Retrospective database analysis of annual direct costs and complications for patients with type 1 diabetes and hypoglycemia in the US

Background Type 1 diabetes and hypoglycemia impose substantial clinical and economic burden on patients and healthcare systems. This study examined T1D-related complications and direct costs in people with T1D (pwT1D) and in a subgroup with hypoglycemia in the US.Methods IQVIA’s PharMetrics Plus database was used to identify adults (≥18 years) with an ICD-10-CM code for T1D between April 1, 2016–April 30, 2020. Two study cohorts were defined, including all pwT1D (cohort 1) and pwT1D with ≥1 hypoglycemia claim (cohort 2). The index date was the first claim associated with T1D diagnosis. Patients were followed until the earliest of the end of continuous enrollment or end of the study period (April 30, 2022). Prevalence rate of T1D-related complications was descriptively summarized, and all-cause direct costs were calculated as per-patient-per-year (PPPY).Results Among 96,946 pwT1D, 18,556 (19.1%) had ≥1 hypoglycemia claim. The demographic characteristics for each cohort were similar. Cohort 2 had higher rates of T1D-related complications than Cohort 1: retinopathy (34% vs. 26.9%), neuropathy (30.2% vs. 21.7%), nephropathy (7.4% vs. 4.7%), chronic kidney disease (any stage; 9.3% vs. 6.6%), coronary artery disease (7.6% vs. 5.8%) and peripheral vascular disease (7.6% vs. 5.2%). Total all-cause direct costs PPPY were 14% higher in cohort 2 ($29,903 in 2022 USD, $33,790 in 2025 USD) vs. cohort 1 ($26,293 in 2022 USD, $29,711 in 2025 USD).Conclusion In a predominantly commercially insured population, pwT1D with ≥1 hypoglycemia claim had higher complication rates and higher annual direct costs than the broader T1D population, signaling a more complex patient population.