Background: Hospital inpatient care for patients with diabetes was estimated to cost $76 billion in 2012.\nSubstantial expense resulted from those patients having multiple hospitalizations. The objective was to compare\nthe risk for diabetesââ?¬â??related hospital readmission in patients with type 2 diabetes treated with sulfonylureas (SUs)\ncompared to those treated with other oral antihyperglycemic agents (AHAs).\nMethods: A retrospective cohort analysis was conducted using two-year panels, from 1999 to 2010, from the\nMedical Expenditure Panel Survey. The study included patients with type 2 diabetes taking an oral AHA who\nexperienced a diabetes-related hospitalization. A Cox proportional hazard regression predicting time to readmission\nwas used to estimate and compare the risks of readmission for SU-monotherapy versus other-AHA-monotherapy\npatients. Covariates included age, gender, marital status, cardiovascular disease, kidney disease, and eye disease,\nalong with a propensity score to control for selection bias. The lack of clinical data on disease severity and\nprogression limited our ability to estimate causal relationships between drug use and risk of hospital readmission.\nResults: From 1999 to 2010, an estimated 13.5 million patients experienced a diabetes-related hospital admission\nand subsequent AHA treatment. While 23.2 % (n = 746,579) of patients in the SU monotherapy cohort had a\nreadmission, only 16.1 % (n = 881,984) in the other-AHA monotherapy group were readmitted. Average readmission\nexpenditure for readmitted SU users (in 2010 dollars) was $11,148 (Ã?±$1,558) compared to $7,673 (Ã?±$763) for users\nof other oral AHAs. The estimated readmission hazard ratio was 1.29 (95 % CI: 1.01ââ?¬â??1.65; p-value = 0.04) for SU\nmonotherapy users. If a patientââ?¬â?¢s first hospital admission was during the time period 2008ââ?¬â??2010, a readmission was\nsignificantly less likely (HR 0.49, 95 % CI: 0.31ââ?¬â??0.78; p = 0.003) relative to 2004ââ?¬â??2007.\nConclusions: Among patients with type 2 diabetes, SU use was associated with an approximately 30 % increased\nrisk for readmission compared to other-AHA use, while each readmission for an SU user cost on average 45 % more\nthan one for an other-AHA patient. Because of the rapidly rising prevalence of diabetes in the U.S. and the large\nnumber of patients with prediabetes, preventing hospital readmissions will continue to be an important cost-saving\nstrategy in the future.
Loading....