Aims
To estimate risk factors associated with early hypoglycaemia and its impact on adherence to and persistence with therapy in Medicare Part D beneficiaries with type 2 diabetes who are initiating basal insulin (BI).
Materials and methods
This retrospective analysis used a 5% sample of Medicare files from 2007–2013, identifying beneficiaries with type 2 diabetes initiating BI from 1 January 2008 to 31 December 2012. Early hypoglycaemia was defined as ≥1 hypoglycaemic event ≤6 months postindex. Outcomes included medication adherence and persistence over 12‐ and 36‐month follow‐up. Multivariable logistic and Cox regression analyses were conducted to examine factors associated with early hypoglycaemia and BI adherence/persistence.
Results
Of the 14 466 included patients, 1315 (9.1%) experienced hypoglycaemia ≤6 months after initiating BI. Factors associated with early hypoglycaemia were female sex (odds ratio [OR] 1.16 [95% confidence interval [CI] 1.02–1.32]), receipt of a low‐income subsidy under Medicare Part D (OR 1.20 [95% CI 1.01–1.43]), high diabetes complication score index (OR 1.08 [95% CI 1.01–1.15]), and hypoglycaemia during the baseline period (OR 4.24 [95% CI 3.63–4.96]). At 12 months, patients with baseline hypoglycaemia were less likely to be adherent to (OR 0.81 [95% CI 0.70–0.93]) and more likely to discontinue (OR 1.33 [95% CI 1.07–1.66]) their insulin therapy. Results were similar at 36 months.
Conclusions
Within 6 months of BI initiation, almost 1 in 10 Medicare Part D beneficiaries experienced hypoglycaemia. Early hypoglycaemia was associated with decreased adherence to BI treatment over 12‐ and 36‐month follow‐up.