Type 2 diabetes: incremental medical care costs during the 8 years preceding diagnosis.

Nichols, Gregory A.; Glauber, Harry; Brown, Jonathan B.

doi:10.2337/diacare.23.11.1654

Cited by 75 publications

(76 citation statements)

References 5 publications

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“…This estimate was based on a single study that found that medical costs 8 years prior to diabetes diagnosis, at the time patients would have IGT, were 46% of the annual costs of a patient with T2DM. 196 In this study, costs increased over the 8 years and peaked at the time of diabetes diagnosis. Palmer and colleagues 172 used these findings to model annual increases in costs throughout the preclinical diabetes phase.…”

Section: Costsmentioning

confidence: 89%

Screening for type 2 diabetes: literature review and economic modelling

Waugh¹,

Scotland²,

McNamee³

et al. 2007

Health Technol Assess

243

194

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Section: Costsmentioning

confidence: 89%

Screening for type 2 diabetes: literature review and economic modelling

Waugh¹,

Scotland²,

McNamee³

et al. 2007

Health Technol Assess

243

194

View full text Add to dashboard Cite

show abstract

“…Such adverse effects have included increased CVD, 28,46 greater utilization of primary care, 27,47 and higher costs. [29][30][31]48 In patients at KPNW who had impaired fasting glucose (IFG, with fasting plasma glucose levels 100-125 mg/dl), marginal costs in patients with fasting glucose 110-125 mg/dl were $1,308 more per year in 2007 dollars compared to patients who had normal fasting plasma glucose and were matched for age, sex, and year of fasting plasma glucose, and marginal costs were $881 in patients with fasting glucose 100-109 mg/dl. 30 The Medical Expenditure Panel Survey (MEPS) found marginal costs for a 50-year-old patient with new-onset diabetes to be higher by $4,431/year in 2007 U.S. dollars, after adjusting for age, race/ethnicity, sex, and a variety of other variables, but not BMI.…”

Section: Discussionmentioning

confidence: 99%

“…We conducted a case-control analysis, similar to reports in the literature, 27,28,31 using Corporate Data Warehouse (CDW) information on veterans in SC, GA, and AL receiving healthcare through Veterans Integrated Service Network (VISN) 7. This study was approved by the Institutional Review Board at Emory University.…”

Section: Designmentioning

confidence: 99%

“…25,26 Screening might be more common in large healthcare systems if adverse associations with diabetes, such as increased healthcare costs, were widely recognized to occur early in the natural history of the disease, at a time when adverse effects might be forestalled with preventive management. Higher rates of CVD, increased healthcare resource use, and higher costs have been reported before a clinical diagnosis of diabetes in data from the Nurses' Health Study, primary care clinics in the United Kingdom, and Kaiser Permanente Northwest (KPNW), respectively, [27][28][29][30][31] but there has been no coordinated study of the time course of adverse associations with early diabetes within a single healthcare system. We sought to determine when the adverse associations with diabetes could be detected, using CVD as a measure of impact on health, and resource use and cost as measures of impact on the healthcare system, in veterans in the southeastern U.S. who received care through the VA. We demonstrated that CVD, resource use, and costs were all significantly and substantially increased four years prior to clinical diagnosis, and that costs rose further after the diagnosis was made.…”

Section: Introductionmentioning

confidence: 99%

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Increased Cardiovascular Disease, Resource Use, and Costs Before the Clinical Diagnosis of Diabetes in Veterans in the Southeastern U.S.

et al. 2015

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IMPORTANCE:Screening for diabetes might be more widespread if adverse associations with cardiovascular disease (CVD), resource use, and costs were known to occur earlier than conventional clinical diagnosis. OBJECTIVE: The purpose of this study was to determine whether adverse effects associated with diabetes begin prior to clinical diagnosis. DESIGN: Veterans with diabetes were matched 1:2 with controls by follow-up, age, race/ethnicity, gender, and VA facility. CVD was obtained from ICD-9 codes, and resource use and costs from VA datasets. SETTING: VA facilities in SC, GA, and AL. PARTICIPANTS: Patients with and without diagnosed diabetes. MAIN OUTCOME MEASURES: Diagnosed CVD, resource use, and costs. RESULTS: In this study, the 2,062 diabetic patients and 4,124 controls were 63 years old on average, 99 % male, and 29 % black; BMI was 30.8 in diabetic patients vs. 27.8 in controls (p<0.001). CVD prevalence was higher and there were more outpatient visits in Year −4 before diagnosis through Year +4 after diagnosis among diabetic vs. control patients (all p<0.01); in Year −2, CVD prevalence was 31 % vs. 24 %, and outpatient visits were 22 vs. 19 per year, respectively. Total VA costs/year/veteran were higher in diabetic than control patients from Year −4 ($4,083 vs. $2,754) through Year +5 ($8,347 vs. $5,700) (p<0.003) for each, reflecting underlying increases in outpatient, inpatient, and pharmacy costs KEY WORDS: diabetes; health care cost; cardiovascular disease; prediabetes. ABBREVIATIONS A1cHemoglobin A1c 749(p<0.05 for each). Regression analysis showed that diabetes contributed an average of $1,748/year to costs, independent of CVD (p<0.001). CONCLUSIONS AND RELEVANCE: VA costs per veteran are higher-over $1,000/year before and $2,000/year after diagnosis of diabetes-due to underlying increases in outpatient, inpatient, and pharmacy costs, greater number of outpatient visits, and increased CVD. Moreover, adverse associations with veterans' health and the VA healthcare system occur early in the natural history of the disease, several years before diabetes is diagnosed. Since adverse associations begin before diabetes is recognized, greater consideration should be given to systematic screening in order to permit earlier detection and initiation of preventive management. Keeping frequency of CVD and marginal costs in line with those of patients before diabetes is currently diagnosed has the potential to save up to $2 billion a year.

