title: The impact of insulin type on severe hypoglycaemia events requiring inpatient and emergency department care in patients with type 2 diabetes.
abstract: OBJECTIVE
  To evaluate the risk from different insulin types on severe hypoglycaemia (SHG) events requiring inpatient (IP) or emergency department (ED) care in patients with type 2 diabetes.
  
  
  METHODS
  Type 2 diabetes patients newly started on insulin in a large commercial claims database were evaluated for SHG events. Patients were classified into an insulin group based on their most frequently used insulin type. Multivariable Cox models assessed the association between insulin type and the risk of SHG events.
  
  
  RESULTS
  We identified 8626 patients (mean age 53.5 years; 55% female) with type 2 diabetes followed for an average of 4.0 years after insulin initiation. Of these, 161 (1.9%) had a SHG event at an average of 3.1y after insulin initiation. Patients with SHG events were slightly older (56.4 vs. 53.4 years), used a similar number of OADs (1.1 vs. 1.2) but had more co-morbidities compared with those without SHG events. In multivariate Cox models, premixed insulin (HR 2.12; p<0.01), isophane insulin (NPH) (HR 2.02; p<0.01), and rapid acting insulin (HR 2.75; p<0.01) had significantly higher risks of SHG events compared with glargine. No statistically significant difference in SHG events was seen with detemir (HR 1.20; p=0.73).
  
  
  CONCLUSIONS
  Among patients with type 2 diabetes, the use of newer basal insulin analogues was associated with lower rates of SHG events requiring IP or ED care compared with users of other insulin formulations. Future research should examine the impact of hypoglycaemia events of different severity levels.
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Solomon
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vijan
authors.forename: Felicia M
authors.initials: FM
authors.lastname: Forma
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Conrad
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Summers
authors.forename: Darius N
authors.initials: DN
authors.lastname: Lakdawalla
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D048909:Diabetes Complications / Q000139:chemically induced*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007297:Inpatients / Q000706:statistics & numerical data*; D007328:Insulin / Q000145:classification* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Hypoglycaemia; Insulin; Type 2 diabetes