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

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

doi:10.2337/diacare.22.7.1116

Cited by 114 publications

(114 citation statements)

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“…[1][2][3]5 Disease management programs that incorporate these findings into routine practice are widespread, but published evaluations have been short-term and generally have not measured mortality or other final outcomes. [20][21][22][23][24] In this report, we describe the changes that accompanied the implementation over 10 years of a chronic disease management program for diabetes mellitus in a large nonprofit, group-model health maintenance organization.…”

Section: Discussionmentioning

confidence: 99%

“…The study site is extensively described elsewhere. [20][21][22][23][24] Intervention In 1988, the organization began a program of populationbased primary care management of diabetes. Up until 1995, this program had evolved to include an electronic diabetes register (begun in 1987) that has been updated weekly since 1993 and that supports most of the organi-zation's other diabetes programs; a diabetes steering committee, consisting of endocrinologists, primary care physicians, nurse managers, pharmacists, a health plan administrator, a data analyst, and a researcher; a program of diabetes research in the affiliated research center that created the register and extensively evaluated diabetes care in 1990; annual educational updates for providers affiliated with the health plan and, since 1991, the publication of a quarterly newsletter for health plan clinicians.…”

Section: Study Site and Populationmentioning

confidence: 99%

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Case-control study of 10 years of comprehensive diabetes care

Ga²,

Hs³

2000

Western Journal of Medicine

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ⅷ Objective To describe the long-term clinical impact of a comprehensive management program instituted throughout a health system for members with diabetes mellitus. ⅷ Design 10 year case-control evaluation. ⅷ Setting Kaiser Permanente Northwest, Portland, OR. ⅷ Participants Members of the health maintenance organization between 1987 and 1996; members with diabetes were compared with equal numbers of members without diabetes. The number of participants with diabetes ranged from 5331 in 1987 to 13,099 in 1996. ⅷ Main outcome measures Number in diabetes register, mortality, change in comorbidity, rates of uptake of preventive health measures, use of pharmaceuticals, levels of risk factors, hospital days per thousand per year, emergency room visits per thousand per year. ⅷ Results The prevalence of diabetes identified in this population rose from 2.54% (7,895/310,819) in 1987 to 3.66% (14,741/402,754) in 1996, and the mean (SEM) age of members at the time of diagnosis fell slightly from 62.9 (±0.21) years to 62.0 (±0.13) years (P < 0.05). By 1996, 10,885 of the 13,099 (83% ±0.3%) of members with diabetes had an annual laboratory test to assess glycemic control, the annual screening rate for retinopathy was 67.6% (±0.4%), the rate of uptake of influenza immunizations was 60.2% (7,886/13,099) and the screening rate for nephropathy was 43% (5,698/13,099) (±0.49%). The use of home glucose testing increased from 32.4% (1721/5331) of members with diabetes to 53.0% (6,942/12,099); the use of lipid lowering drugs increased from 3.5% (187/55,331) to 19.8% (2,594/13,099). The use of angiotensin converting enzyme inhibitors increased from 8.5% to 34.8% of members with diabetes. Mean blood pressure decreased from 144/82 mm Hg (±0.8/0.4) to 138/79 mm Hg (±0.3/0.15), and mean total cholesterol concentrations dropped from 243 mg/dL (±4.2) to 215 mg/dL (±0.6). By 1996, 56.4% (7,388/1,3099) (±0.5%) of members on the diabetes register had good to excellent glycemic control (HbA 1c <8%). Mortality decreased from 4.8% (256/5331) (±0.3%) to 3.6% (472/13,099) (±0.2%) among members with diabetes, this was a more rapid decrease than was observed among those without diabetes (P < 0.01). The annual ratio of visits to the emergency room by members with diabetes to members without fell from 2.5 to 1.8, and the ratio for the number of days spent in acute care in the hospital dropped from 3.6 to 2.5. ⅷ Conclusions This centrally organized program based in a primary care setting and utilizing a register of patients with diabetes was associated with substantial improvements in the process and outcomes of care in a large population of health maintenance organization members with diabetes.

