Healthcare Resource Utilization and Costs Related to Falls and Fractures Among People With Type 2 Diabetes Receiving Basal Insulin: The FRAGILE Study
# Background The association between falls or fall-related fractures and hypoglycemia in people with type 2 diabetes is well established. Insulin treatment is associated with an increased risk of hypoglycemia, which is compounded in people of older age, but the risk is lower with longer-acting vs in...
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| Format: | Article |
| Language: | English |
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Columbia Data Analytics, LLC
2025-04-01
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| Series: | Journal of Health Economics and Outcomes Research |
| Online Access: | https://doi.org/10.36469/001c.133274 |
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| author | Guillermo E. Umpierrez Elizabeth K. Pogge Xuan Li Ronald Preblick Jasvinder Gill Naushira Pandya |
| author_facet | Guillermo E. Umpierrez Elizabeth K. Pogge Xuan Li Ronald Preblick Jasvinder Gill Naushira Pandya |
| author_sort | Guillermo E. Umpierrez |
| collection | DOAJ |
| description | # Background
The association between falls or fall-related fractures and hypoglycemia in people with type 2 diabetes is well established. Insulin treatment is associated with an increased risk of hypoglycemia, which is compounded in people of older age, but the risk is lower with longer-acting vs intermediate- or long-acting basal insulin analogs.
# Objective
To examine healthcare resource utilization and costs related to falls/fractures in people with type 2 diabetes treated with the longer-acting basal insulin Gla-300 (insulin glargine 300 U/mL) vs long-acting basal insulins (insulin glargine 100 U/mL or insulin detemir)/neutral protamine Hagedorn (NPH).
# Methods
This retrospective study of Optum’s de-identified Clinformatics® Data Mart Database compared data for people aged 50 years or older with at least 1 prescription claim for basal insulin (excluding insulin degludec) between April 1, 2015, and April 30, 2021, who initiated Gla-300 insulin (basal insulin–naive) or transitioned to Gla-300 from a different basal insulin (basal insulin–switch). Cohorts were propensity score–matched. The primary outcome was fall/fracture-related hospitalization and emergency department visit events (per 100 person-years of follow-up [P100PYFU]). The association between fall/fracture events and hypoglycemia and costs were secondary outcomes. Outcomes were compared using 95% confidence intervals of rate and other ratios; no statistical inference was performed.
# Results
Fall/fracture-related hospitalization (2.88 vs 3.33 P100PYFU) and emergency department visit events (5.28 vs 5.95 P100PYFU) were numerically lower in people who initiated basal insulin with Gla-300 vs long-acting basal insulins/NPH, and in those who switched to Gla-300 vs long-acting basal insulins/NPH (2.54 vs 3.38 and 4.48 vs 5.21 P100PYFU, respectively). People with vs without hypoglycemia experienced more falls/fractures, regardless of whether initiating basal insulin or switching basal insulin treatment. Costs tended to be lower for people who switched to Gla-300; however, low event rates caused variability.
