Healthcare Resource Utilization and Costs Related to Falls and Fractures Among People With Type 2 Diabetes Receiving Basal Insulin: The FRAGILE Study

Background: The association between falls or fall-related fractures and hypoglycemia in people with type 2 diabetes is well established. Insulin treatment is associated with an increased risk of hypoglycemia, which is compounded in people of older age, but the risk is lower with longer-acting vs intermediate- or long-acting basal insulin analogs. Objective: To examine healthcare resource utilization and costs related to falls/fractures in people with type 2 diabetes treated with the longer-acting basal insulin Gla-300 (insulin glargine 300 U/mL) vs long-acting basal insulins (insulin glargine 100 U/mL or insulin detemir)/neutral protamine Hagedorn (NPH). Methods: This retrospective study of Optum’s de-identified Clinformatics® Data Mart Database compared data for people aged 50 years or older with at least 1 prescription claim for basal insulin (excluding insulin degludec) between April 1, 2015, and April 30, 2021, who initiated Gla-300 insulin (basal insulin–naive) or transitioned to Gla-300 from a different basal insulin (basal insulin–switch). Cohorts were propensity score–matched. The primary outcome was fall/fracture-related hospitalization and emergency department visit events (per 100 person-years of follow-up [P100PYFU]). The association between fall/fracture events and hypoglycemia and costs were secondary outcomes. Outcomes were compared using 95% confidence intervals of rate and other ratios; no statistical inference was performed. Results: Fall/fracture-related hospitalization (2.88 vs 3.33 P100PYFU) and emergency department visit events (5.28 vs 5.95 P100PYFU) were numerically lower in people who initiated basal insulin with Gla-300 vs long-acting basal insulins/NPH, and in those who switched to Gla-300 vs long-acting basal insulins/NPH (2.54 vs 3.38 and 4.48 vs 5.21 P100PYFU, respectively). People with vs without hypoglycemia experienced more falls/fractures, regardless of whether initiating basal insulin or switching basal insulin treatment. Costs tended to be lower for people who switched to Gla-300; however, low event rates caused variability. Conclusions: The results of this study suggest that there is a positive correlation between fall/fracture events and hypoglycemia in people with type 2 diabetes and also, that fall/fracture-related healthcare resource utilization was numerically lower in people who initiated basal insulin with Gla-300 vs long-acting basal insulins/NPH, and in those who switched to Gla-300 vs long-acting basal insulins/NPH.