Association Between the Diabetes Drug Cost and Cardiovascular Events for Type 2 Diabetes in Korea: A National Health Insurance Service Database Analysis

2021 ◽  
Author(s):  
Seung Min Chung ◽  
Ji-In Lee ◽  
Eugene Han ◽  
Hyun-Ae Seo ◽  
Eonju Jeon ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Insurance ◽  
National Health Insurance ◽  
Drug Cost ◽  
National Health ◽  
Protective Factor ◽  
Coronary Revascularization ◽  
Long Term Effects ◽  
Diabetes Drug

Abstract Background: We aimed to investigate the long-term effects of diabetes drug costs on cardiovascular (CV) events and death. Methods: This retrospective observational study used the 2009–2018 National Health Insurance data in Korea. Among patients with type 2 diabetes, those who were taking antidiabetic drugs and did not have CV events before 2009 were included. Data on the annual cost of each diabetes drug were collected. The 10-year incidence of CV events (cardiac death, non-fatal myocardial infarction, stroke, hospitalization for heart failure, and coronary revascularization) and CV death were analyzed according to the diabetes drug cost quartiles (Q1 [the lowest] – Q4 [the highest]).Results: A total of 441,914 participants were enrolled (median age, 60 years; male, 57%). CV events and death occurred in 28.1% and 8.36% of patients, respectively. The overall diabetes drug cost was USD 271/year per person (range: 1–18,921). The 10-year incidence of CV events and death was lowest in Q3 and high in Q4 and Q1. After adjusting for CV risk factors, the risk of CV events increased in the sequential order of cost quartiles (hazard ratio (HR)=1 [ref], 1.102 [95% confidence interval (CI): 1.084–1.120], 1.137 [95% CI: 1.118–1.156], and 1.323 [95% CI: 1.3011.346]). The risk of CV death showed U-shaped pattern which was lowest in the Q3 (HR=0.943, 95% CI 0.903-0.984) and highest in the Q4 (HR= 1.234, 95% CI 1.182-1.287).Conclusion: The expenditure for diabetes drug affects 10-year CV events and death. Affording an appropriate diabetes cost at a similar CV risk is an independent protective factor for CV death.Trial registration: retrospectively registered

scholarly journals Fenofibrate Use Is Associated With Lower Mortality and Fewer Cardiovascular Events in Patients With Diabetes: Results of 10,114 Patients From the Korean National Health Insurance Service Cohort

2021 ◽  
Author(s):  
Sang-Ho Jo ◽  
Hyewon Nam ◽  
Jeongwoo Lee ◽  
Sojeong Park ◽  
Jungkuk Lee ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Primary Endpoint ◽  
Cardiac Death ◽  
Cardiovascular Events ◽  
Coronary Revascularization ◽  
Korean National Health Insurance

<b>Objective:</b> We investigate long term clinical efficacy of fenofibrate use on mortality and cardiovascular outcomes in patients with type 2 diabetes. <p><b>Research design and Methods: </b>We performed population based cohort study using data of Korean National Health Insurance from 2003 to 2014. Among 63727 participants with diabetes aged 40-79, 5057 users of fenofibrate only were compared with 5057 non-users of fenofibrate and/or omega-3 fatty acid with 1:1 propensity matching. Primary endpoint was composite of myocardial infarction, stroke, percutaneous coronary revascularization and cardiac death for median 3 years. </p> <p><b>Results:</b> Primary endpoint was significantly lower in fenofibrate users as compared to neither users, 13.4 vs. 15.5 per 1000 person years (hazard ratio [HR] 0.76, confidence interval [CI], 0.62-0.94, P=0.010). Cardiac death (1.8 vs. 3.1 per 1000 person years [HR 0.59, CI, 0.352- 0.987, p=0.0446]), all cause death (7.6 vs. 15.3 per 1000 person years [HR 0.437, CI, 0.340 -0.562, p<0.0001]), and stroke (6.5 vs. 8.6 per 1000 person years [HR 0.621, CI, 0.463-0.833, P=0.0015]) were significantly lower in fenofibrate group. As the duration of fenofibrate use stratified by quartiles (Q1-4), the risk decreased in Q4 with HR of 0.347 (95% CI 0.226-0.532, P<0.0001). In subgroup analysis, the favoring effect of fenofibrate is sustained consistently across all subset of patients including those classified by LDL-C, HDL-C and TG levels.</p> <p><b>Conclusions:</b> Use of fenofibrate was associated with lower rate of total and cardiac mortality and cardiovascular events in type 2 diabetes patients for 3 year follow-up in real world large populations.</p>