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“…Many hope that preventing diabetes will reduce future medical costs. We have demonstrated that excess costs for patients who ultimately develop diabetes begin at least 8 years before diabetes diagnosis (4), and these prediagnostic costs are driven primarily by the treatment of cardiovascular risk factors and emerging cardiovascular disease (CVD). CVD is also the primary cost driver after diabetes has been diagnosed (5).…”

mentioning

confidence: 99%

Higher Medical Care Costs Accompany Impaired Fasting Glucose

Nichols

Brown

2005

Diabetes Care

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OBJECTIVE -The purpose of this study was to estimate medical costs associated with elevated fasting plasma glucose (FPG) and to determine whether costs differed for patients who met the 2003 (Ն100 mg/dl) versus the 1997 (Ն110 mg/dl) American Diabetes Association (ADA) cut point for impaired fasting glucose.RESEARCH DESIGN AND METHODS -We identified 28,335 patients with two or more FPG test results of at least 100 mg/dl between 1 January 1994 and 31 December 2003. Those with evidence of diabetes before the second test were excluded. We categorized patients into two stages of abnormal glucose (100 -109 mg/dl and 110 -125 mg/dl) and matched each of these subjects to a patient with a normal FPG test (Ͻ100 mg/dl) on age, sex, and year of FPG test. All subjects were followed until an FPG test qualified them for a higher stage, dispensing of an antihyperglycemic drug, health plan termination, or 31 December 2003.RESULTS -Adjusted annual costs were $4,357 among patients with normal FPG, $4,580 among stage 1 patients, and $4,960 among stage 2 patients (P Ͻ 0.001, all comparisons). After removing patients with normal FPG tests whose condition progressed to a higher stage or diabetes, costs in the normal FPG stage were $3,799. Patients in both stages 1 and 2 had more cardiovascular comorbidities than patients with normal FPG.CONCLUSIONS -Our results demonstrate that abnormal glucose metabolism is associated with higher medical care costs. Much of the excess cost was attributable to concurrent cardiovascular disease. The 2003 ADA cut point identifies a group of patients with greater costs and comorbidity than normoglycemic patients but with lower costs and less comorbidity than patients with FPG above the 1997 cut point. Diabetes Care 28:2223-2229, 2005T he Diabetes Prevention Program, (1) the Finnish Diabetes Prevention Study, (2) and the STOP-NIDDM Trial (3) have now established that it is possible to prevent or delay onset of type 2 diabetes in persons with abnormal glucose metabolism. Many hope that preventing diabetes will reduce future medical costs. We have demonstrated that excess costs for patients who ultimately develop diabetes begin at least 8 years before diabetes diagnosis (4), and these prediagnostic costs are driven primarily by the treatment of cardiovascular risk factors and emerging cardiovascular disease (CVD). CVD is also the primary cost driver after diabetes has been diagnosed (5). Therefore, recognizing that delaying the hyperglycemia of diabetes might also delay CVD, we must examine the potential economic benefits of hyperglycemic screening and prevention. To our knowledge, no study has yet described the costs associated with elevated subdiabetic levels of fasting plasma glucose (FPG).In November 2003, the American Diabetes Association (ADA) reduced the cut point for defining impaired fasting glucose (IFG) from 110 to 100 mg/dl, primarily to optimize the value of IFG in predicting future development of diabetes (6). Reducing the IFG cut point has generated considerable controversy partly because the...

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Type 2 diabetes: incremental medical care costs during the 8 years preceding diagnosis.

Cited by 75 publications

References 5 publications

Screening for type 2 diabetes: literature review and economic modelling

Screening for type 2 diabetes: literature review and economic modelling

Increased Cardiovascular Disease, Resource Use, and Costs Before the Clinical Diagnosis of Diabetes in Veterans in the Southeastern U.S.

Higher Medical Care Costs Accompany Impaired Fasting Glucose

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