Economic burden of hypoglycemia for type II diabetes mellitus patients in Malaysia

Autoři: Syed Mohamed Aljunid aff001;  Yin Nwe Aung aff001;  Aniza Ismail aff001;  Siti Athirah Zafirah Abdul Rashid aff001;  Amrizal M. Nur aff001;  Julius Cheah aff004;  Priya Matzen aff004
Působiště autorů: International Centre for Casemix and Clinical Coding, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia aff001;  Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Hawalli, Kuwait aff002;  Department of Pathology and Community Medicine, Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia aff003;  Market Access and Public Affairs, Novo Nordisk Pharma (Malaysia) Sdn Bhd, Kuala Lumpur, Malaysia aff004;  Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Kuala Lumpur, Malaysia aff005;  Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom aff006
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0211248


This study mainly aims to identify the direct cost and economic burden of hypoglycemia for patients with type II diabetes mellitus in Malaysia. A cross-sectional study explored the cost incurred for hypoglycemia among patients admitted to University Kebangsaan Malaysia Medical Centre (UKMMC). The study covered patients aged 20–79 years hospitalized with a primary diagnosis of ICD-10 hypoglycemia and discharged between January 2010 and September 2015 according to the casemix database. A costing analysis was done through a step-down approach from the perspective of health providers. Cost data were collected for three levels of cost centers with the help of a hospital-costing template. The costing data from UKMMC were used to estimate the national burden of hypoglycemia among type II diabetics for the whole country. Of 244 diabetes patients admitted primarily for hypoglycemia to UKMMC, 52% were female and 88% were over 50 years old. The cost increased with severity. Managing a hypoglycemic case requires five days (median) of inpatient stay on average, with a range of 2–26 days, and costs RM 8,949 (USD 2,289). Of the total cost, 30% related to ward (final cost center), 16% to ICU, and 15% to pharmacy (secondary-level cost center) services. Considering that 3.2% of all admissions were hypoglycemia related, the total annual cost of hypoglycemia care for adult diabetics in Malaysia is estimated at RM 117.4 (USD 30.0) million, which translates to 0.5% of the Ministry of Health budget. Hypoglycemia imposes a substantial economic impact even without the direct and indirect cost incurred by patients and other cost of complications. Diabetic management needs to include proper diabetic care and health education to reduce episodes of hypoglycemia.

Klíčová slova:

Diabetes mellitus – Health economics – Hospitals – Hypoglycemia – Hypoglycemics – Inpatients – Insulin – Malaysia


1. Cryer PE. Glucose homeostatis and hypoglycemia. 10th ed. Philadelphia: Saunders/Elsevier; 2003.

2. Shafiee G, Mohajeri-Tehrani M, Pajouhi M, Larijani B. The importance of hypoglycemia in diabetic patients. J Diabetes Metab Disord. 2012; 11: 17. doi: 10.1186/2251-6581-11-17 23497433

3. Sircar M, Bhatia A, Munshi M. Review of hypoglycemia in the older adult: clinical implications and management. Can J Diabetes. 2016; 40: 66–72. doi: 10.1016/j.jcjd.2015.10.004 26752195

4. McCrimmon RJ, Sherwin RS. Hypoglycemia in type 1 diabetes. Diabetes. 2010; 59: 2333–39. doi: 10.2337/db10-0103 20876723

5. Cryer PE. Diverse causes of hypoglycemia-associated autonomic failure in diabetes. New England J Med. 2004; 350: 2272–79.

6. Miller CD, Phillips LS, Ziemer DC, Gallina DL, Cook CB, El-Keebi IM. Hypoglycemia in patients with type II diabetes mellitus. Arch Intern Medicine. 2001; 161: 1653–9.

7. Jonsson L, Bolinder B, Lundkvist J. Cost of hypoglycemia in patients with type II diabetes in Sweden. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research. 2006; 9: 193–8.

8. Pramming S, Thorsteinsson B, Bendtson I, Binder C. Symptomatic hypoglycaemia in 411 type 1 diabetic patients. Diabetic Medicine: A Journal of the British Diabetic Association. 1991; 8: 217–22.

