Hypoglycemic risk and utilization in diabetic population initiating basal insulin treatment
Date Issued
2009
Date
2009
Author(s)
Yeh, Tzu-Chen
Abstract
Background: The usage of insulin analogue in Taiwan increase in latest years. Recent studies stated that long-acting insulin analogues (LAIA) provide a delayed onset of action and a peakless effect that may be associated with fewer episodes of hypoglycemia than conventional insulin. It might also provide moderation of health utilization and medical cost. However, there is lack of studies in postmarketing comparative effectiveness or health utilization of basal insulins in Taiwan. The aims of this study were to evaluate hypoglycemic risk of different basal insulin and to analyze the utilization from patients newly initiated these agents Besides, we evaluated which factors would influence prescriptions of insulin analogue with propensity score (PS) method.ethods: We conducted a retrospective analysis using National Health Insurance claims data for diabetes newly treated with LAIA or conventional intermediate-long acting insulin (ILI) between July 1, 2004 and December 31, 2006 (n=19075). Eligibility required at least 6 months of insurance before the index prescription date. The PS for receiving LAIA was estimated using logistic regression based on observed characteristics such as patient levels, hospital levels, and diabetes-related costs and utilization. Patients who had at least one hypoglycemic event during this period were extracted (n=930). The first hypoglycemic event was defined as index event. We defined case period as 1-14 days immediately before the event and 3 matched control periods 29-42, 43-56, 57-70 days prior to the index event of the same patient. Exposure to LAIA or ILI during different periods was compared using conditional logistic regression adjusting with time-dependent covariates. n the cohort study, individuals with prescriptions for only insulin detemir (IDet, n=683), insulin glargine (IGlar, n=2961) or ILI(n=13356) were followed until death or the end of study. Utilization of these groups was analyzed with general linear model and post hoc analyses. esults: Part I. The associated factors related to prescribing LAIA were medical centers, clinics, endocrinologists, family physicians, female doctors, metabolic disease, A1c tests, premixed insulin, or diabetes-related outpatient costs. Part II. By using case-crossover approach, recent use of ILI was associated with hypoclycemia. [Odds ratio (OR) = 1.45, p<0.01]. There was no significantlly increasing hypoglycemic risk of LAIA [OR=1.57, p=0.08]. The OR of LAIA over ILI was 1.05 and non-significant (p=0.85). Part III. On average, IDet and IGlar subjects had obviously more outpatient visits and costs, analogues usage, diabetes-related pharmacy costs and A1c tests (p<0.001) but fewer inpatient visits and costs (p<0.001) compared to ILI users. Total medical costs were reduced in analogues users (IDet NT$104769, IGlar NT$103111 vs ILI NT$140413, p<0.001).onclusion: Subjects newly treated with intermediate-long acting insulin have indeed higher hypoglycemic risk than nonusers of this drug. Owing to fewer subjects of long-acting insulin analogues, we couldn’t confirm that there was no statistical difference of hypoglycemic risk between long-acting insulin analogues and intermediate-long acting insulin. We need to collect more information to prove it in future study. Compared to intermediate-long acting insulin users, long-acting insulin analogues users incurred higher outpatient utilization and diabetes-related pharmacy costs but fewer hospitalizations which led lower total costs. Finally, we should improve quality of care, such as increasing A1c tests, in those patients using intermediate-long acting insulin who have more comorbidities and higher hospitalization rates, thus diabetic complications would be decreased and total medical cost would be reduced thereafter.
Subjects
insulin
hypoglycemia
health care utilization
case-crossover design
propensity score
SDGs
Type
thesis
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