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The American Journal of Managed Care October 2011
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The Incidence and Costs of Hypoglycemia in Type 2 Diabetes

Brian J. Quilliam, PhD; Jason C. Simeone, PhD; A. Burak Ozbay, PhD; and Stephen J. Kogut, PhD
The overall incidence of hypoglycemia was considerable in this large working-age population and was associated with $52 million (2008 dollars) in direct medical costs.
While our study provides several advantages over previous studies of hypoglycemia, there are several limitations that we must address. First, the data we used are from a large healthcare database, generally containing workplace-sponsored insurance plans, and therefore may not be generalizable to all persons with type 2 diabetes. Notably, within our study, 4.3% and 7.0% of patients had evidence of micro- and macrovascular complications of diabetes, respectively, within 90 days of cohort entry. Another study estimated the prevalence of macrovascular complications to be 28.1% and 20.2% for microvascular complications.30 Secondly, our analyses focused on 1 direct effect of hypoglycemic episodes—medical encounters. As a result, our study does not capture minor instances of hypoglycemia and therefore underestimates the true burden of hypoglycemia, including the resulting impact on morbidity, mortality, and indirect factors (eg, lost work or productivity). Lastly, we were unable to capture medical claims for hypoglycemia that might have occurred prior to the date of cohort entry. Therefore, the incidence of hypoglycemia calculated within our study represents the first event experienced by the patient during the time period of the study, not necessarily the first episode.

CONCLUSIONS

The overall rate of hypoglycemia requiring medical intervention was 153.8 hypoglycemic episodes per 10,000 p-yrs among patients with type 2 diabetes taking at least 1 OAD.The rate of hypoglycemia was highest in youngest (18-34 years) and older (65 years) patients and higher in women than men. The total costs associated with medical visits and hospitalizations for hypoglycemia were in excess of $52 million (2008 dollars; $30,930,649 for inpatient, $6,606,733 for ED, and $14,686,293 for outpatient visits). Further, the total costs of all hypoglycemia-related inpatient admissions exceeded the costs of all hypoglycemia-related ED and outpatient visits combined. Younger adults and women with type 2 dia-betes may require more assistance to prevent hypoglycemic episodes. Continued vigilance for the occurrence and costs of hypoglycemia in patients with type 2 diabetes is essential. As hypoglycemia remains an important barrier to medication treatment of type 2 diabetes, strategies to decrease the incidence of hypoglycemia are needed.

Author Affiliations: From College of Pharmacy (BJQ, JCS, ABO, SJK), University of Rhode Island, Kingston, RI.


Funding Source: This research was funded by a grant from Takeda Pharmaceuticals America, Inc.


Author Disclosures: Dr Quilliam reports consultancies or paid advisory boards from OMJ Scientific Affairs. He and Dr Simeone have received grants from Takeda Pharmaceuticals America, Inc, and both have received payment for involvement in the preparation of this manuscript as part of a grant study funded by Takeda. Dr Kogut has received grants from Takeda Pharmaceuticals. Dr Ozbay reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

 

Authorship Information: Concept and design (BJQ, JCS, ABO, SJK); acquisition of data (BJQ, SJK); analysis and interpretation of data (BJQ, JCS, ABO); drafting of the manuscript (BJQ, JCS); critical revision of the manuscript for important intellectual content (BJQ, JCS); statistical analysis (BJQ, JCS, ABO); obtaining funding (BJQ, SJK); and administrative, technical, or logistic support (SJK).

 

Address correspondence to: Brian J. Quilliam, PhD, College of Pharmacy, University of Rhode Island, 41 Lower College Rd, Kingston, RI 02881. E-mail: bquilliam@uri.edu.

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