9. Jorgensen HV, Pedersen-Bjergaard U, Rasmussen AK, Borch-Johnsen K. The impact of severe hypoglycemia and impaired awareness of hypoglycemia on relatives of patients with type 1 diabetes. Diabetes Care. 2003; 26: 1106–9. doi: 10.2337/diacare.26.4.1106 12663581

10. International Diabetic Federation I. IDF diabetes atlas. 7th ed. Brussels: IDF; 2015.

11. Ministry of Health, Malaysia. National Health Morbidity Survey. Kuala Lumpur: Institute for Public Health; 2015.

12. OECD, WHO. Health at a glance: Asia/Pacific 2014. OECD Publishing; 2014.

13. Institute for Public Health Ministry of Health Malaysia. National Health and Morbidity Survey (NHMS) 2015. Kuala Lumpur: Ministry of Health; 2015.

14. Mafauzy BM. Diabetes mellitus in Malaysia. J Med Malaysia. 2006; 61: 2.

15. American Diabetes Association. Standards of Medical Care in Diabetes 2011. Diabetes Care. 2011; 34: S11–S61. doi: 10.2337/dc11-S011 21193625

16. Shepard DS, Hodgkin D and Anthony YE. Analysis of hospital cost: a manual for managers. Geneva: World Health Organization; 2000.

17. Hussein Z, Kamaruddin NA, Chan SP, Jain A, Uppal S, Bebakar WMW. Hypoglycemia awareness among insulin-treated patients with diabetes in Malaysia: A cohort subanalysis of the HAT study. Diabetes Res Clin Pract. 2017; 133: 40–49. doi: 10.1016/j.diabres.2017.08.007 28888148

18. Ministry of Health, Malaysia. Annual Report 2014. Kuala Lumpur: Ministry of Health; 2014.

19. Leese GP, Wang J, Broomhall J, Kelly P, Marsden A, Morrison W et al. Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type II diabetes: a population-based study of health service resource use. Diabetes Care. 2003; 26: 1176–80. doi: 10.2337/diacare.26.4.1176 12663593

20. Mosian J, Breton M-C, Villeneuve J, Grégoire J-P. Hypoglycemia-related emergency department visits and hypoglycemia-related hospitalizations among new users of antidiabetes treatments. Can J Diabetes. 2013; 37: 143–49. doi: 10.1016/j.jcjd.2013.02.039 24070836

21. Bloomfield HE, Greer N, Newman D, MacDonald R, Carlyle M, Fitzgerald P et al. Predictors and consequences of severe hypoglycemia in adults with diabetes—a systematic review of the evidence. USA: Department of Veterans Affairs; 2012.

22. McEwan P, Thorsted BL, Wolden M, Jacobsen J, Evans M. Healthcare resource implications of hypoglycemia-related hospital admissions and inpatient hypoglycemia: retrospective record-linked cohort studies in England. BMJ Open Diabetes Research & Care. 2015; 3(1): e000057.

23. Amiel SA, Dixon T, Mann R, Jameson K. Hypoglycaemia in type II diabetes. Diabetic Med. 2008; 25: 245–54. doi: 10.1111/j.1464-5491.2007.02341.x 18215172

24. Brackenridge A, Wallbank H, Lawrenson RA, Russell-Jones D. Emergency management of diabetes and hypoglycaemia. Emergency Med Journal: EMJ. 2006; 23: 183–5. doi: 10.1136/emj.2005.026252 16498153

25. Riewpaiboon A, Chatterjee S, Piyauthakit P. Cost analysis for efficient management: diabetes treatment at a public district hospital in Thailand. Int J Pharm Pract. 2011; 19: 342–9. doi: 10.1111/j.2042-7174.2011.00131.x 21899614

26. Kim G, Lee YH, Han MH, Lee EK, Kim CH, Kwon HS et al. Economic burden of hypoglycemia in patients with type II diabetes mellitus from Korea. PloS One. 2016; 11: e0151282. doi: 10.1371/journal.pone.0151282 26975054

27. Holstein A, Patzer OM, Machalke K, Holstein JD, Stumvoll M, Kovacs P. Substantial increase in incidence of severe hypoglycemia between 1997–2000 and 2007–2010: a German longitudinal population-based study. Diabetes Care. 2012; 35: 972–5. doi: 10.2337/dc11-1470 22410817

28. Holstein A, Plaschke A, Egberts E-H. Incidence and costs of severe hypoglycemia. Diabetes Care. 2002; 25: 2109–10. doi: 10.2337/diacare.25.11.2109 12401771

29. Frier BM. Hypoglycaemia in the diabetic adult. Bailliere’s Clin Endocrinol Metab. 1993; 7: 757–77.

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2019 Číslo 10