Comorbidity in an Older Population with Type-2 Diabetes Mellitus: Identification of the Characteristics and Healthcare Utilization of High-Cost Patients

Abstract

Objectives: Little is known about the specific comorbidities contributing to higher costs in patients with type-2 diabetes mellitus (T2DM), particularly in older cases. We aimed to evaluate the prevalence, type, and cost of comorbidities occurring in older T2DM patients versus older non-T2DM patients, and the factors associated with high cost (HC) T2DM patients.Methods: Retrospective cohort study using information from the Campania Region healthcare database. People aged ≥65 years who received ≥2 prescriptions for antidiabetic drugs were identified as “T2DM patients.” Comorbidities among T2DM and non-T2DM groups were assessed through the RxRiskV Index (modified version). T2DM individuals were classified according to the total cost distribution as HC or “non-high cost.” Two sub-cohorts of HC T2DM patients were assessed: above 90th and 80th percentile of the total cost. Age- and sex-adjusted logistic regression models were created.Results: Among the T2DM cohort, concordant and discordant comorbidities occurred significantly more frequently than in the non-T2DM cohort. Total mean annual cost per T2DM patient due to comorbidities was €7,627 versus €4,401 per non-T2DM patient. Among T2DM patients identified as being above 90th and 80th percentiles of cost distribution, the total annual costs were >€19,577 and >€2,563, respectively. The hospitalization cost was higher for T2DM cases. Strongest predictors of being a HC T2DM patient were having ≥5 comorbidities and renal impairment.Conclusion: HC patients accrued >80% of the total comorbidities cost in older T2DM patients. Integrated care models, with holistic and patient-tailored foci, could achieve more effective T2DM care.

Delineating the Type 2 Diabetes Population in the Netherlands Using an All-Payer Claims Database: Specialist Care, Medication Utilization and Expenditures 2016–2018

“…We found a skewed distribution of expenditures related to specialist care, as well as medication use, and that mean per patient expenditures were consistently higher than median per patient expenditures. Prior research has also recognized this skewed distribution of costs, as a disproportional amount of the economic burden of type 2 diabetes was found to be attributable to a minority of patients [17,[39][40][41][42][43]. This could result from the focus on treating patients' emergent problems or could be due to the presence of multiple complications in patients with advanced diabetes, as well as comorbidities [39,40].…”

“…This could result from the focus on treating patients’ emergent problems or could be due to the presence of multiple complications in patients with advanced diabetes, as well as comorbidities [ 39 , 40 ]. Moreover, previous studies have found that factors such as the presence of obesity, insulin use, renal impairment, and hospitalization predict high costs for patients with diabetes [ 17 , 43 ].…”

Self-Care Experiences of Empty-Nest Elderly Living With Type 2 Diabetes Mellitus: A Qualitative Study From China

“…With the gradual reduction of family size and the disintegration of the traditional large family structure, the function of family endowment is gradually weakened, and the elderly cannot get direct living care (42). Comorbidities are common in older adults with diabetes, more than 97% of them had at least one of the comorbidities (43). Comorbidities not only increase the health care needs, utilization and mortality of people with diabetes (44)(45)(46), they also increase the complexity of disease management and the burden of self-management (47,48) which is a challenge for empty-nester patients to cope with.…”

Feasibility and Acceptability of the HOME Model to Promote Self-Management Among Ethnic Minority Elderly with Type 2 Diabetes Mellitus in Rural Thailand: A Pilot Study

“…In the past three decades, the prevalence of type 2 diabetes mellitus (T2DM) has increased dramatically and has become an important global health problem. 1–4 In 2017, ∼5 million deaths worldwide were attributable to diabetes. One of the major concerns is that more than 80% of people with T2DM live in low- and middle-income countries, accounting for 90–95% of all diagnosed cases that do not require insulin treatment.…”