom.13671. Epub 2019 Mar 27.
To study the association of body mass index (BMI) and insulin use with type 2 diabetes-related healthcare expenditures (T2D-HE).
Retrospective study using de-identified electronic health records linked to insurance claims data. Study included a prevalence-based sample of overweight or obese patients with antihyperglycaemic-treated T2D. Patients had ≥1 A1c measurement in 2014 (last observed = index A1c), ≥1 BMI measurement within ±90 days of index (average BMI = baseline BMI), and continuous enrolment for 180 days before (baseline) through 395 days after index (day 30-395 = follow-up). BMI was categorized as: 25 to 29.9 kg/m = overweight; 30 to 34.9 kg/m = obese class I (OCI); 35 to 39.9 kg/m = OCII; ≥40 kg/m = OCIII. Multivariable regressions were used to examine one-year follow-up T2D-HE as a function of BMI, insulin use, an interaction term between BMI and insulin use, and patient demographics.
Study included 13 026 patients (mean age = 63.6 years; 48.1% female; 29.5% overweight, 31.6% OCI, 20.3% OCII, 18.6% OCIII; 25.3% insulin users). Baseline insulin use rates monotonically ranged from 19.7% in overweight patients to 33.0% in OCIII patients (P < 0.001). Together, BMI and insulin use were jointly associated with one-year follow-up T2D-HE, which monotonically ranged from $5842 in overweight patients with no insulin to $17 700 OCIII insulin users, P < 0.001. Within each BMI category, insulin users' one-year T2D-HE was at least double that of non-users. Additional analyses of all-cause healthcare expenditures yielded consistent results.
BMI and insulin use represent simple stratifiers for identifying high-cost patients. OCIII insulin users incurred the greatest annual healthcare expenditures; these patients may be an ideal group for targeted interventions.
研究体重指数（BMI）和胰岛素使用与 2 型糖尿病相关医疗支出（T2D-HE）的相关性。
使用与保险索赔数据相关联的去识别电子健康记录进行回顾性研究。该研究包括一个基于患病率的超重或肥胖接受抗高血糖治疗的 2 型糖尿病患者样本。患者在 2014 年有≥1 次糖化血红蛋白测量值（最后一次观察=指数糖化血红蛋白），在指数前±90 天内有≥1 次 BMI 测量值（平均 BMI=基线 BMI），并且在指数前 180 天（基线）至指数后 395 天（第 30-395 天=随访）期间连续入组。BMI 分类为：25 至 29.9kg/m=超重；30 至 34.9kg/m=肥胖 I 级（OCI）；35 至 39.9kg/m=肥胖 II 级（OCII）；≥40kg/m=肥胖 III 级（OCIII）。多变量回归用于检查 BMI、胰岛素使用、BMI 和胰岛素使用之间的交互项以及患者人口统计学因素对一年随访 T2D-HE 的影响。
该研究纳入了 13026 名患者（平均年龄=63.6 岁；48.1%为女性；29.5%超重，31.6%OCI，20.3%OCII，18.6%OCIII；25.3%胰岛素使用者）。基线时胰岛素使用率从超重患者的 19.7%单调递增至 OCIII 患者的 33.0%（P<0.001）。BMI 和胰岛素使用共同与一年随访 T2D-HE 相关，从超重患者的 5842 美元到 OCIII 胰岛素使用者的 17700 美元不等，呈单调递增趋势（P<0.001）。在每个 BMI 类别中，胰岛素使用者的一年 T2D-HE 至少是未使用者的两倍。对全因医疗支出的进一步分析得出了一致的结果。
BMI 和胰岛素使用是识别高成本患者的简单分层因素。OCIII 胰岛素使用者的年度医疗保健支出最高；这些患者可能是目标干预的理想群体。
