Evaluation of the effect of medication adherence and utilization of insulin pumps on rates of hypoglycemia and resulting costs
Diabetes mellitus (DM) is a metabolic disorder caused by heterogeneous group of diseases with disturbance of carbohydrate, protein and fat metabolism from inadequate insulin secretion, insulin action or both. Hypoglycemia is a condition that decreases the blood glucose level or its tissue utilization, which results in demonstrable signs and symptoms. Insulin and oral anti-diabetic drug(OAD) treatments are the primary reasons of severe hypoglycemia. The purpose of this dissertation was to evaluate the effect of medication adherence and utilization of continuous subcutaneous insulin infusion pumps on rates of severe hypoglycemia and resulting costs. The categorized adherence rates to oral anti-diabetic drugs in patients with type 2 diabetes mellitus newly initiated to the therapy and type 1 diabetes mellitus patients using continuous subcutaneous insulin infusion pumps or having multi-daily insulin injections therapy were examined with respect to risk and frequency of hypoglycemia. Moreover, the cost of hypoglycemia was studied regarding to direct medical care expenditures. Cox regression and negative binomial regression models were used for assessing the independent effect, while adjusting for a number of potential confounders. Furthermore, logistic regression model was used for prediction of the probability of occurrence of hypoglycemia. The main findings suggested that the risk of hypoglycemia was lower for the highest level adherence and higher for the lowest level of adherence compared to the rates for patients with type 2 DM newly initiated to oral anti-diabetic drugs whose adherence level were normal. Patients treated by benzodiazepines, having diabetic ulcer and having uncomplicated hypertension demonstrated significantly higher risk and frequency of hypoglycemia. Also, patients using angiotensin-converting enzyme (ACE) inhibitors, beta-adrenergic blocking agents and self-monitoring blood glucose demonstrated lower risk and frequency of hypoglycemia. Increased number of concomitant medications demonstrated slightly higher risk and frequency of hypoglycemia. Also, the negative binomial regression model showed that clinically intuitive categorized adherence rates were not predictors of severe frequent hypoglycemia. The risk and frequency of hypoglycemia is significantly higher for patients with type 1 DM using continuous subcutaneous insulin infusion pump compare to multi-daily insulin injections therapy. Patients with diabetic nephropathy and chronic pulmonary disease experienced higher rates and frequency of hypoglycemia compared patients without these diseases. Also, increased number of concomitant medications demonstrated higher rates and frequency of hypoglycemia. Furthermore, hypoglycemia was associated with worse outcomes among a large number of hospitalized patients with diabetes mellitus. Patients with diabetes who developed hypoglycemia had higher odds of diabetes-related ulcer, uncomplicated hypertension, hypothyroidism, myocardial infarction, fluid and electrolyte disorders, cerebrovascular disease and moderate or severe liver disease and lower odds of using angiotensin II receptor blockers than hospitalized patients with diabetes who did not have hypoglycemia. The median general cost per hospitalization was significantly higher in patients with hypoglycemia, compared to patients without hypoglycemia. Moreover, the median cost of subsequent diagnosis of hypoglycemia admissions higher than primary diagnoses hypoglycemia admissions.
Ahmet Burak Ozbay,
"Evaluation of the effect of medication adherence and utilization of insulin pumps on rates of hypoglycemia and resulting costs"
Dissertations and Master's Theses (Campus Access).