A severe hypoglycemic event (SHE) in adults with type 1 diabetes (T1D) is defined by the need to involve another person for recovery and is associated with, among other things, an increased risk of mortality. A study from Germany investigated the extent to which SHE in T1D is not only a burden for the patient, but also for the healthcare system.
Although the use of advanced diabetes technology has increased, many people with type 1 diabetes still suffer from severe hypoglycemia. In addition, there is limited evidence on healthcare resource utilization (HCRU) and the costs incurred by adults with type 1 diabetes and severe hypoglycemia.
Dr. Ralph Ziegler from the Diabetes Clinic for Children and Adolescents in Münster (D) and his colleagues investigated the costs caused by SHE and the HCRU between two populations with type 1 diabetes with and without severe hypoglycemia. For this study, adults (≥18 years) with T1D were selected from the German BKK insurance database, which included 5.7 million people with statutory health insurance between January 1, 2013 and December 31, 2020.
The study cohort iSHE (for index SHE) included individuals with an inpatient hospitalization due to severe hypoglycemia (defined as hospitalization with a primary hypoglycemia diagnosis or a secondary hypoglycemia diagnosis with a concomitant diabetes diagnosis code (K60)). The index date was the date of the first observed hospitalization for severe hypoglycemia.
Subsequently, individuals with T1D but without inpatient SHE were matched with the iSHE cohort in terms of age, gender, index year and geographic region in a ratio of up to 5:1 and received the same index date as their matched pairs (matched cohort). Patients selected for the study had to be continuously registered with a health insurance company for 12 months before (baseline) and after (follow-up period; except in case of death) the index date. Persons with secondary/pregnancy diabetes were excluded. The HCRU and cost outcomes were then examined per patient per year (PPPY) and compared for both cohorts.
T1D patients with SHE had a higher HCRU
A total of 736 patients with T1D and SHE were identified and included in the study. After matching, 3680 patients with T1D without SHE were selected.
Age, gender, index year and geographic region between the iSHE cohorts (n=736) and the matched cohorts (n=3680) were balanced (standardized mean difference (SMD) ≤10%). The mean age for both cohorts was 42 years, with more men than women (52.9%) included in the study. The demographic region of the patients was also the same, which was important as some parts of Germany may not have the same level of insurance coverage as another part of the country.
Baseline clinical characteristics reflected that Charlson Comorbidity Index (CCI) scores were similar between the iSHE and matched cohort (2.3 vs. 2.2, SMD=6.3%). The most common comorbidities were hypertension (iSHE 35.9% vs. 34.3%) and hyperlipidemia (28.5% vs. 27.7%). The most common complications were neuropathy (iSHE: 30.8%; matched 25.8%) and retinopathy (26.9% vs. 26.1%). Dr. Ziegler also pointed out that depression (23.0%) and anxiety (10.1%) were common in the iSHE cohort.
The HCRU results showed that during the one-year follow-up, the iSHE cohort and the matched cohort had a mean (standard deviation [SD]) of 1.7 (3.4) and 0.3 (1.0) inpatient hospitalizations per capita per year, respectively (p<0.001), with a higher mean [SD] length of stay in iSHE of 10.6 (7.4) vs. 9.0 (10.7) days (p<0.001). In addition, there were also more outpatient visits, prescriptions and sickness absence per capita per year in the iSHE cohort (p<0.01). In addition, the mean (SD) length of stay for the index SHE was 10.8 (3.6) days.
The average total annual healthcare costs were significantly higher in the iSHE cohort than in the matched cohort (€13 482 vs €7500, all p<0.05), costs for inpatient admission were €6219 vs €1588, for prescriptions €2615 vs €2498 and other costs were €3243 vs €2049.
These results indicate that there is a significantly higher burden not only for the patient but also for the healthcare system when patients are admitted with severe hypoglycemia. Furthermore, the burden is high not only at the time of admission, but also in the year following hospitalization. Her study underlines the high unmet need of these patients, emphasized Dr. Ziegler.
Source: Ziegler R: Real-world burden of severe hypoglycaemic events in type 1 diabetes in Germany. Oral Presentation #103, Session OP 18: How to blow the low. EASD, 11.09.2024.
InFo DIABETOLOGIE & ENDOKRINOLOGIE 2024; 1(4): 20-21 (published on 29.11.24, ahead of print)
