title: Cost and co-morbidities associated with hypoglycemic inpatients in Belgium.
abstract: OBJECTIVE
  Little is known about the economic burden of hypoglycemia in Belgium, or its related co-morbidities. This study aimed at estimating the cost and length of stay associated with hypoglycemia-related hospitalizations in diabetic patients in Belgium and the association between hypoglycemia and in-hospital all-cause mortality, incidence of traumatic fractures, depression, and cardiovascular diseases (myocardial infarction or unstable angina), using retrospective data from 2011.
  
  
  METHODS
  Patient data were retrieved from the IMS Hospital Disease Database, including longitudinal (per calendar year) information on diagnoses, procedures, and drugs prescribed in ∼20% of all Belgian hospital beds. The eligible population included all adult (<19 year) diabetic (both types) patients, further split between those with/without a history of hypoglycemia-related hospitalizations. Diabetes, hypoglycemia, and co-morbidities of interest were identified based on International Classification of Diseases and Related Health Problems Version 9 (ICD-9) diagnosis codes. All costs were extrapolated to 2014 using progression in hospitalization costs since 2001.
  
  
  RESULTS
  A total of 43,410 diabetes-related hospitalizations were retrieved, corresponding to 30,710 distinct patients. The average hospitalization cost was €10,258 when hypoglycemia was documented (n = 2625), vs €7173 in other diabetic hospitalized patients (n = 40,785). When controlling for age and sex, a higher mortality risk (OR = 1.59; p-value <0.001), a higher incidence of traumatic fractures (OR = 1.25; p-value = 0.009), and a higher probability of depression-related hospitalizations (OR = 1.90; p-value <0.001) were observed in hypoglycemic patients. A similar risk of cardiovascular event was observed in both groups, but hypoglycemic patients were more at risk of experiencing multiple events.
  
  
  CONCLUSIONS
  Hospitalizations for hypoglycemia are expensive and associated with an increased risk of depression and traumatic fractures as well as increased in-hospital mortality. Interventions that can help reduce the risk of hypoglycemia, and consequently the burden on hospitals and society, without compromising glycemic control, will help to further improve diabetes management.
authors.affiliation: a a IMS Health HEOR , Vilvoorde , Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Chevalier
authors.affiliation: b b Novo Nordisk , Brussels , Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Vandebrouck
authors.affiliation: b b Novo Nordisk , Brussels , Belgium.
authors.forename: D
authors.initials: D
authors.lastname: De Keyzer
authors.affiliation: c c Department of Endocrinology , University Hospitals of Leuven , Leuven , Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Mertens
authors.affiliation: a a IMS Health HEOR , Vilvoorde , Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Lamotte
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D001786:Blood Glucose; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy / Q000191:economics*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000191:economics*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007003:Hypoglycemia / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D007004:Hypoglycemic Agents / Q000009:adverse effects; D015994:Incidence; D007297:Inpatients; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: Burden; Cost study; Diabetes; Hospital disease database; Hypoglycemia