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Body mass index and insulin use as identifiers of high‐cost patients with type 2 diabetes: A retrospective analysis of electronic health records linked to insurance claims data
Author(s) -
Johnston Stephen S.,
Ammann Eric M.,
Kashyap Sangeetha R.,
Stokes Andrew,
Hsiao Carine ChiaWen,
Daskiran Mehmet,
Scamuffa Robin
Publication year - 2019
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13671
Subject(s) - overweight , medicine , body mass index , type 2 diabetes , insulin , obesity , diabetes mellitus , retrospective cohort study , demography , endocrinology , sociology
Aims To study the association of body mass index (BMI) and insulin use with type 2 diabetes‐related healthcare expenditures (T2D‐HE). Materials and methods Retrospective study using de‐identified electronic health records linked to insurance claims data. Study included a prevalence‐based sample of overweight or obese patients with antihyperglycaemic‐treated T2D. Patients had ≥1 A1c measurement in 2014 (last observed = index A1c ), ≥1 BMI measurement within ±90 days of index (average BMI = baseline BMI ), and continuous enrolment for 180 days before ( baseline ) through 395 days after index (day 30‐395 = follow‐up ). BMI was categorized as: 25 to 29.9 kg/m 2 = overweight; 30 to 34.9 kg/m 2 = obese class I (OCI); 35 to 39.9 kg/m 2 = OCII; ≥40 kg/m 2 = OCIII. Multivariable regressions were used to examine one‐year follow‐up T2D‐HE as a function of BMI, insulin use, an interaction term between BMI and insulin use, and patient demographics. Results Study included 13 026 patients (mean age = 63.6 years; 48.1% female; 29.5% overweight, 31.6% OCI, 20.3% OCII, 18.6% OCIII; 25.3% insulin users). Baseline insulin use rates monotonically ranged from 19.7% in overweight patients to 33.0% in OCIII patients ( P < 0.001). Together, BMI and insulin use were jointly associated with one‐year follow‐up T2D‐HE, which monotonically ranged from $5842 in overweight patients with no insulin to $17 700 OCIII insulin users, P < 0.001. Within each BMI category, insulin users' one‐year T2D‐HE was at least double that of non‐users. Additional analyses of all‐cause healthcare expenditures yielded consistent results. Conclusions BMI and insulin use represent simple stratifiers for identifying high‐cost patients. OCIII insulin users incurred the greatest annual healthcare expenditures; these patients may be an ideal group for targeted interventions.