# Conclusions
The results of this study suggest that there is a positive correlation between fall/fracture events and hypoglycemia in people with type 2 diabetes and also, that fall/fracture-related healthcare resource utilization was numerically lower in people who initiated basal insulin with Gla-300 vs long-acting basal insulins/NPH, and in those who switched to Gla-300 vs long-acting basal insulins/NPH. |
| format | Article |
| id | doaj-art-9c096cdd1145455faa9ad092761a7e12 |
| institution | DOAJ |
| issn | 2327-2236 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Columbia Data Analytics, LLC |
| record_format | Article |
| series | Journal of Health Economics and Outcomes Research |
| spelling | doaj-art-9c096cdd1145455faa9ad092761a7e122025-08-20T02:47:06ZengColumbia Data Analytics, LLCJournal of Health Economics and Outcomes Research2327-22362025-04-0112110.36469/001c.133274Healthcare Resource Utilization and Costs Related to Falls and Fractures Among People With Type 2 Diabetes Receiving Basal Insulin: The FRAGILE StudyGuillermo E. UmpierrezElizabeth K. PoggeXuan LiRonald PreblickJasvinder GillNaushira Pandya# Background The association between falls or fall-related fractures and hypoglycemia in people with type 2 diabetes is well established. Insulin treatment is associated with an increased risk of hypoglycemia, which is compounded in people of older age, but the risk is lower with longer-acting vs intermediate- or long-acting basal insulin analogs. # Objective To examine healthcare resource utilization and costs related to falls/fractures in people with type 2 diabetes treated with the longer-acting basal insulin Gla-300 (insulin glargine 300 U/mL) vs long-acting basal insulins (insulin glargine 100 U/mL or insulin detemir)/neutral protamine Hagedorn (NPH). # Methods This retrospective study of Optum’s de-identified Clinformatics® Data Mart Database compared data for people aged 50 years or older with at least 1 prescription claim for basal insulin (excluding insulin degludec) between April 1, 2015, and April 30, 2021, who initiated Gla-300 insulin (basal insulin–naive) or transitioned to Gla-300 from a different basal insulin (basal insulin–switch). Cohorts were propensity score–matched. The primary outcome was fall/fracture-related hospitalization and emergency department visit events (per 100 person-years of follow-up [P100PYFU]). The association between fall/fracture events and hypoglycemia and costs were secondary outcomes. Outcomes were compared using 95% confidence intervals of rate and other ratios; no statistical inference was performed. # Results Fall/fracture-related hospitalization (2.88 vs 3.33 P100PYFU) and emergency department visit events (5.28 vs 5.95 P100PYFU) were numerically lower in people who initiated basal insulin with Gla-300 vs long-acting basal insulins/NPH, and in those who switched to Gla-300 vs long-acting basal insulins/NPH (2.54 vs 3.38 and 4.48 vs 5.21 P100PYFU, respectively). People with vs without hypoglycemia experienced more falls/fractures, regardless of whether initiating basal insulin or switching basal insulin treatment. Costs tended to be lower for people who switched to Gla-300; however, low event rates caused variability. # Conclusions The results of this study suggest that there is a positive correlation between fall/fracture events and hypoglycemia in people with type 2 diabetes and also, that fall/fracture-related healthcare resource utilization was numerically lower in people who initiated basal insulin with Gla-300 vs long-acting basal insulins/NPH, and in those who switched to Gla-300 vs long-acting basal insulins/NPH.https://doi.org/10.36469/001c.133274 |
| spellingShingle | Guillermo E. Umpierrez Elizabeth K. Pogge Xuan Li Ronald Preblick Jasvinder Gill Naushira Pandya Healthcare Resource Utilization and Costs Related to Falls and Fractures Among People With Type 2 Diabetes Receiving Basal Insulin: The FRAGILE Study Journal of Health Economics and Outcomes Research |
| title | Healthcare Resource Utilization and Costs Related to Falls and Fractures Among People With Type 2 Diabetes Receiving Basal Insulin: The FRAGILE Study |
| title_full | Healthcare Resource Utilization and Costs Related to Falls and Fractures Among People With Type 2 Diabetes Receiving Basal Insulin: The FRAGILE Study |
| title_fullStr | Healthcare Resource Utilization and Costs Related to Falls and Fractures Among People With Type 2 Diabetes Receiving Basal Insulin: The FRAGILE Study |
| title_full_unstemmed | Healthcare Resource Utilization and Costs Related to Falls and Fractures Among People With Type 2 Diabetes Receiving Basal Insulin: The FRAGILE Study |
| title_short | Healthcare Resource Utilization and Costs Related to Falls and Fractures Among People With Type 2 Diabetes Receiving Basal Insulin: The FRAGILE Study |
| title_sort | healthcare resource utilization and costs related to falls and fractures among people with type 2 diabetes receiving basal insulin the fragile study |
| url | https://doi.org/10.36469/001c.133274 |
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