The burden of hypoglycemia on healthcare utilization, costs, and quality of life among type 2 diabetes mellitus patients

Williams, Setareh A.; Shi, Lizheng; Brenneman, Susan K.; Johnson, Jonathan; Wegner, Jessica C.; Fonseca, Vivian

doi:10.1016/j.jdiacomp.2012.05.002

Cited by 97 publications

(77 citation statements)

References 39 publications

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“…8,9 It has also been documented that episodes of hypoglycaemia increase length of stay and add to financial burden of healthcare cost. 10 Thus, it is evident that healthcare providers need to minimise the incidence of hypoglycaemia. It is seen that (a) lack of adequate awareness to recognise early hypoglycaemia; (b) inadequate or inappropriate recording/reporting of hypoglycaemia; (c) lack of quality root cause analyses for every hypoglycaemic incident and (d) delay in treating hypoglycaemia due to lack of standardised protocol are the major factors contributing to the morbidity and prolonged hospital stay for the diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

“…It is seen that (a) lack of adequate awareness to recognise early hypoglycaemia; (b) inadequate or inappropriate recording/reporting of hypoglycaemia; (c) lack of quality root cause analyses for every hypoglycaemic incident and (d) delay in treating hypoglycaemia due to lack of standardised protocol are the major factors contributing to the morbidity and prolonged hospital stay for the diabetic patients. [6][7][8][9][10][11] In recent years, there has been an increasing emphasis on nurse-led diabetic management. A nursing professional often coordinates, and is aware of, the multiple services required by the patient, such as travel out of unit (e.g., physical therapy, radiograph), amount of food eaten (carbohydrates) and patient's day-to-day concerns and changes in medication order (by various providers).…”

Section: Discussionmentioning

confidence: 99%

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Study of a structured action pathway and persistent monitoring tool among nurses to achieve cent percent management of hypoglycaemia in in-patients: A measure of quality of healthcare

Mishra

Chauhan²,

Jha

2016

Medical Journal Armed Forces India

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Study of a structured action pathway and persistent monitoring tool among nurses to achieve cent percent management of hypoglycaemia in in-patients: A measure of quality of healthcare

Mishra

Chauhan²,

Jha

2016

Medical Journal Armed Forces India

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“…Hence, it is appropriate that glyburide be avoided in these population groups. This becomes even more important as it is well known that hypoglycemia has a negative impact on patients' health status and may result in increased health care utilization and cost (8).…”

Section: Dwilliam T Cefalu Editor In Chief Diabetes Carementioning

confidence: 99%

Should Sulfonylureas Remain an Acceptable First-Line Add-on to Metformin Therapy in Patients With Type 2 Diabetes? Yes, They Continue to Serve Us Well!

Abrahamson

2014

Diabetes Care

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Since their introduction to clinical practice in the 1950s, sulfonylureas have been widely prescribed for use in patients with type 2 diabetes. Of all the other medications currently available for clinical use, only metformin has been used more frequently. However, several new drug classes have emerged that are reported to have equal glucose-lowering efficacy and greater safety when added to treatment of patients in whom metformin monotherapy is no longer sufficient. Moreover, current arguments also suggest that the alternative drugs may be superior to sulfonylureas with regard to the risk of cardiovascular complications. Thus, while there is universal agreement that metformin should remain the first-line pharmacologic therapy for those in whom lifestyle modification is insufficient to control hyperglycemia, there is no consensus as to which drug should be added to metformin. Therefore, given the current controversy, we provide a Point-Counterpoint on this issue. In the point narrative presented below, Dr. Abrahamson provides his argument suggesting that avoiding use of sulfonylureas as a class of medication as an add-on to metformin is not appropriate as there are many patients whose glycemic control would improve with use of these drugs with minimal risk of adverse events. In the following counterpoint narrative, Dr. Genuth suggests there is no longer a need for sulfonylureas to remain a first-line addition to metformin for those patients whose clinical characteristics are appropriate and whose health insurance and/or financial resources make an alternative drug affordable. —William T. Cefalu Editor in Chief, Diabetes Care

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“…[10][11][12][13] In addition, both sulfonylureas and insulin cause hypoglycemia, which remains a major therapy-limiting concern of both patients and providers. [14][15][16] In this study, our aim was to investigate the risk of several important clinical outcomes among U.S. veterans who intensified their initial sulfonylurea monotherapy by switching to insulin alone or adding insulin. We specifically focused on CVD as a long-term outcome and hypoglycemia as a shortterm outcome.…”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of Insulin versus Combination Sulfonylurea and Insulin: a Cohort Study of Veterans with Type 2 Diabetes

et al. 2016

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BACKGROUND: Type 2 diabetes patients often initiate treatment with a sulfonylurea and subsequently intensify their therapy with insulin. However, information on optimal treatment regimens for these patients is limited. OBJECTIVE: To compare risk of cardiovascular disease (CVD) and hypoglycemia between sulfonylurea initiators who switch to or add insulin. DESIGN: This was a retrospective cohort assembled using national Veterans Health Administration (VHA), Medicare, and National Death Index databases. PARTICIPANTS: Veterans who initiated diabetes treatment with a sulfonylurea between 2001 and 2008 and intensified their regimen with insulin were followed through 2011. MAIN MEASURES:The association between insulin versus sulfonylurea + insulin and time to CVD or hypoglycemia were evaluated using Cox proportional hazard models in a 1:1 propensity score-matched cohort. CVD included hospitalization for acute myocardial infarction or stroke, or cardiovascular mortality. Hypoglycemia included hospitalizations or emergency visits for hypoglycemia, or outpatient blood glucose measurements <60 mg/dL. Subgroups included age < 65 and ≥ 65 years and estimated glomerular filtration rate ≥ 60 and < 60 ml/min. KEY FINDINGS: There were 1646 and 3728 sulfonylurea monotherapy initiators who switched to insulin monotherapy or added insulin, respectively. The 1596 propensity score-matched patients in each group had similar baseline characteristics at insulin initiation. The rate of CVD per 1000 person-years among insulin versus sulfonylurea + insulin users were 49.3 and 56.0, respectively [hazard ratio (HR) 0.85, 95 % confidence interval (CI) 0.64, 1.12]. Rates of first and recurrent hypoglycemia events per 1000 person-years were 74.0 and 100.0 among insulin users compared to 78.9 and 116.8 among sulfonylurea plus insulin users, yielding HR (95 % CI) of 0.94 (0.76, 1.16) and 0.87 (0.69, 1.10), respectively. Subgroup analysis results were consistent with the main findings. CONCLUSIONS: Compared to sulfonylurea users who added insulin, those who switched to insulin alone had numerically lower CVD and hypoglycemia events, but these differences in risk were not statistically significant.

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The burden of hypoglycemia on healthcare utilization, costs, and quality of life among type 2 diabetes mellitus patients

Cited by 97 publications

References 39 publications

Study of a structured action pathway and persistent monitoring tool among nurses to achieve cent percent management of hypoglycaemia in in-patients: A measure of quality of healthcare

Study of a structured action pathway and persistent monitoring tool among nurses to achieve cent percent management of hypoglycaemia in in-patients: A measure of quality of healthcare

Should Sulfonylureas Remain an Acceptable First-Line Add-on to Metformin Therapy in Patients With Type 2 Diabetes? Yes, They Continue to Serve Us Well!

Comparative Effectiveness of Insulin versus Combination Sulfonylurea and Insulin: a Cohort Study of Veterans with Type 2 Diabetes

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