Economic costs and medications for diabetes in older patients in Beijing, China: Electronic insurance data analysis

Yanhua Ma ^1,2 Yan Zhao ¹ Ran Wei ¹ Jingtao Qiao ¹ Jingyi Luo ¹ Lina Zhang ¹ Jie Zhang ¹ Mingqun Deng ¹ Yang Yu ¹ Weihao Wang ^1* Qi Pan ^1* Lixin Guo ^1,2*

• ¹ Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
• ² Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China

Background: With the aging of population, the proportion of elderly patients with diabetes is gradually increasing, which poses challenges in the management and treatment of diabetes in this population.Methods: The aim of the study was to investigate the temporal changes in the treatment regimens and medical expenditures in older patients with diabetes in Beijing, China. Data of patients with diabetes from the Beijing Medical Insurance Database with medical records from 2016 to 2018 were retrospectively analyzed. Primary and secondary outcomes included the number of medications, comorbidities, diabetes-related complications, the estimated annual drug cost, the treatment strategies for elderly diabetic patients, and the classes of drugs prescribed.Results: Data of 598440 patients with diabetes in 2018 revealed that 49.8% of the recruited patients were female among elderly patients (> 65 years old). The most common comorbidity was hypertension (87.6%). Over the three years, about 4.51 medications, including 1.88 antiglycemic drugs and 2.63 non-antiglycemic drugs were prescribed in elderly patients. The mean total annual medication cost was ¥12186 ($1676), including ¥6116 ($841) for antiglycemic drugs and ¥6070 ($835) for nonantiglycemic drugs. Hypertension (cost ¥4658, $640, mean medications 2.12 for elderly patients), dyslipidemia (¥5044, $693, 1.70), and coronary heart disease (¥4004, $550, 1.40) were the top three diseases that caused the increase in the cost and medications. Over the three years, more than 94% of elderly diabetic patients received at least one type of antiglycemic drugs, and the α-glucosidase inhibitors and premixed insulin are the most commonly prescribed hypoglycemic drugs and insulin, respectively. Conclusion:Diabetes management in older patients faces challenges due to extensive variability. Medication analysis in this study found that the current situation of comprehensive control of diabetes in elderly patients is worrying, and the complexity of their medication is still on the increasing trend. It is important to select more appropriate antiglycemic drugs to economically benefit the patients and to control the progression of complications.