Hospital Admissions due to Dysglycaemia and Prescriptions of Antidiabetic Medications in England and Wales: An Ecological Study

Diabetes Ther https://doi.org/10.1007/s13300-017-0349-1 ORIGINAL RESEARCH Hospital Admissions due to Dysglycaemia and Prescriptions of Antidiabetic Medications in England and Wales: An Ecological Study Abdallah Y. Naser . Qian Wang . Lisa Y. L. Wong . Jenni Ilomaki . Simon J. Bell . Gang Fang . Ian C. K. Wong . Li Wei Received: October 19, 2017 Ó The Author(s) 2017. This article is an open access publication ABSTRACT Introduction: Hypoglycaemia and hyperglycaemia are common adverse events associated with antidiabetic medications. They are also a common cause of hospital admissions for people with diabetes. The objective of the study was to explore the trends in hospital admissions due to hypoglycaemia and hyperglycaemia and in the prescriptions of antidiabetic medications in England and Wales. Methods: We conducted an observational study during the period 1999–2016. Hospital Enhanced content To view enhanced content for this article go to http://www.medengine.com/Redeem/ E9FCF0602042168F. A. Y. Naser
I. C. K. Wong
L. Wei (&) Research Department of Practice and Policy, UCL School of Pharmacy, London, UK e-mail: Q. Wang Beijing Tongren Eye Center, Capital Medical University, Beijing, China L. Y. L. Wong UCL Institute of Child Health, London, UK J. Ilomaki
S. J. Bell Centre for Medicine Use and Safety, Monash University, Monash, Australia G. Fang Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, Chapel Hill, NC, USA admission data for patients from all age groups were extracted from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Data on prescriptions of antidiabetic medications were extracted from the Prescription Cost Analysis database from 2004 to 2016. Results: Between 1999 and 2016, the hospital admission rate increased by 173.0% [from 17.2 (95% CI 16.9–17.6) to 47.1 (95% CI 46.5–47.6) per 100,000 persons] for hypoglycaemia and by 147.0% [from 22.8 (95% CI 22.4–23.2) to 56.3 (95% CI 55.7–56.9) per 100,000 persons] for hyperglycaemia. The prescription rate for all antidiabetic medications increased between 2004 and 2016 by 116.0% [from 373.0 (95% CI 373.0–373.0) to 806.0 (95% CI 806.0–806.0) prescriptions per 1000 persons]. There was a parallel increase in the rate of antidiabetic medication prescriptions during the same study period, with correlation coefficients of 0.94 for hypoglycaemia and 0.98 for hyperglycaemia, respectively. Conclusions: There have been parallel increases in the rate of admissions due to dysglycaemia and the rate of antidiabetic prescriptions in England and Wales. Further analytical studies are required to investigate whether increased admission for dysglycaemia is associated with increased use of antidiabetic medications. Diabetes Ther Keywords: Admission rate; Antidiabetic medication; Diabetes mellitus; Hyperglycaemia; Hypoglycaemia; Trend INTRODUCTION In the United Kingdom, there are around 4 million people living with diabetes mellitus, corresponding to an estimated prevalence rate of about 6.2% in 2015 [1]. During the same year, diabetes mellitus accounted for around 23,000 deaths in people aged between 20 and 79 years old [1]. Diabetes mellitus is a chronic condition in which glycaemic control should be managed in order to prevent the development of complications such as microvascular and macrovascular diseases [2]. Antidiabetic therapy, in addition to diet and lifestyle modifications, is an essential component of the management of people with diabetes mellitus with uncontrolled HbA1C levels [3, 4]. Current treatment guidelines recommend the initiation of intensive diabetes therapy in uncontrolled HbA1C patients to achieve better control over their HbA1C levels, since the use of a single antidiabetic agent does not always achieve the targeted glycaemic control [5]. One of the main drawbacks of intensive antidiabetic therapy is the incidence of adverse drug events such as hypoglycaemic events [6]. On the other hand, inappropriate use of antidiabetic therapy is the main leading cause of raised blood glucose levels and the occurrence of hyperglycaemic events [7, 8]. Hospitalisation increased by 11.7% and declined by 38.6% due to hypoglycaemia and hyperglycaemia, respectively, among US Medicare beneficiaries aged 65 years and older between 1999 and 2011 [9]. In England, a previous study showed that hypoglycaemic admissions increased by 14.0% between 2005 and 2014 [10]. However, no study has investigated hospital admissions due to hyperglycaemia in patients aged below 65 years old. The objective of this ecological study was to explore national trends in hospital admissions due to dysglycaemia among patients from all age groups in England and Wales from 1999 to 2016. Additionally, we examined antidiabetic medication prescriptions for the available period of 2004–2016 to investigate a potential correlation between the trend in admissions due to dysglycaemia and the trend in antidiabetic medication prescriptions. METHODS Study Sources and the Population This was a secular trend study using publicly available national data taken from the Hospital Episode Statistics (HES) database in England [11] and the Patient Episode Database for Wales (PEDW) for the period between April 1999 and March 2016 [12]. The HES and PEDW databases contain hospital admission data for hypoglycaemia and hyperglycaemia in patients from all age groups that were subdivided into four categories; below 15 years, 15–59 years, 60– 74 years, and 75 years and above. Hospital admissions were identified using the diagnostic codes E16.0, E16.1, E16.2, and T38.3 for hypoglycaemia admissions and E10.1, E11.1, E12.1, E13.1, E14.1, and R73.9 for hyperglycaemia admissions from the 10th version of the International Statistical Classification of Diseases (ICD) system. Admission codes for hypoglycaemia and hyperglycaemia were consistent with those used in previous studies [9, 10, 13]. Hyperglycaemia admission codes were selected and included based on the clinical fact that ketoacidosis, if presented in patients with diabetes mellitus, is considered a sign of hyperglycaemia, where the body is unable to produce enough insulin in response to raised blood glucose levels [14]. In addition, the diagnostic code (R73.9) was selected based on its description, which stands for unspecified hyperglycaemia. HES and PEDW are the main healthcare databases in England and Wales. They record all hospital admissions, outpatients and Accident and Emergency (A&E) activities performed at all National Health Service (NHS) trusts and any independent sector funded by NHS trusts. Data for hospital admissions in England and Wales are available from the years 1999/2000 onwards. Available data include patient demographics, Diabetes Ther clinical diagnoses, procedures, and durations of stay. HES and PEDW data are checked regularly to ensure their validity and accuracy [11, 15]. Mid-year population data for the period between 1 (...truncated)