Hypoglycemia in patients with type 2 diabetes newly initiated on basal insulin in the US in a community setting: impact on treatment discontinuation and hospitalization

Abstract

Objective: To evaluate the impact of 6 month hypoglycemia on treatment discontinuation and hospitalization of patients initiating basal insulin for type 2 diabetes (T2D) in real-world practice. Methods: This was a retrospective cohort study of patient-level data using electronic medical records (EMRs) in the Predictive Health Intelligence diabetes dataset. Data from adult patients with T2D initiating basal insulin glargine, insulin detemir, or Neutral Protamine Hagedorn insulin between January 2008 and March 2014 was analyzed. The date of first basal insulin prescription in an outpatient setting was the index date. A 12 month baseline prior to the index date was established; follow-up was 6-24 months from the index date. Patients were assigned to cohorts by experience of hypoglycemia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code or blood glucose test) in the first 6 months following the index date; with hypoglycemia and without hypoglycemia cohorts were compared for basal insulin treatment discontinuation and hospitalization. Results: Overall, 49,062 patients were included; 5159 (10.5%) experienced hypoglycemia in the 6 months following basal insulin initiation. In the first 12 months, 68.1% of patients in the with hypoglycemia cohort discontinued basal insulin versus 53.9% in the without hypoglycemia cohort (p < .0001); more patients in the with hypoglycemia cohort had at least one hospitalization in the first year of follow-up (50.1% vs. 14.6%; p < .0001). Conclusion: Patients with hypoglycemia soon after initiating basal insulin are at greater risk of discontinuation of their basal insulin therapy and hospitalization versus those who did not have hypoglycemic events within the first 6 months of basal insulin initiation. A limitation of this study is that it was a retrospective analysis of EMR data and the study may not be representative of all US patients with T2D on basal insulin and it cannot be assumed that every hypoglycemic event was recorded.ARTICLE HISTORY

Early hypoglycaemia and adherence after basal insulin initiation in a nationally representative sample of Medicare beneficiaries with type 2 diabetes

“…This study is the first to provide a nationally representative analysis of the Medicare‐insured population that examines the incidence of hypoglycaemia in new initiators of BI, factors associated with hypoglycaemia, and the association between early hypoglycaemia and patient adherence to and persistence with treatment. Our findings are consistent with a recent electronic medical record data analysis showing that patients with type 2 diabetes who have hypoglycaemia that occurs within the first 6 months after initiating BI were at an increased risk of discontinuing insulin compared with those who did not experience early hypoglycaemia . We found that early hypoglycaemia occurred in 9.1% of Medicare patients with type 2 diabetes who initiated BI.…”

“…Our findings are consistent with a recent electronic medical record data analysis showing that patients with type 2 diabetes who have hypoglycaemia that occurs within the first 6 months after initiating BI were at an increased risk of discontinuing insulin compared with those who did not experience early hypoglycaemia. 15 We found that early hypoglycaemia occurred in 9.1% of Medicare patients with type 2 diabetes who initiated BI. The real rate of hypoglycaemia is probably even higher as hypoglycaemia events that were not captured in claims data were not included, with the result that the incidence of hypoglycaemia is underreported.…”

“…14 Furthermore, patients who do initiate insulin may experience early hypoglycaemia (ie within 6 months of initiation), which may lead to poor insulin adherence and a higher risk of hospitalization, especially in older and disabled patients. 15 Older patients make up the majority of patients with type 2 diabetes and are at a higher risk of hypoglycaemia because of a number of factors, including age-related changes in renal and hepatic metabolism, co-morbid illness, and polypharmacy. 3,16 Even mild cognitive dysfunction might increase the risk of experiencing severe hypoglycaemia.…”

Clinical outcomes in real‐world patients with type 2 diabetes switching from first‐ to second‐generation basal insulin analogues: Comparative effectiveness of insulin glargine 300 units/mL and insulin degludec in the DELIVER D+ cohort study

“…Both the BEGIN and SWITCH 2 studies reported significantly reduced hypoglycaemia in patients randomized to IDeg vs Gla‐100, and the DEVOTE trial also reported less adjudicated severe hypoglycaemia in patients using IDeg vs Gla‐100 in a longer 2‐year follow‐up . This reduced risk of hypoglycaemia with the second‐generation basal insulin analogues may help reduce barriers for basal insulin use, improve adherence, and reduce hypoglycaemia‐related healthcare resource utilization and associated costs; further studies could provide evidence related to these possibilities.…”

Switching to insulin glargine 300 units/mL in real‐world older patients with type 2 diabetes (DELIVER 3)

“…4,5 Not surprisingly, hypoglycaemia has been associated with increased healthcare resource utilization and hospitalizations. 6 Additionally, among older adults with T2D, hypoglycaemia has been associated with cognitive decline, dementia, falls, accidents and fractures. [7][8][9][10] Therefore, the American Diabetes Association recommends that treatments for older adults with T2D should focus on minimizing the risk of hypoglycaemia.…”