Utilization patterns of insulin for patients with type 2 diabetes from national health insurance claims data in South Korea

• Published in: PloS one Vol. 14; no. 3; p. e0210159
• Main Authors: Min, Kyoung Lok, Koo, Heejo, Choi, Jun Jeong, Kim, Dae Jung, Chang, Min Jung, Han, Euna
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.03.2019; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Analysis; Antidiabetics; Biology and Life Sciences; Care and treatment; Chronic diseases; Chronic illnesses; Complications; Confidence intervals; Dependent variables; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - epidemiology; Diabetes therapy; Diabetic neuropathy; Diabetics; Diagnosis; Drugs; Female; Glucose; Hazards; Health aspects; Health care; Health Care Costs; Health care industry; Health care policy; Health insurance; Hemoglobin; Hospitals; Humans; Hypoglycemic agents; Hypoglycemic Agents - economics; Hypoglycemic Agents - therapeutic use; Income; Independent variables; Insulin; Insulin - economics; Insulin - therapeutic use; Insurance; Lag time; Low income groups; Low level; Male; Managed Care Programs - statistics & numerical data; Medical personnel; Medical research; Medicine; Medicine and Health Sciences; Metabolism; Middle Aged; Mortality; National health insurance; National Health Programs - statistics & numerical data; Patients; People and Places; Pharmaceutical sciences; Pharmacy; Physicians; Planning; Primary care; Republic of Korea - epidemiology; Retrospective Studies; Risk factors; Social Sciences; Studies; Treatment outcome; Type 2 diabetes; Young Adult; Republic of Korea; Asia; United States > US; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0210159

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.