Severe hypoglycaemia in adults with insulin-treated diabetes: impact on healthcare resources

Diabet Med. 2016 Apr;33(4):471-7. doi: 10.1111/dme.12844. Epub 2015 Jul 16.

Abstract

Aims: To assess resource utilization associated with severe hypoglycaemia across three insulin regimens in a large phase 3a clinical programme involving people with Type 1 diabetes treated with basal-bolus insulin, people with Type 2 diabetes treated with multiple daily injections and people with Type 2 diabetes treated with basal-oral therapy.

Methods: Data relating to severe hypoglycaemia events (defined as episodes requiring external assistance) from the insulin degludec and insulin degludec/insulin aspart programme (15 trials) were analysed using descriptive statistics. Comparators included insulin glargine, biphasic insulin aspart, insulin detemir and sitagliptin. Mealtime insulin aspart was used in some regimens. This analysis used the serious adverse events records, which documented the use of ambulance/emergency teams, a hospital/emergency room visit ≤ 24 h, or a hospital visit > 24 h.

Results: In total, 536 severe hypoglycaemia events were analysed, of which 157 (29.3%) involved an ambulance/emergency team, 64 (11.9%) led to hospital/emergency room attendance of ≤ 24 h and 36 (6.7%) required hospital admission (> 24 h). Although there were fewer events in people with Type 2 diabetes compared with Type 1 diabetes, once a severe episode occurred, the tendency to utilize healthcare resources was higher in Type 2 diabetes vs. Type 1 diabetes. A higher proportion (47.6%) in the basal-oral therapy group required hospital treatment for > 24 h versus the Type 1 diabetes (5.0%) and Type 2 diabetes multiple daily injections (5.3%) groups.

Conclusion: This analysis suggests that severe hypoglycaemia events often result in emergency/ambulance calls and hospital treatment, incurring a substantial health economic burden, and were associated with all insulin regimens.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Clinical Trials, Phase III as Topic
  • Cohort Studies
  • Costs and Cost Analysis
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / economics
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / economics
  • Dipeptidyl-Peptidase IV Inhibitors / administration & dosage
  • Dipeptidyl-Peptidase IV Inhibitors / adverse effects
  • Dipeptidyl-Peptidase IV Inhibitors / economics
  • Dipeptidyl-Peptidase IV Inhibitors / therapeutic use
  • Drug Administration Schedule
  • Drug Combinations
  • Drug Therapy, Combination / adverse effects
  • Drug Therapy, Combination / economics
  • Health Care Costs
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemia / economics
  • Hypoglycemia / physiopathology
  • Hypoglycemia / therapy*
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / adverse effects*
  • Hypoglycemic Agents / economics
  • Hypoglycemic Agents / therapeutic use
  • Insulin Aspart / administration & dosage
  • Insulin Aspart / adverse effects
  • Insulin Aspart / economics
  • Insulin Aspart / therapeutic use
  • Insulin Detemir / administration & dosage
  • Insulin Detemir / adverse effects
  • Insulin Detemir / economics
  • Insulin Detemir / therapeutic use
  • Insulin Glargine / administration & dosage
  • Insulin Glargine / adverse effects
  • Insulin Glargine / economics
  • Insulin Glargine / therapeutic use
  • Insulin, Long-Acting / administration & dosage
  • Insulin, Long-Acting / adverse effects
  • Insulin, Long-Acting / economics
  • Insulin, Long-Acting / therapeutic use
  • Middle Aged
  • Severity of Illness Index
  • Sitagliptin Phosphate / administration & dosage
  • Sitagliptin Phosphate / adverse effects
  • Sitagliptin Phosphate / economics
  • Sitagliptin Phosphate / therapeutic use

Substances

  • Dipeptidyl-Peptidase IV Inhibitors
  • Drug Combinations
  • Hypoglycemic Agents
  • Insulin, Long-Acting
  • insulin degludec, insulin aspart drug combination
  • Insulin Glargine
  • Insulin Detemir
  • insulin degludec
  • Insulin Aspart
  • Sitagliptin Phosphate