Healthcare and associated costs related to type 2 diabetes in youth and adolescence: the TODAY clinical trial experience

Abstract

The economic issues related to medical treatments in youth with type 2 diabetes (T2D) are rarely reported and thus not fully understood. The TODAY clinical trial of youth recently diagnosed with T2D collected healthcare and related cost information from the largest cohort studied to date. Costs related to medical treatments and expenses faced by caregivers were identified over a two-year period from 496 participants. Data were collected by surveys and diaries to document frequency of use of diabetes care (excluding study laboratory tests), non-diabetes care services and treatments, caregiver time, and expenses related to exercise and dietary activities recommended for patients. Economic costs were derived by applying national cost values to the reported utilization frequency data. Annual medical costs in the first year varied by treatment group, averaging $1798 in those assigned to metformin alone (M), $2971 to combination drug therapy with metformin + rosiglitazone (M+R), and $2092 to metformin + an intensive lifestyle and behavior change program (M+L). Differences were primarily due to costs related to combination drug therapy. Adult caregiver support costs were higher for participants in the lifestyle program, which was delivered in weekly sessions in the first six months. Expenses for purchases to enhance diet and exercise change did not vary by treatment assignment. In year 2, medication costs increased in M and M+L due to the initiation of insulin in subjects who failed to maintain glycemic control on the assigned treatment. Data are reported for use by researchers and those providing healthcare to this vulnerable patient population.

Quality improvement efforts in a safety net institution: Increased diabetes screening is associated with lower HbA1c at diagnosis and improved HbA1c outcomes in youth with type 2 diabetes

“…Type 2 diabetes has significant health care costs, with typical lifetime costs for an adult with T2D estimated between $125 and 150,000 9 . The TODAY trial showed costs for adolescents with T2D at approximately $2000–3000 per year 10 . Long‐term health care costs for T2D in the adult study were higher for those with microvascular complications and would be expected to be higher for individuals diagnosed as youth, as they have more years living with the disease and evidence for more rapid development of T2D complications.…”

Hospital cost analysis of Chinese patients with diabetes, 2015-2019

“…Laboratory costs and imaging examination costs have increased rapidly in various expenses, suggesting that there are still many di culties in controlling the excessive growth of medical expenses. The reason for the excessively rapid increase in costs may be the acceleration of the upgrading of medical technology and the more examinations and laboratory tests performed by the hospital during the diagnosis and treatment process [25] .…”

Adolescents with Type 2 Diabetes: Overcoming Barriers to Effective Weight Management

“…In the TODAY study, the estimated annual medical costs in the first year of treatment was $1798 in patients assigned to metformin alone, $2971 to combination drug therapy with metformin plus rosiglitazone and $2092 to metformin plus an intensive lifestyle and behavior change. 37 In the TODAY study, low income was not associated with lack of medication adherence. However, the lack of correlation could be attributed to the fact that most families had an estimated annual income of less than 25,000.…”