Medical Resource Use, Disturbance of Daily Life and Burden of Hypoglycemia in Insulin-treated Patients With Diabetes

Results From a European Online Survey

William D Willis; Jesús I Diago-Cabezudo; Anne Madec-Hily; Aftab Aslam

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2013;13(1):123-130. 

In This Article

Results

Frequency of Events Due to Hypoglycemia

Across the three countries surveyed (all patients, n = 1848), the mean number of major self-reported hypoglycemic events per patient per 12 months was 2.4. In total, 13% of patients reported one to two major hypoglycemic events during the previous 12 months; no significant between-country differences were evident in the overall frequency and distribution of major hypoglycemia (Table 2). In all the three countries, significantly more patients with Type 2 diabetes than Type 1 diabetes reported one to ten minor hypoglycemic events during the previous 12 months (UK: 41 vs 26%; France: 36 vs 17%; Germany: 50 vs 18%; all p < 0.05). No significant between-country differences were noted in the total frequency and distribution of minor hypoglycemia.

Altogether, 79% of patients had no major hypoglycemic events (i.e., the patient did not require assistance from another person to treat his/her hypoglycemia) in the previous 12 months. This proportion was significantly greater in patients with Type 2 than Type 1 diabetes (84 vs 70%; p < 0.05). Overall, 10% of patients reported no minor hypoglycemic events (i.e., low blood glucose readings where the patient did not require assistance from another person) in the previous 12 months. This proportion was also significantly greater in patients with Type 2 rather than Type 1 diabetes (15 vs 5%; p < 0.05) (Table 3).

A proportion of patients (4%) reported emergency room visits due to hypoglycemia during the previous 12 months; 0.5% of all patients reported at least three visits. The mean number of emergency room visits per patient per 12 months was 0.65. Trends in emergency room visitation were similar across the three countries studied, although in Germany, but not in France and the UK, significantly more Type 1 than Type 2 diabetics reported one to two emergency room visits during the previous 12 months (5 vs 2% of patients; p < 0.05).

Overall, 3% of the patients were hospitalized (excluding emergency room visits) in the prior 12-months for hypoglycemia; of these patients 2.3% reported one to two hospitalizations in the previous 12 months. The mean number of hospitalizations per patient per 12 months was 0.47, and no major differences in hospitalization trends were noted between the three countries surveyed.

Overall, during the previous 12 months, 6.5% of patients had consulted a pharmacist about hypoglycemia. No major differences in pharmacist consultation trends were evident between patients with Type 1 or Type 2 diabetes, or between the three countries surveyed, although the mean number of pharmacist consultations per patient was significantly less in patients with Type 1 rather than Type 2 diabetes in France (1.0 vs 2.8 consultations; p < 0.05) and Germany (0.6 vs 1.6; p < 0.05), but not in the UK (0.3 vs 1.0).

Altogether, no major intercountry differences, or differences between patients with Type 1 or Type 2 diabetes, were noted regarding the incidence of consultation (about hypoglycemia) with a healthcare practitioner during the previous 12 months: approximately 55% of patients consulted at least once and 49% consulted ≤five-times (Figure 1). Nonetheless, the mean number of consultations was lower in the UK than in France and Germany (2.4 vs 3.8 vs 3.2; no significant difference between countries). In France, but not in the UK and Germany, patients with Type 1 diabetes reported a significantly lower mean number of consultations than patients with Type 2 diabetes (3.1 vs 4.1; p < 0.05).

Figure 1.

Frequency of consultation (about hypoglycemia) with a healthcare practitioner, among insulin-treated patients with diabetes in France, Germany and the UK (n = 1841), during the previous 12 months.

Effects of Hypoglycemia on Work & Leisure

In total, 10% of 1073 patients who work more than 30 h/week reported that they had taken days off sick because of hypoglycemia during the previous 12 months. No major differences in this finding were evident between the three countries surveyed. Furthermore, although patient numbers were relatively low (based on a total of 107 patients who reported taking at least 1 day off sick in the previous 12 months), and findings should therefore be interpreted cautiously, an analysis of number of days off sick per patient per 12 months revealed a mean of 4 days (based on 26 patients) in the UK, 7 days (32 patients) in France and 6 days (49 patients) in Germany.

There was no significant difference in attitude toward hypoglycemia between patients who participate in some kind of sport/physical activity compared with those who do not participate. At least twice a week, 25% of patients were involved in individual sports, 4% in team sports, 20% in low-impact endurance training and 6% in high-impact intensive training.

In all three survey countries combined, the mean number of hours spent driving each week was similar for patients with Type 1 and Type 2 diabetes: 7.0 h and 6.6 h, respectively. Interestingly, significantly more patients with Type 1 than Type 2 diabetes (31 vs 20%; p < 0.05) reported testing their blood glucose level every time before they started driving, and this pattern was evident in each of the three countries surveyed.

SMBG

Altogether, 80% of patients in the three survey countries said they would value a meter that tells them when their blood glucose level is getting high/low at a particular time of the day (the UK, 81% of patients; France, 85% and Germany, 75%). In addition, 74% of patients said that a meter giving an advanced warning of a potential hypoglycemic event would be useful (the UK, 80%; France, 77% and Germany, 68%; Figure 2). In total, 60% of patients said that a blood glucose meter (BGM) that warned of low blood glucose levels or 'patterns' would facilitate sustained glycemic control at levels recommended by the doctor (i.e., avoiding the tendency for patients to adopt hyperglycemia). Approximately 50% of all patients surveyed also said that a more accurate meter would provide greater confidence in diabetes self-management, and approximately 50% said that a more accurate meter (at low blood glucose levels) would facilitate better self-management of hypoglycemic risk. The tendency for agreement with these three statements was higher in France and the UK than in Germany, although differences between countries were not statistically significant.

Figure 2.

Proportions of insulin-treated patients with diabetes (n = 1848) with positive perceptions about a new blood glucose meter.

processing....