title: Outcomes and healthcare resource utilization associated with medically attended hypoglycemia in older patients with type 2 diabetes initiating basal insulin in a US managed care setting.
abstract: To assess health outcomes and the economic burden of hypoglycemia in older patients with type 2 diabetes initiating basal insulin (BI).
  
  
  
  Medicare Advantage claims data were extracted for patients with type 2 diabetes initiating BI and patients were stratified into two groups: those with medically attended hypoglycemia during the first year of BI treatment (HG group) and those without (non-HG group). Main outcome measures were hospitalization, mortality, healthcare utilization and costs 1 year before and 1 year after BI initiation.
  
  
  
  Of 31,035 patients included (mean age 72 years [SD 9.2]), 3066 (9.9%; HG group) experienced hypoglycemia during 1 year post-BI initiation. After adjustment for demographic, comorbidity and medication history, hypoglycemia was associated with risk of hospitalization (HR 1.59; 95% CI: 1.53-1.65) and death (HR 1.50; 95% CI: 1.40-1.60). Healthcare utilization was higher pre-index and showed greater increases post-BI initiation in the HG vs. the non-HG group. Per-patient healthcare costs were substantially higher for the HG group than the non-HG group, both pre-index ($54,057 vs. $30,249, respectively) and post-BI initiation ($75,398 vs. $27,753, respectively).
  
  
  
  Based on available claims data, hypoglycemia during the first year of BI treatment is associated with risk of hospitalization or death in older people, increasing healthcare utilization and costs. Due to the observational nature of this study, causality cannot be attributed, and further prospective studies into the effect of hypoglycemia on health outcomes in this population are warranted.
authors.affiliation: a Department of Endocrinology and Nutrition , Clínica Universidad de Navarra , Pamplona , Spain ;
authors.forename: Javier
authors.initials: J
authors.lastname: Escalada
authors.affiliation: b Sanofi , Bridgewater , NJ , USA ;
authors.forename: Laura
authors.initials: L
authors.lastname: Liao
authors.affiliation: c Pro Unlimited , Boca Raton , FL , USA ;
authors.forename: Chunshen
authors.initials: C
authors.lastname: Pan
authors.affiliation: b Sanofi , Bridgewater , NJ , USA ;
authors.forename: Hongwei
authors.initials: H
authors.lastname: Wang
authors.affiliation: d Sanofi , Cambridge , MA , USA.
authors.forename: Mohan
authors.initials: M
authors.lastname: Bala
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents
keywords: Health care delivery; hypoglycemia; insulin therapy; macrovascular disease; microvascular disease