title: Dosing of U-100 insulin and associated outcomes among Medicare enrollees with type 1 or type 2 diabetes.
abstract: OBJECTIVE
  To examine costs, resource utilization, adherence, and hypoglycemic events among various doses of U-100 insulin regimens among elderly patients (age ≥65 years) diagnosed with diabetes.
  
  
  METHODS
  Truven Health Analytics Medicare databases from January 1, 2008 through December 31, 2011 were utilized. General linear models with a gamma distribution and log link were used to examine costs, while logistic and negative binomial regressions were used to examine resource utilization and hypoglycemic events. Analyses controlled for patient characteristics, pre-period comorbidities, general health, and use of antidiabetic medications as well as index dose of insulin.
  
  
  RESULTS
  All-cause inpatient, emergency room, and outpatients costs, as well as diabetes-related inpatient costs, were highest among individuals who were treated with an index dose of 10-100 units/day followed by >300 units/day, while drug costs and total costs generally increased as index dosage increased. Resource utilization generally followed the same pattern as costs, with number of office visits increasing as the dose increased and the highest hospital length of stay, number of hospitalizations, number of emergency room visits, and number of diabetes-related hospitalizations were generally highest among those in the lowest and highest index dose cohorts. Compared to patients who initiated with an index dose of 10-100 units/day, all other patients were significantly less likely to achieve an adherence threshold of 80% based upon index dose range, and while those with an index dose of >100-150 units/day were significantly more likely to experience a hypoglycemic event.
  
  
  CONCLUSIONS
  These results suggest that, for elderly individuals with diabetes, there is a higher patient burden among those who receive the lowest and highest insulin doses.
authors.affiliation: Global Patient Outcomes and Real World Evidence, Eli Lilly and Co., Indianapolis IN USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Eby
authors.affiliation: Eli Lilly and Co., Windlesham, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Van Brunt
authors.affiliation: Lilly USA, LLC, Indianapolis, IN, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brusko
authors.affiliation: Eli Lilly and Co., Indianapolis, IN, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Curtis
authors.affiliation: HealthMetrics Outcomes Research, LLC, Bonita Springs, FL, USA.
authors.forename: Maureen J
authors.initials: MJ
authors.lastname: Lage
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003365:Costs and Cost Analysis; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D004305:Dose-Response Relationship, Drug; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare; D055118:Medication Adherence; D017059:Models, Econometric; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: adherence; costs; diabetes; hypoglycemia; insulin; resource utilization