ADA 2010: Hypoglycemic episodes linked to oral antidiabetic drug discontinuation, higher costs

Hypoglycemic episodes in type 2 diabetes predict discontinuation of oral antidiabetic drugs as well as higher costs of care. The increased risk of discontinuing therapy associated with a hypoglycemic episode carries over at least into the following 6-month period, according to an analysis of a database of managed care plans.

The Ingenix Impact database, a large administrative database of managed care plans, was used to identify 212,061 patients with type 2 diabetes receiving 1 or more oral antidiabetic drug. Of these, 4,860 (2.29%) had at least 1 hypoglycemic episode during the first year after the index date.

The risk of hypoglycemia varied among the treatments. In the 6-month interval after the index date, use of a sulfonylurea or insulin was associated with the largest increase in the risk of hypoglycemia, followed by other oral antidiabetic drugs and thiazolidinediones, said lead investigator Morgan Bron, PharmD, associate director of global health outcomes at Takeda Pharmaceuticals International, Deerfield, Illinois. The use of metformin had no effect on the risk of hypoglycemia, and dipeptidyl peptidase-4 (DPP-4) inhibitors were associated with a decreased risk.

On multivariate analysis, the use of sulfonylureas as an index drug increased the risk of hypoglycemia by 58% (PPP=.0141).

A diagnosis of hypoglycemia in a given 6-month interval significantly increased the likelihood of treatment discontinuation, with an odds ratio (OR) of 1.27 within the same 6-month interval and an OR of 1.14 in the next 6-month interval.

“Cost differences [associated with hypoglycemic episodes] were a lot higher than we thought they would be,” said Bron. “Instead of the $2,000 range, they were more in the range of $4,000 to $5,000.”

After adjusting for confounding factors, incremental annual total costs and diabetes-related total costs were $5,031 higher and $3,751 higher, respectively (both P