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- Title
Association of Medical Costs and Pre-Diabetic Dysglycemia.
- Authors
Nichols, Gregory A.; Arondekar, Bhakti; Herman, William H.
- Abstract
Clinical trials have demonstrated that life-style or pharmaceutical interventions can prevent or delay diabetes onset among patients with impaired glucose tolerance (IGT). Currently, there is a lack of published studies that estimate the overall economic burden of pre-diabetes outside of clinical trials. The objective of this study was to assess patient characteristics, health care utilization and costs among patients with IGT or impaired fasting glucose (IFG). We used laboratory test results analyzed by the Kaiser Permanente Northwest Regional Laboratory to identify patients who had both a random and fasting glucose test result no more than 90 days apart between 1 January 1998 and 31 December 2004. Those with evidence of diabetes (chart diagnosis, FPG > 125mg/dl, or use of an anti-hyperglycemic), cancer, renal disease or pregnancy were excluded. We then applied a validated algorithm that uses random glucose to screen for dysglycemia (IFG or IGT) and results from the fasting glucose tests to assign patients to one of four categories: 1) isolated IFG (fasting glucose 100-125mg/dl but did not screen as dysglycemic, n=2241); 2) isolated IGT (fasting glucose < 100mg/dl but screened as dysglycemic, n=1146); 3) undetermined dysglycemia (fasting glucose 100-125mg/dl and screened as dysglycemic, n=1246); 4) normoglycemia (fasting glucose < 100mg/dl and did not screen as dysglycemic, n=5088). We then compared age and sex adjusted annual medical costs across the four groups. Compared to normoglycemic subjects, total age and sex adjusted annual medical costs were 9% greater among subjects with isolated IGT, 7% greater among those with undetermined dysglycemia, and 5% greater among isolated IFG subjects. None of the differences were statistically significant. However, inpatient costs were 26% greater among isolated IGT subjects compared to those with normoglycemia (p=0.017). Cardiovascular disease was the most common cause of these hospitalizations. The highest costs were found among those with isolated IGT, a form of pre-diabetes that would seldom be identified in US populations. Although not significantly greater than normoglycemia, our results suggest that costs are higher in the pre-diabetic state. Thus, preventing progression to diabetes, when costs are known to be dramatically greater, would likely provide substantial economic benefit.
- Subjects
MEDICAL care costs; MEDICAL care use; DIABETES; PEOPLE with diabetes; BLOOD sugar
- Publication
Diabetes, 2007, Vol 56, pA310
- ISSN
0012-1797
- Publication type
Article