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Cited by 14Diabetes Management and ResearchDiabetes Treatment and ManagementPatient Safety and Medication Errors

Hypoglycemia in patients with type 2 diabetes newly initiated on basal insulin in the US in a community setting: impact on treatment discontinuation and hospitalization

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Dalal, Mehul R., Kazemi, Mahmood R., Ye, Fen·2017·Current Medical Research and Opinion
DOI 10.1080/03007995.2016.1248911
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Abstract

OBJECTIVE: To evaluate the impact of 6 month hypoglycemia on treatment discontinuation and hospitalization of patients initiating basal insulin for type 2 diabetes (T2D) in real-world practice. METHODS: This was a retrospective cohort study of patient-level data using electronic medical records (EMRs) in the Predictive Health Intelligence diabetes dataset. Data from adult patients with T2D initiating basal insulin glargine, insulin detemir, or Neutral Protamine Hagedorn insulin between January 2008 and March 2014 was analyzed. The date of first basal insulin prescription in an outpatient setting was the index date. A 12 month baseline prior to the index date was established; follow-up was 6-24 months from the index date. Patients were assigned to cohorts by experience of hypoglycemia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code or blood glucose test) in the first 6 months following the index date; with hypoglycemia and without hypoglycemia cohorts were compared for basal insulin treatment discontinuation and hospitalization. RESULTS: Overall, 49,062 patients were included; 5159 (10.5%) experienced hypoglycemia in the 6 months following basal insulin initiation. In the first 12 months, 68.1% of patients in the with hypoglycemia cohort discontinued basal insulin versus 53.9% in the without hypoglycemia cohort (p < .0001); more patients in the with hypoglycemia cohort had at least one hospitalization in the first year of follow-up (50.1% vs. 14.6%; p < .0001). CONCLUSION: Patients with hypoglycemia soon after initiating basal insulin are at greater risk of discontinuation of their basal insulin therapy and hospitalization versus those who did not have hypoglycemic events within the first 6 months of basal insulin initiation. A limitation of this study is that it was a retrospective analysis of EMR data and the study may not be representative of all US patients with T2D on basal insulin and it cannot be assumed that every hypoglycemic event was recorded.

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  • Our findings are consistent with a recent electronic medical record data analysis showing that patients with type 2 diabetes who have hypoglycaemia within the first 6 months after initiating basal insulin were at increased risk of discontinuing insulin compared with those who did not experience early hypoglycaemia.

    “Our findings are consistent with a recent electronic medical record data analysis showing that patients with type 2 diabetes who have hypoglycaemia that occurs within the first 6 months after initiating BI were at an increased risk of discontinuing insulin compared with those who did not experience early hypoglycaemia.15”

    From Early hypoglycaemia and adherence after basal insulin initiation in a nationally representative sample of Medicare beneficiaries with type 2 diabetes (2019) · cites this paper as [15]

  • Patients who initiate insulin may experience early hypoglycaemia within 6 months of initiation, which may lead to poor insulin adherence and a higher risk of hospitalization, especially in older and disabled patients.

    “Furthermore, patients who do initiate insulin may experience early hypoglycaemia (ie within 6 months of initiation), which may lead to poor insulin adherence and a higher risk of hospitalization, especially in older and disabled patients.15”

    From Early hypoglycaemia and adherence after basal insulin initiation in a nationally representative sample of Medicare beneficiaries with type 2 diabetes (2019) · cites this paper as [15]

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Authors
Dalal, M. R., Kazemi, M. R., & Ye, F.
Affiliations
  • Sanofi (United States) (US)
  • Techdata Service LLC, King of Prussia, PA, USA
Corresponding author
Dalal, Mehul R.
ORCID
Venue
Current Medical Research and Opinion
Publisher
Informa UK Limited
Published
2016-11-04
Volume
33
Issue
2
Pages
209-214
ISSN
  • 0300-7995 (ISSN-L)
  • 1473-4877
DOI
10.1080/03007995.2016.1248911
OpenAlex
W2531020345
Cited by
14
References
28
Citations by year
2025: 1 · 2023: 2 · 2022: 1 · 2020: 3 · 2019: 3 · 2018: 4
FWCI
2.35
Type
journal article
Language
en
Open access
Locations
  • Current Medical Research and Opinion (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Sanofi
  • European Association for the Study of Diabetes
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Keywords
hypoglycemia, type 2 diabetes, basal insulin, insulin initiation, insulin glargine, insulin detemir, NPH insulin, treatment discontinuation, hospitalization, real-world outcomes, community-based care
MeSH terms
Insulin Glargine, Aged, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Hospitalization, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin, Isophane, Male, Middle Aged, Retrospective Studies, Risk, Electronic Health Records

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