scholarly journals Fenofibrate Use Is Associated With Lower Mortality and Fewer Cardiovascular Events in Patients With Diabetes: Results of 10,114 Patients From the Korean National Health Insurance Service Cohort

2021 ◽  
Author(s):  
Sang-Ho Jo ◽  
Hyewon Nam ◽  
Jeongwoo Lee ◽  
Sojeong Park ◽  
Jungkuk Lee ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Primary Endpoint ◽  
Cardiac Death ◽  
Cardiovascular Events ◽  
Coronary Revascularization ◽  
Korean National Health Insurance

<b>Objective:</b> We investigate long term clinical efficacy of fenofibrate use on mortality and cardiovascular outcomes in patients with type 2 diabetes. <p><b>Research design and Methods: </b>We performed population based cohort study using data of Korean National Health Insurance from 2003 to 2014. Among 63727 participants with diabetes aged 40-79, 5057 users of fenofibrate only were compared with 5057 non-users of fenofibrate and/or omega-3 fatty acid with 1:1 propensity matching. Primary endpoint was composite of myocardial infarction, stroke, percutaneous coronary revascularization and cardiac death for median 3 years. </p> <p><b>Results:</b> Primary endpoint was significantly lower in fenofibrate users as compared to neither users, 13.4 vs. 15.5 per 1000 person years (hazard ratio [HR] 0.76, confidence interval [CI], 0.62-0.94, P=0.010). Cardiac death (1.8 vs. 3.1 per 1000 person years [HR 0.59, CI, 0.352- 0.987, p=0.0446]), all cause death (7.6 vs. 15.3 per 1000 person years [HR 0.437, CI, 0.340 -0.562, p<0.0001]), and stroke (6.5 vs. 8.6 per 1000 person years [HR 0.621, CI, 0.463-0.833, P=0.0015]) were significantly lower in fenofibrate group. As the duration of fenofibrate use stratified by quartiles (Q1-4), the risk decreased in Q4 with HR of 0.347 (95% CI 0.226-0.532, P<0.0001). In subgroup analysis, the favoring effect of fenofibrate is sustained consistently across all subset of patients including those classified by LDL-C, HDL-C and TG levels.</p> <p><b>Conclusions:</b> Use of fenofibrate was associated with lower rate of total and cardiac mortality and cardiovascular events in type 2 diabetes patients for 3 year follow-up in real world large populations.</p>

scholarly journals The Influence of National Health Insurance on Medication Adherence Among Outpatient Type 2 Diabetics in Southwest Nigeria

2017 ◽  
Vol 5 (2) ◽  
pp. 114-119
Author(s):  
Saka S Ajibola ◽  
Fajemirokun O Timothy
Keyword(s):  
Health Insurance ◽  
Medication Adherence ◽  
National Health Insurance ◽  
Drug Cost ◽  
National Health ◽  
Diabetic Patients ◽  
Uninsured Patients ◽  
Type 2 Diabetics ◽  
Southwest Nigeria

