Umpierrez Guillermo E, Pogge Elizabeth K, Li Xuan, Preblick Ronald, Gill Jasvinder, Pandya Naushira
Emory University School of Medicine, Department of Medicine, Atlanta, Georgia, USA.
Midwestern University College of Pharmacy, Glendale, Arizona, USA.
J Health Econ Outcomes Res. 2025 Apr 28;12(1):171-183. doi: 10.36469/001c.133274. eCollection 2025.
The association between falls or fall-related fractures and hypoglycemia in people with type 2 diabetes is well established. Insulin treatment is associated with an increased risk of hypoglycemia, which is compounded in people of older age, but the risk is lower with longer-acting vs intermediate- or long-acting basal insulin analogs. To examine healthcare resource utilization and costs related to falls/fractures in people with type 2 diabetes treated with the longer-acting basal insulin Gla-300 (insulin glargine 300 U/mL) vs long-acting basal insulins (insulin glargine 100 U/mL or insulin detemir)/neutral protamine Hagedorn (NPH). This retrospective study of Optum's de-identified Clinformatics® Data Mart Database compared data for people aged 50 years or older with at least 1 prescription claim for basal insulin (excluding insulin degludec) between April 1, 2015, and April 30, 2021, who initiated Gla-300 insulin (basal insulin-naive) or transitioned to Gla-300 from a different basal insulin (basal insulin-switch). Cohorts were propensity score-matched. The primary outcome was fall/fracture-related hospitalization and emergency department visit events (per 100 person-years of follow-up [P100PYFU]). The association between fall/fracture events and hypoglycemia and costs were secondary outcomes. Outcomes were compared using 95% confidence intervals of rate and other ratios; no statistical inference was performed. Fall/fracture-related hospitalization (2.88 vs 3.33 P100PYFU) and emergency department visit events (5.28 vs 5.95 P100PYFU) were numerically lower in people who initiated basal insulin with Gla-300 vs long-acting basal insulins/NPH, and in those who switched to Gla-300 vs long-acting basal insulins/NPH (2.54 vs 3.38 and 4.48 vs 5.21 P100PYFU, respectively). People with vs without hypoglycemia experienced more falls/fractures, regardless of whether initiating basal insulin or switching basal insulin treatment. Costs tended to be lower for people who switched to Gla-300; however, low event rates caused variability. The results of this study suggest that there is a positive correlation between fall/fracture events and hypoglycemia in people with type 2 diabetes and also, that fall/fracture-related healthcare resource utilization was numerically lower in people who initiated basal insulin with Gla-300 vs long-acting basal insulins/NPH, and in those who switched to Gla-300 vs long-acting basal insulins/NPH.
2型糖尿病患者跌倒或与跌倒相关的骨折与低血糖之间的关联已得到充分证实。胰岛素治疗与低血糖风险增加相关，在老年人中这种情况更为复杂，但与中效或长效基础胰岛素类似物相比，长效基础胰岛素的风险更低。为了研究使用长效基础胰岛素甘精胰岛素300（胰岛素甘精300 U/mL）与长效基础胰岛素（胰岛素甘精100 U/mL或地特胰岛素）/中性鱼精蛋白锌胰岛素（NPH）治疗的2型糖尿病患者中与跌倒/骨折相关的医疗资源利用和成本。这项对Optum的去识别化临床信息学®数据集市数据库的回顾性研究，比较了2015年4月1日至2021年4月30日期间年龄在50岁及以上、至少有1份基础胰岛素（不包括德谷胰岛素）处方申请的患者的数据，这些患者开始使用甘精胰岛素300（初治基础胰岛素）或从不同的基础胰岛素转换为甘精胰岛素300（基础胰岛素转换）。队列进行了倾向评分匹配。主要结局是与跌倒/骨折相关的住院和急诊科就诊事件（每100人年随访[P100PYFU]）。跌倒/骨折事件与低血糖和成本之间的关联是次要结局。使用率和其他比率的95%置信区间比较结局；未进行统计推断。与开始使用长效基础胰岛素/NPH相比，开始使用甘精胰岛素300的患者以及从长效基础胰岛素/NPH转换为甘精胰岛素300的患者中，与跌倒/骨折相关的住院（分别为2.88 vs 3.33 P100PYFU）和急诊科就诊事件（分别为5.28 vs 5.95 P100PYFU）在数值上更低（分别为2.54 vs 3.38和4.48 vs 5.21 P100PYFU）。无论开始基础胰岛素治疗还是转换基础胰岛素治疗，有低血糖与无低血糖的患者经历的跌倒/骨折更多。转换为甘精胰岛素300的患者成本往往更低；然而，事件发生率低导致了变异性。这项研究的结果表明，2型糖尿病患者的跌倒/骨折事件与低血糖之间存在正相关，并且，与开始使用长效基础胰岛素/NPH相比，开始使用甘精胰岛素300的患者以及从长效基础胰岛素/NPH转换为甘精胰岛素300的患者中，与跌倒/骨折相关的医疗资源利用在数值上更低。
