Diabetes Study and National Health Insurance Database in Taiwan

SD-1-1

Application of National Health Insurance DATA in Disease Association Studies in Patients with Diabetes

CHung-YI LI

Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University

Over the past years, my co-authors and I published, using Taiwan’s National Health Insurance (NHI) data, a number of epidemiological studies that described the co-morbidity in patients with diabetes. These co-morbidities covered a wide range of diseases including macro- / micro- vascular events, neoplasm, urological / nephrological disease, neurological disorders, and psychological illnesses. Strengths of application of NHI data in epidemiological studies include population-based study design, large study sample, and lesser likelihood of selection bias. However, the accuracy of disease diagnosis and lack of certain data such as laboratory and lifestyle variables always limit the causal inference of the study findings. In this lecture, I will present first our previous studies that provided local data on the co-morbidity of patients with diabetes. Two bi-directional studies that explored the association of type 2 diabetes with depression and acute pancreatitis, respectively will then be presented in order to illustrate the usefulness of using Taiwan’s NHI data in such design. Some perspectives of claim data based studies on diabetes will also be discussed.

SD-1-2

From Large Healthcare Database Studies to Clinical Practice - Path for Improving Care of Diabetic Patients and Individualizing Therapeutic Decision Making

1,2CHIa-HsuIn CHang, 1MEI-SHU LAI, 1,2LEE-MING CHUANG

1Institute of Preventive Medicine, College of Public Health, National Taiwan University; 2Department of Internal Medicine, National Taiwan University Hospital

Large healthcare databases compile tremendous amount of various patients' diagnostic and treatment records, far greater than the limited experiences of any physician or hospital. How to make the best use of these data to facilitate individual patient's therapeutic decision making and to improve outcome of care will become an important issue.

We analyzed Taiwan National Health Insurance claims database to evaluate patterns and determinants of first-line and second-line anti-diabetic therapy, regional differences, prescription quality, and cost. Cardiovascular outcomes associated with use of metformin as compared with acarbose as the first-line therapy, and among several dual oral anti-diabetic regimens in combination with metformin as the second-line therapy were examined. In addition, we used data mining technique and Bayesian hierarchical rule modeling to evaluate 3 months incidence of severe cardiovascular events, including myocardial infarction, heart failure, and stroke, among individual type 2 diabetic patients with different risk profiles while receiving different oral anti-diabetic agents, including metformin, sulfonylurea, glinide, alpha-glucosidase inhibitor, pioglitazone, and DPP4-inhibitor.

We propose that a diabetes registry which includes patients’ important lifestyle factors, clinical information, and medical records is in urgent need in Taiwan in order to monitor treatment cost, improve quality of care, and facilitate individual therapeutic decision making.