A Retrospective Cohort Study of Patients with Type 2 Diabetes in China: Associations of Hypoglycemia with Health Care Resource Utilization and Associated Costs

Abstract

IntroductionThis 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.MethodsThis 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.ResultsIn 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%).ConclusionHypoglycemia 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.

The association between hypoglycemia and hospital use, food insufficiency, and unstable housing conditions: a cross-sectional study among patients with type 2 diabetes in Sudan

“…A J-shaped relationship was found between the glycated hemoglobin and all-cause mortality with an increasing death at both high and low HbA1c [4], a recent study showed an inverse or U-shaped relationship between the HbA1c and death among patients with diabetes and heart failure especially among patients who were on insulin, sulphonylureas and thiazolidinediones [5]. Hypoglycemia among patients with diabetes is associated with an increasing health-related expenditure and healthcare resources utilization [6]. In the United state a single episode of hypoglycemia requiring a healthcare provider assistance is estimated at $1161 and 160 for direct and indirect costs respectively, a study conducted in Korea found that, the cost of a single hypoglycemic attack ranged from $17.28 to $1857.09 for secondary and tertiary hospitals.…”

The individualisation of glycaemic targets in response to patient characteristics in type 2 diabetes: a scoping review

“…[14][15][16][19][20][21]23,24 Follow-up data from the ACCORD, ADVANCE and VADT trials suggest elderly patients with a longer duration of diabetes are unlikely to gain macrovascular benefits from intensive glycaemic control and may be exposed to excess risk of severe hypoglycaemia, increased morbidity and mortality. 6,11,12,18 These findings are expanded upon in a study by Monami et al: follow-up over 6 years in those with a longer diabetes duration (10 years and over) showed that mortality only increases when HbA 1c levels are greater than 68 mmol/mol (>8.4%). 25 Similarly, over the same follow-up when considering those aged 71 years and over, mortality was shown to increase only when HbA 1c levels rose above 68 mmol/mol (>8.4%).…”

“…Concurrence of themes between articles resulted in the determination of key patient factors where individualised HbA 1c targets were beneficial. These factors were: > presence of established cardiovascular disease [5][6][7][8][9][10][11][12][13][14] > advancing age and diabetes duration 6,11,12,[14][15][16][17][18][19][20][21][22][23][24][25] > presence of frailty, disability, cognitive impairment or comorbidity 6,11,12,14,[26][27][28][29][30][31][32][33][34][35][36] > presence of problematic hypoglycaemia 18,20,[37][38][39][40][41][42][43]…”

“…41,42 Symptomatic hypoglycaemia in diabetes, whether mild or severe, is a significant source of hospitalisation (HR 2.09; 95% CI 1.63-2.67) and death (HR 2.48; 95% CI 1.41-4.38) and is associated with increased morbidity, all-site cancer, disability, medical visits, diabetes-related medical costs, medication costs, healthcare resource utilisation, and reduced quality of life, well-being and self-management. 18,20,38,40,42,44,61 Independent of glycaemic control, comorbid status and diabetes treatment, hypoglycaemia is associated with a greater risk of dementia (2.39% per year; 95% CI 1.72-3.01). 45 In older adults with Alzheimer's dementia, Chen et al showed a reduced progression of dementia, reduced rate of hypoglycaemia, reduced medication burden and reduced rate of diabetes complications over a 3-year follow-up period in patients following a moderate rather than intensive glucose control strategy.…”

The Impact of a Family Doctor Contract Service on Outcomes for Type 2 Diabetes Patients in Zhejiang Province

“…According to the report, patients with T2DM spent more than 7 days in hospital on average, and each hospitalization cost was more than 6000 yuan, accounting for more than 20% of China’s urban per capita disposable income (31 195 yuan) in 2015. 21 Studies also showed that the largest share of expenditures among the T2DM-related direct medical costs was for hospitalizations (50%-55%). T2DM-related complications often contribute to hospitalizations.…”