PMID- 34238287
OWN - NLM
STAT- MEDLINE
DCOM- 20210712
LR  - 20210713
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 21
IP  - 1
DP  - 2021 Jul 8
TI  - Evaluating the relationship between clinical and demographic characteristics of 
      insulin-using people with diabetes and their health outcomes: a cluster analysis 
      application.
PG  - 669
LID - 10.1186/s12913-021-06603-0 [doi]
LID - 669
AB  - BACKGROUND: The aim of this study was to determine how clusters or subgroups of 
      insulin-treated people with diabetes, based upon healthcare resource utilization, 
      select social demographic and clinical characteristics, and diabetes management 
      parameters, are related to health outcomes including acute care visits and 
      hospital admissions. METHODS: This was a non-experimental, retrospective cluster 
      analysis. We utilized Aetna administrative claims data to identify insulin-using 
      people with diabetes with service dates from 01 January 2015 to 30 June 2018. The 
      study included adults over the age of 18 years who had a diagnosis of type 1 
      (T1DM) or type 2 diabetes mellitus (T2DM) on insulin therapy and had Aetna 
      medical and pharmacy coverage for at least 18 months (6 months prior and 
      12 months after their index date, defined as either their first insulin 
      prescription fill date or their earliest date allowing for 6 months' prior 
      coverage). We used K-means clustering methods to identify relevant subgroups of 
      people with diabetes based on 13 primary outcome variables. RESULTS: A total of 
      100,650 insulin-using people with diabetes were identified in the Aetna 
      administrative claims database and met study criteria, including 11,826 (11.7%) 
      with T1DM and 88,824 (88.3%) with T2DM. Of these 79,053 (78.5%) people were 
      existing insulin users. Seven distinct clusters were identified with different 
      characteristics and potential risks of diabetes complications. Overall, clusters 
      were significantly associated with differences in healthcare utilization 
      (emergency room visits, inpatient admissions, and total inpatient days) after 
      multivariable adjustment. CONCLUSIONS: This analysis of healthcare claims data 
      using clustering methodologies identified meaningful subgroups of patients with 
      diabetes using insulin. The subgroups differed in comorbidity burden, healthcare 
      utilization, and demographic factors which could be used to identify higher risk 
      patients and/or guide the management and treatment of diabetes.
FAU - Eby, Elizabeth L
AU  - Eby EL
AD  - Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA. 
      ebye@lilly.com.
FAU - Edwards, Alison
AU  - Edwards A
AD  - Healthagen LLC (renamed CVS Health Clinical Trial Services LLC, effective 01 
      November 2020), 151 Farmington Avenue, Hartford, CT, 06156, USA.
FAU - Meadows, Eric
AU  - Meadows E
AD  - Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
FAU - Lipkovich, Ilya
AU  - Lipkovich I
AD  - Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
FAU - Benneyworth, Brian D
AU  - Benneyworth BD
AD  - Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
FAU - Snow, Kenneth
AU  - Snow K
AD  - Healthagen LLC (renamed CVS Health Clinical Trial Services LLC, effective 01 
      November 2020), 151 Farmington Avenue, Hartford, CT, 06156, USA.
LA  - eng
PT  - Journal Article
DEP - 20210708
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
RN  - 0 (Insulin)
SB  - IM
MH  - Adult
MH  - Cluster Analysis
MH  - Demography
MH  - *Diabetes Mellitus, Type 2/drug therapy/epidemiology
MH  - Health Care Costs
MH  - Humans
MH  - *Insulin/therapeutic use
MH  - Middle Aged
MH  - Retrospective Studies
PMC - PMC8265072
OTO - NOTNLM
OT  - Diabetes management
OT  - Healthcare claims data
OT  - Healthcare utilization
OT  - Subgroup identification
COIS- ELE, EM, IL, and BDB are employees and shareholders of, and serve as authors for 
      Eli Lilly and Company and AE and KS are employees of, and serve as authors for 
      CVS Health Clinical Trial Services LLC.
EDAT- 2021/07/10 06:00
MHDA- 2021/07/13 06:00
PMCR- 2021/07/08
CRDT- 2021/07/09 05:44
PHST- 2021/02/02 00:00 [received]
PHST- 2021/05/27 00:00 [accepted]
PHST- 2021/07/09 05:44 [entrez]
PHST- 2021/07/10 06:00 [pubmed]
PHST- 2021/07/13 06:00 [medline]
PHST- 2021/07/08 00:00 [pmc-release]
AID - 10.1186/s12913-021-06603-0 [pii]
AID - 6603 [pii]
AID - 10.1186/s12913-021-06603-0 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2021 Jul 8;21(1):669. doi: 10.1186/s12913-021-06603-0.