PMID- 30840630
OWN - NLM
STAT- MEDLINE
DCOM- 20191127
LR  - 20200309
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 14
IP  - 3
DP  - 2019
TI  - Utilization patterns of insulin for patients with type 2 diabetes from national 
      health insurance claims data in South Korea.
PG  - e0210159
LID - 10.1371/journal.pone.0210159 [doi]
LID - e0210159
AB  - Type 2 diabetes mellitus (T2DM) is a chronic disease that requires long-term 
      therapy and regular check-ups to prevent complications. In this study, insurance 
      claim data from the National Health Insurance Service (NHIS) of Korea were used 
      to investigate insulin use in T2DM patients according to the economic status of 
      patients and their access to primary physicians, operationally defined as the 
      frequently used medical care providers at the time of T2DM diagnosis. A total of 
      91,810 participants were included from the NHIS claims database for the period 
      between 2002 and 2013. The utilization pattern of insulin was set as the 
      dependent variable and classified as one of the following: non-use of 
      antidiabetic drugs, use of oral antidiabetic drugs only, or use of insulin with 
      or without oral antidiabetic drugs. The main independent variables of interest 
      were level of income and access to a frequently-visited physician. Multivariate 
      Cox proportional hazards analysis was performed. Insulin was used by 9,281 
      patients during the study period, while use was 2.874 times more frequent in the 
      Medical-aid group than in the highest premium group [hazard ratio (HR): 2.874, 
      95% confidence interval (CI): 2.588-3.192]. Insulin was also used ~50% more often 
      in the patients managed by a frequently-visited physician than in those managed 
      by other healthcare professionals (HR: 1.549, 95% CI: 1.434-1.624). The lag time 
      to starting insulin was shorter when the patients had a low income and no 
      frequently-visited physicians. Patients with a low level of income were more 
      likely to use insulin and to have a shorter lag time from diagnosis to starting 
      insulin. The likelihood of insulin being used was higher when the patients had a 
      frequently-visited physician, particularly if they also had a low level of 
      income. Therefore, the economic statuses of patients should be considered to 
      ensure effective management of T2DM. Utilizing frequently-visited physicians 
      might improve the management of T2DM, particularly for patients with a low 
      income.
FAU - Min, Kyoung Lok
AU  - Min KL
AD  - Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of 
      Medicine and Pharmacy, Yonsei University, Incheon, Republic of Korea.
FAU - Koo, Heejo
AU  - Koo H
AD  - Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College 
      of Pharmacy, Yonsei University, Incheon, Republic of Korea.
FAU - Choi, Jun Jeong
AU  - Choi JJ
AD  - Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College 
      of Pharmacy, Yonsei University, Incheon, Republic of Korea.
FAU - Kim, Dae Jung
AU  - Kim DJ
AD  - Department of Endocrinology and Metabolism, Ajou University School of Medicine, 
      Suwon, Republic of Korea.
FAU - Chang, Min Jung
AU  - Chang MJ
AD  - Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of 
      Medicine and Pharmacy, Yonsei University, Incheon, Republic of Korea.
AD  - Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College 
      of Pharmacy, Yonsei University, Incheon, Republic of Korea.
FAU - Han, Euna
AU  - Han E
AUID- ORCID: 0000-0003-2656-7059
AD  - Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of 
      Medicine and Pharmacy, Yonsei University, Incheon, Republic of Korea.
AD  - Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College 
      of Pharmacy, Yonsei University, Incheon, Republic of Korea.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190306
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Diabetes Mellitus, Type 2/*drug therapy/economics/epidemiology
MH  - Female
MH  - *Health Care Costs
MH  - Humans
MH  - Hypoglycemic Agents/economics/*therapeutic use
MH  - Insulin/economics/*therapeutic use
MH  - Male
MH  - Managed Care Programs/*statistics & numerical data
MH  - Middle Aged
MH  - National Health Programs/*statistics & numerical data
MH  - Republic of Korea/epidemiology
MH  - Retrospective Studies
MH  - Young Adult
PMC - PMC6402628
COIS- The authors have declared that no competing interests exist.
EDAT- 2019/03/07 06:00
MHDA- 2019/11/28 06:00
PMCR- 2019/03/06
CRDT- 2019/03/07 06:00
PHST- 2018/03/25 00:00 [received]
PHST- 2018/12/18 00:00 [accepted]
PHST- 2019/03/07 06:00 [entrez]
PHST- 2019/03/07 06:00 [pubmed]
PHST- 2019/11/28 06:00 [medline]
PHST- 2019/03/06 00:00 [pmc-release]
AID - PONE-D-18-09075 [pii]
AID - 10.1371/journal.pone.0210159 [doi]
PST - epublish
SO  - PLoS One. 2019 Mar 6;14(3):e0210159. doi: 10.1371/journal.pone.0210159. 
      eCollection 2019.