Using the PMSI database, we identified, within a one-year period, 147 IH-related hospital admissions in Alsace. These hospital admissions represented a total cost of €407,441. The data obtained through the review of the medical records allowed us to identify causes of IH such as errors in treatment administration and inappropriate medicine prescriptions.
The French PMSI database contains more than 98% of all public and private hospital stays of medicine, surgery, and obstetrics. This medical-administrative database has been used for epidemiology and medical-economic purposes. However, it is clear that the PMSI database still remains an untapped source of information on the healthcare system and is underexploited. To our knowledge, this study is the first to have used a French regional PMSI database to identify hospital admissions due to hypoglycemia in diabetic patients. However, it can be specified that anticoagulant adverse reactions leading to hospitalizations have already been identified using a similar pattern.
The reports contained in the PMSI database are coded by medical staff under the supervision of the PMSI department of each hospital. Coding quality in the PMSI database is expected to be high and is guaranteed by quality checks regularly performed within each hospital. External audits are also conducted by health insurance as hospital financial resources are directly related to the coded information.
Patients going through emergency departments and then immediately leaving the hospital (e.g., emergency visit alone) were not considered in our approach. Thus, the use of the PMSI led to an underestimation of the total number of iatrogenic hypoglycemic events leading to hospitalization.
The use of the regional PMSI database allowed us to evaluate the economic burden associated with IH-related hospital admissions. In Alsace, the 147 hospital admissions cost €407,441 for one year. Reported on a national scale, it would reach €13,581,367 for one year in France. This estimated cost represents the total direct cost for the French national health insurance. Considering that we did not gather all cases (exclusion of emergency visits alone) and that neither physician fees of private hospitals nor private insurance charges were included, this result represents the lower range of the cost associated with the management of IH-related hospital admissions. Furthermore, hospital admissions are only one aspect of IH-related morbidity. A larger proportion of hypoglycemic events may occur in ambulatory care and are also costly.
The median cost of hospitalization for IH in T1DM patients was €1,224.6, while the one for T2DM patients was €3,670.9. The costs associated with hypoglycemia in patients with T1DM and T2DM were assessed by other authors. For severe hypoglycemic events requiring hospitalization, the estimated costs per event and for any kind of diabetic patients ranged from €1,300 to €3,298 (United Kingdom, Spain, and Germany). The mean cost of a severe hypoglycemic event requiring hospitalization in T2DM patients in Portugal was estimated to be €3,132; a little lower than the one found in a Swedish study which reported total costs of €3,918 per severe hypoglycemic event treated in hospital.
Even if costs observed in European countries do not differ meaningfully from ours, they cannot be readily compared with our data (and between them). They were obtained by using different methodological approaches and sources: direct analysis, micro-costing, claims database, reports. Despite these limitations, our data as well as the published studies clearly illustrate that hypoglycemia must be recognized as an important factor in the management of diabetic patients and support the development of improvement strategies.
While there are extensive evidences on the risk of hypoglycemia in T1DM, until recently there has been little published data on hypoglycemia in T2DM. This is suggesting that hypoglycemia in T2DM is not a serious or frequent adverse event. In our study, although the occurrence of IH-related hospital admissions was greater in T1DM, the total number of IH-related hospital admissions in Alsace was higher in T2DM (101 vs. 41). This shows that physicians should not consider hypoglycemia as a minor medical event in T2DM.
The missed meals or meals low in carbohydrate content were the most frequent causes of IH-related hospital admissions in UHS. This is remarkably consistent across different data sets, suggesting that this factor should be reviewed with all diabetic patients as well as with their caregivers.
