Economic burden of hypoglycemia with basal insulin in type 2 diabetes

To assess the impact of hypoglycemia and potential underlying factors of economic burden in patients with type 2 diabetes (T2D) who are initiating basal insulin therapy.

This retrospective cohort study combined commercial insurance and Medicare Advantage data from the Clinformatics Data Mart.

Adults with T2D on oral antidiabetes drugs initiating basal insulin (n = 18,918) were assessed at baseline (12 months prior to insulin initiation) and follow-up (1 and 2 years). The population was stratified by whether or not patients experienced hypoglycemia during year 1 after insulin initiation. Outcomes included hypoglycemia rate, complications, comorbidities, and adjusted economic burden (primary).

There were 1683 (8.9%) patients in the hypoglycemia group and 17,235 (91.1%) in the no-hypoglycemia group. During year 1, the estimated rate of hypoglycemia events was 0.412 per member per year. Baseline hypoglycemia was the strongest predictor of subsequent hypoglycemia. The hypoglycemia group was older, with a significantly greater clinical and economic burden at baseline; these differences persisted during follow-up. In the hypoglycemia group, for every 100 members per year, 463 hypoglycemia episodes were recorded, with a mean cost per episode of $986. Hypoglycemia-related medical expenses accounted for 12.6% ($4563/$36,272) of total healthcare expenditure, with hypoglycemia-related hospitalizations accounting for 19.7% ($2602/$13,191) of total hospitalization expenditure.

Compared with patients with no hypoglycemia-related claims in year 1 after basal insulin initiation, patients with a hypoglycemia-related claim had a greater burden of complications and comorbidity associated with significantly higher healthcare utilization and cost at baseline; these persisted during follow-up.