Association between hypoglycaemic events and fall-related fractures in Medicare-covered patients with type 2 diabetes.

AIMS: This retrospective observational study examined the association between International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-coded outpatient hypoglycaemic events and fall-related fractures in Medicare-covered patients with type 2 diabetes. METHODS: Data were derived from healthcare claims for individuals with employer-sponsored Medicare supplemental insurance. The study period consisted of two consecutive 1-year periods; the baseline period (1 April 2008 to 31 March 2009) and the evaluation period (1 April 2009 to 31 March 2010). Patients selected for study were at least 65 years of age with evidence of type 2 diabetes during the baseline period, as identified using a Healthcare Effectiveness Data and Information Set algorithm or by at least two prescription claims for oral antidiabetic drugs. The baseline period was used to collect information on the patients' demographics and clinical characteristics. The evaluation period was used to identify the presence of hypoglycaemic events and fall-related fractures. Logistic regression was employed to examine the association between hypoglycaemic events and fall-related fractures occurring during the evaluation period, adjusting for patients' demographics and clinical characteristics. RESULTS: Of 361 210 included patients, 16 936 had hypoglycaemic events during the evaluation period. Patients with hypoglycaemic events had 70% higher regression-adjusted odds (hypoglycaemic events odds ratio = 1.70; 95% confidence interval = 1.58-1.83) of fall-related fractures than patients without hypoglycaemic events. Multiple sensitivity analyses also yielded results suggesting increased odds of fall-related fractures in patients with hypoglycaemic events. CONCLUSIONS: ICD-9-CM-coded outpatient hypoglycaemic events were independently associated with an increased risk of fall-related fractures. Further studies of the relationship between hypoglycaemia and the risk of fall-related fractures are warranted.

Analysis of glycaemic control and weight change in patients initiated with human or analog insulin in an US ambulatory care setting.

BACKGROUND: Insulin is a mainstay in the treatment of type 1 diabetes and is a recommended option in patients with type 2 diabetes who fail to maintain glycaemic control on other non-insulin therapies. The purpose of this study was to describe patient characteristics and evaluate changes in glycaemic control and weight in patients treated with insulin in an ambulatory care setting. METHODS: Patients with diabetes were identified from the General Electric electronic medical record (EMR) database (1 September 2004 to 30 April 2008). Patients were > or =18 years, insulin naive, newly treated with monoinsulin therapy (index date). Baseline characteristics were identified overall and stratified by insulin type (basal, mixed, and rapid). Basal insulins were described by human versus analog and for insulin detemir and insulin glargine. Change in haemoglobin A1C (HbA1C) and weight from baseline (45 days pre- to 15 days postindex date) to 6 months (+/-90 days) were compared. Regression analyses were used to evaluate HbA1C outcomes across insulins and for the likelihood of gaining 0.9 kg (2 lbs) for detemir versus glargine controlling for baseline characteristics. RESULTS: A total of 12 136 patients were included. A majority were initiated on a basal insulin (64.7%) followed by mixed (20.8%) and rapid (14.4%). Basal users had significantly higher mean body weight and lower mean baseline HbA1C than mixed users (p < 0.001 for all), and were significantly older, had higher baseline HbA1C and higher baseline body mass index (BMI) than rapid insulin users (p < 0.001 for all). Glargine patients had a significantly higher mean baseline HbA1C (p = 0.003) than detemir patients. The adjusted reduction in HbA1C was greater for rapid insulin than for mixed or basal insulin (p < or = 0.05). The adjusted differences in HbA1C between basal human and basal analog insulins and between detemir and glargine were not statistically significant (p > 0.05). Patients using detemir were 30% less likely to gain 0.9 kg or more than glargine users (p < 0.05). CONCLUSIONS: HbA1C outcomes in the ambulatory care setting were generally not different between insulin classes. The likelihood of weight gain was less with insulin detemir than with insulin glargine. Thus, real-world weight outcomes for basal analog insulin may differ by specific product.

Late-stage, primary open-angle glaucoma in Europe: social and health care maintenance costs and quality of life of patients from 4 countries.

OBJECTIVE: The purpose of this study was to estimate costs and quality of life (QoL) of late-stage glaucoma patients in 4 European countries. METHODS: Retrospective review of medical charts of patients with POAG who were followed in a low-vision or vision rehabilitation center in one of 4 countries for at least 1 year was used to determine patient characteristics, health status, and health care resource use. Visual impairment was measured by best-corrected visual acuity (Snellen score). Patients were also interviewed over the telephone in order to assess their health-related QoL (using EuroQol EQ-5D) and use of resources including: the number of visits to rehabilitation centers, visits to hospital and non-hospital specialists, the use of low-vision devices, medication, tests, and the use of hired home help. The costs associated with resource use were calculated from the perspective of a third-party payer of health and social care based on resource usage and unit costs in each country. RESULTS: Patients undergoing visual rehabilitation in France (n=21), Denmark (n=59), Germany (n=60), and the United Kingdom (n=22) were identified, interviewed and had their medical charts reviewed. Annual maintenance costs of late-stage glaucoma amounted to euro830 (+/-445) on average. Average home help costs were more than 3 times higher. QoL, on average, was 0.65 (+/-0.28). QoL was positively correlated with the level of visual acuity in the patients' best eye. On the other hand, visual acuity was also positively correlated to health care costs, but negatively correlated to costs of home help. CONCLUSIONS: The study was limited by its observational, uncontrolled design. The finding that late-stage glaucoma is associated with higher home help costs than health care maintenance costs suggests that potential savings from a better preventive treatment are to be found for social care payers rather than health care payers.