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Section: Discussionmentioning

confidence: 99%

Section: Study Site and Populationmentioning

confidence: 99%

Case-control study of 10 years of comprehensive diabetes care

Ga²,

Hs³

2000

Western Journal of Medicine

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“…Associated medical and societal costs are considerable (Brown et al, 1999a). Long-term hyperglycaemia promotes development of coronary heart disease, a major cause of death (Donnelly & Davis, 2000) as well as microvascular complications leading to neuropathy, kidney and eye disease (Cooper et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Arabinoxylan fibre improves metabolic control in people with Type II diabetes

et al. 2004

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Objective: To determine whether diet supplementation with arabinoxylan-rich (AX)-fibre from wheat improves glycaemic control in Type II diabetes. Design: Randomized, crossover intervention trial. Setting: Monash Medical Centre. Subjects: A total of 15 subjects with Type II diabetes. Interventions: Over two 5-week periods, subjects supplemented their usual diet with control bread and muffins (50% whole wheat, 50% white flour) (control diet) or with AX-bread and muffins (50% whole wheat, 36% white flour, 14% AX fibre) (AX diet). Subjects completed a 7-day food diary. At 0 and 5 weeks, venous blood was collected for determination of fasting and 2 h glucose, insulin, fructosamine and blood lipids. Blood pressure, body weight and body fat were also determined. A 24 h faecal sample, from 12 subjects, was weighed and analysed for faecal polysaccharide as a marker for dietary compliance. Results: Control and AX diets were similar except the AX diet supplied an additional 15.1 (12.0-18.5) (mean (95% confidence intervals)) g/day dietary fibre (P ¼ 0.000). Consumption of the AX diet increased faecal output by 61.5 (0.2-122.8) g/day (P ¼ 0.05) on a wet weight basis and significantly lowered fasting and 2 h plasma glucose, 2 h insulin and serum fructosamine (P ¼ 0.002, 0.000, 0.015, and 0.02, respectively). Blood lipids, body weight, fat mass and blood pressure remained unchanged. Conclusion: A supplement of 15 g/day of AX-rich fibre can significantly improve glycaemic control in people with Type II diabetes.

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“…We recently described the time pattern of incremental costs over the first 8 years after diagnosis in a population with known dates of recognition of type 2 diabetes (14). No studies have yet examined the time pattern of costs leading up to diagnosis.…”

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confidence: 99%

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

2000

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OBJECTIVE -To describe and analyze medical care costs for the 8 years preceding a diagnosis of type 2 diabetes. RESEARCH DESIGN AND METHODS-From electronic records of a large groupmodel health maintenance organization (HMO), we ascertained the medical care costs preceding diagnosis for all members with type 2 diabetes who were newly diagnosed between 1988 and 1995. To isolate incremental costs (costs caused by the future diagnosis of diabetes), we subtracted the costs of individually age-and sex-matched HMO members without impending diabetes from the costs of members who were destined to receive this diagnosis. We also compared these prediagnosis costs with the first 3 years of postdiagnosis costs.RESULTS -An economic burden from impending diabetes is apparent for at least 8 years before diagnosis, beginning with costs for outpatient and pharmacy services. Diabetes-associated incremental costs (costs of type 2 diabetic patients minus matched costs of nondiabetic patients) averaged $1,205 per type 2 diabetic patient per year during the first eight prediagnostic years, including $1,913 each year for the 3 years preceding diagnosis. In the year immediately preceding diagnosis, incremental costs were equivalent to those observed in the second and third years after diagnosis.CONCLUSIONS -Incremental costs of diabetes begin at least 8 years before diagnosis and grow at an accelerating rate as diagnosis approaches and immediately after diagnosis. These incremental costs span the full range of medical services. Furthermore, the majority of these costs are for conditions not normally associated with diabetes or its complications.

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

Cited by 114 publications

References 1 publication

Case-control study of 10 years of comprehensive diabetes care

Case-control study of 10 years of comprehensive diabetes care

Arabinoxylan fibre improves metabolic control in people with Type II diabetes

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

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