Purpose: Medication adherence (MA) is a challenge among patients with chronic diseases worldwide. Little has been reported on the influence of National Health Insurance Scheme (NHIS) on MA among diabetic patients in Nigeria. Objective: To assess the influence of NHIS on MA among outpatient type 2 diabetics in 2 public secondary health facilities in Southwest Nigeria. Method: A cross-sectional study involving 110 consecutively selected outpatient type 2 diabetics (insured, n = 42; uninsured, n = 68) was carried out. The patients’ perceptions of care and the influence of drug cost on MA between the insured and uninsured were compared. The patients’ perceptions of care were assessed using a 25-item pretested questionnaire. The MA was measured using the Morisky MA-8 scale. The use of oral antidiabetic drugs (OADs) was evaluated using a medical chart review. Information about patients’ sociodemographics, year of diagnosis, comorbidities, and types of OADs prescribed was retrieved from the medical records. Descriptive statistics were used for data presentation. A Pearson χ2 was used for test of associations. P values < .05 were considered significant. Results: Majority of the respondents (68 [61.8%]) were uninsured. The insured and the uninsured patients differed in their perceptions of the adequacy of time used by pharmacists for medication counseling ( P < .0005). The MA between the groups also differs ( P = .0002). The monthly drug cost for OADs was significantly associated with MA ( P = .037). Conclusion: The study concluded that the NHIS may positively influence MA among diabetic patients. The drug cost may have contributed significantly to the difference in MA between the groups. More time should be devoted to the counseling of the uninsured patients.

The Association Between Second-Line Oral Antihyperglycemic Medication on Types of Dementia in Type 2 Diabetes: A Nationwide Real-World Longitudinal Study

2021 ◽  
pp. 1-10
Author(s):  
Won Jun Kim ◽  
Jung Hyun Noh ◽  
Kyungdo Han ◽  
Cheol-Young Park
Keyword(s):  
Type 2 Diabetes ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Lower Risk ◽  
Oral Therapy ◽  
Dual Therapy ◽  
Second Line ◽  
Korean National Health Insurance

Background: There are few reports that evaluated the association between various types of dementia and dual oral therapy with antihyperglycemic medication. Objective: The goal of this study was to investigate the association between treatment of dual antihyperglycemic medication and dementia subclass in type 2 diabetes mellitus using the Korean National Health Insurance System. Methods: This study included 701,193 individuals with diabetes prescribed dual oral therapy between 2009 and 2012 from the Korean National Health Insurance Service Database, which were tracked until 2017. All-cause, Alzheimer’s (AD) and vascular dementia (VaD) were investigated by dual oral therapy. Adjustments were made for age, sex, income, diabetes duration, hypertension, dyslipidemia, smoking, drinking, exercise, body mass index, glucose level, and estimated glomerular filtration rate. Results: Dual therapy with metformin (Met) + dipeptidyl peptidase-4 inhibitor (DPP-4i), Met + thiazolidinedione (TZD), and sulfonylurea (SU) + thiazolidinediones (TZD) were significantly associated with all-cause dementia (HR = 0.904, 0.804, and 0.962, respectively) and VaD (HR = 0.865, 0.725, and 0.911, respectively), compared with Met + SU. Met + DPP-4i and Met + TZD were associated with significantly lower risk of AD (HR = 0.922 and 0.812), compared with Met + SU. Dual therapy with TZD was associated with a significantly lower risk of all-cause dementia, AD, and VaD than nonusers of TZD (HR = 0.918, 0.925 and 0.859, respectively). Conclusion: Adding TZD or DPP-4i instead of SU as second-line anti-diabetic treatment may be considered for delaying or preventing dementia. Also, TZD users relative to TZD non-users on dual oral therapy were significantly associated with lower risk of various types of dementia.

Long term DPP4i use reduces joint pain in patients with type 2 diabetes. A study using the national health insurance

2016 ◽  
Vol 120 ◽  
pp. S203
Author(s):  
Shih Jung Yen ◽  
Yu Han Chang ◽  
Mei Yueh Lee ◽  
Pi Jung Hsiao ◽  
Deng Chyang Wu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Joint Pain
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