Introduction: Hypoglycemia leading to hospitalization is associated with adverse economic outcomes, although the real burden is unknown. The HIPOS-WARD (Hypoglycemia In Portugal Observational Study-Ward) aimed to characterize ward admissions due to hypoglycemia episodes in treated patients with diabetes and assess their economic impact to the National Health System. Methods: Observational, cross-sectional study, conducted in 16 Portuguese centers for 22 months. The applied microcosting approach was based on healthcare resource data, collected from patients' charts upon ward admission until discharge, and unitary costs from official/ public data sources. Absenteeism was also Digital Features To view digital features for this article go to

Background We intended to estimate the proportion hypoglycemic/hyperglycemic emergency episodes in treated diabetes mellitus (DM) patients admitted to a hospital ward, and calculate the prevalence of risk factors for hypoglycemia and diabetic complications. Methods In this cross-sectional, multicentered study, the observational data was collected by physicians from patient’s hospitalization to discharge/death. Statistical tests were 2-tailed considering 5% significance level. Results There were 646 ward admissions due to hyperglycemic emergencies and 176 hypoglycemic episodes with a ratio hypoglycemia/hyperglycemia 0.27 for all DM patients. In T2DM patients the ratio was 0.38. These were mainly female (55.1%), functionally dependent (61.4%) and retired/disabled (73.1%). Median age was 75 years and median duration of disease 11 years. Half the patients were on insulin-based therapy and 30.1% on secretagogue-based therapy. Approximately 57% of patients needed occasional/full assistance to manage the disease. The most frequent risk factor for hypoglycemia was polypharmacy (85.0%). Hypoglycemia in the 12 months before admission was higher in insulin-based therapy patients (66.1%; p = 0.001). Conclusions Hyperglycemic emergencies are the most frequent cause of hospitalization in Portugal, although severe hypoglycemic events represent a health and social problem in elderly/frail patients. There is still the need to optimize therapy in terms of the potential for hypoglycemia in this patient group and a review of anti-hyperglycemic agents to add on to insulin.

No abstract

No abstract

No abstract

Episódios de hipoglicemia são consensualmente considerados como o evento adverso mais frequente e dispendioso relacionado com o tratamento da diabetes mellitus porém, o real impacto económico é ainda pouco estimado. No sentido de avaliar o impacto económico destes eventos, desde a urgência até à alta hospitalar, foram combinados dados de dois estudos de microcusteio conduzidos em Portugal (HIPOS-ER e HIPOS-WARD). Métodos: A homogeneidade da população (diabetes mellitus 2, >40 anos) foi ajustada através de uma regressão linear e o ano de valoração (2018) pela inflação. Foram considerados os custos diretos decorrentes do transporte à urgência, tempo despendido pelos profissionais de saúde, ocupação de cama, análises laboratoriais, exames e medicação utilizados na urgência e no internamento. Custos indiretos foram avaliados de maneira exploratória. Resultados: O custo direto total médio de um episódio de hipoglicemia foi estimado em 2323,73€, sendo 87% atribuído ao internamento hospitalar. Exames e a ocupação de cama são os custos com maior expressão na urgência (36,3%) e no internamento hospitalar (38,4%), respetivamente. Relativamente aos subgrupos de tratamento, doentes tratados com insulina apresentam um maior custo direto total médio (2673,02€). Discussão: Os resultados obtidos confirmam o expectável elevado custo dos eventos de hipoglicémia. Espera-se que estes dados contribuam para um melhor planeamento de políticas públicas (em termos clínicos, humanísticos e económicos) com vista à prevenção de episódios de hipoglicémia -bem como de picos hiperglicémicos -decorrentes do tratamento de diabetes mellitus 2.

Introduction: Hypoglycemia places a significant burden, accounting for adverse clinical and financial outcomes. Objective: Integrated approach to determine burden of hypoglycemia in T2D patients in Portugal, accessed in an Outpatient Setting (pharmacies), Emergency Rooms (ERs) and Hospital Wards, contributing for a full country perspective of complementary settings. Methods: A series of 3 HypoglycemIa in POrtugal Studies (HIPOS) were developed: HIPOS-PHARMA, HIPOS-ER and HIPOS-WARD. They were observational, cross-sectional, multicentric studies designed to evaluate adult T2D patients treated with AHA attending pharmacies and reporting hypoglycemic events (PHARMA), admitted in ERs or hospitalized (WARD) for hypoglycemia. These studies were implemented over a period of non-consecutive 35 months (Jan13-Aug18) and with a national coverage. Results: Mild to moderate hypoglycemia in the 3 months prior recruitment were reported by 17.8% of the 1890 individuals enrolled by 233 pharmacies during HIPOS-PHARMA and were more likely in patients taking insulin and/or secretagogues. Only 46% of patients reported the episode to a HCP. Severe hypoglycemia accounted for 0.074% (n=238) of the 425,706 ER admissions in the 7 HIPOS-ER hospitals and occurred mainly on insulin- (55.0%) and secretagogue-based therapy (31.5%). When these patients needed hospitalization (44%), the mean total cost per hypoglycemic event was € 3,163 (€ 230 - € 26,818). As for HIPOS-WARD, 152 individuals were enrolled in 18 centers, 40.4% had previous hypoglycemia (last 12 months), and were also on insulin (42.1%) or secretagogues (34.9%). Conclusion: This study series allowed for the first time a nationwide multi-setting perspective of hypoglycemia in T2D patients, signaling that this event still represents a relevant burden in Portugal, despite significant improvements in hypoglycemia prevention strategies and the growing number AHA with low hypoglycemia risk. Disclosure S. Alão: Employee; Self; Merck Sharp & Dohme Corp. L.C. Santos: Speaker’s Bureau; Self; Merck Sharp & Dohme Corp. F. Araujo: None. J.M. Dores: Advisory Panel; Self; Merck Sharp & Dohme Corp. J. Pelicano-Romano: Employee; Self; Merck & Co., Inc. J.M. Conceicao: Employee; Self; Merck Sharp & Dohme Corp. Stock/Shareholder; Self; Merck Sharp & Dohme Corp. P. Mj: Employee; Self; Merck Sharp & Dohme Corp.

model was built to study the optimal glycemic monitoring among T2DM patients with stable glycemic control. In the Markov model, different HbA1c test intervals were compared to evaluate costs per quality-adjusted life year (QALY) and the incremental cost-effectiveness ratio (ICER). We compared every 3 months intervals (current Japanese strategy), every six months (US and UK recommendations) and annual monitoring, focusing on HbA1c test characteristics of signal (true change) and noise (error), which were reported in the previous study. All model parameters including screening and treatment costs, complication and mortality rates and utilities were also drawn from published studies. The willingness-to-pay threshold in cost-effectiveness analysis was set to US $50,000/QALY. Results: Based on our analysis, annual interval was most cost-effective to monitor T2DM patients with stable glycemic control. Three months interval was dominated. ICER for annual interval was $463.39/QALY compared to 6 months interval. Conclusions: Once patients achieve stable glycemic control at their HbA1c goal, an informative interval for HbA1c monitoring is once every year. Current guidelines, which suggest testing every six months, may contribute to substantial over-testing.