Cost-of-illness studies of diabetes mellitus: a systematic review

Socioeconomic inequality in financial hardship in accessing quality healthcare services in Ethiopia: a community-based cross-sectional study

Background

The 2030 Agenda for Sustainable Development aims to ensure that no one is left behind in health. However, the high magnitude of catastrophic health expenditure (CHE) and impoverishing health expenditure (IHE) remain global challenges. The financial hardship caused by healthcare has not been extensively studied in Ethiopia to date. Therefore, this study aimed to assess socioeconomic inequality in financial hardship and its determinants among households in the South Wollo zone, Ethiopia.

Methods

This cross-sectional study surveyed 845 households in the South Wollo zone from 1 May to 31 May 2023. Financial hardship was measured using the IHE and CHE metrics. The households were considered to experience IHE if their health expenditure pushed them below a poverty line of $2.15 (ETB 118.25) and considered to experience CHE if their health expenditure exceeded 10% of their total expenditure. Costs were estimated using prevalence-based and patient-perspective approaches. STATA version 17.0 was used for data management and analysis. We used the cixr and lorenz estimate STATA commands to estimate the concentration index (CIX) and generate the concentration curve (CC), respectively. An adjusted odds ratio (AORs) with a 95% confidence interval and a p-value of <0.05 were used to determine statistical significance.

Results

The CIX for wealth status was -0.17 (CI: -0.23, -0.11), with a p-value <0.001, indicating significant socioeconomic inequality in financial hardship of healthcare. The incidence of CHE was ~30% (95%CI; 26.91-33.16%) at the 10% threshold, while the incidence of IHE was ~4% at the $2.15 poverty line. Significant determinants of CHE included the poorest wealth status (AOR: 4.80, CI: 2.61-8.86), older age of the household head (AOR: 3.40, CI: 1.52-7.60), lack of insurance (AOR: 2.70, CI: 1.67-4.38), chronic illnesses (AOR: 5.12, CI: 3.24-8.10), being widowed (AOR: 4.30, CI: 1.27-14.57) or divorced (AOR: 6.45, CI: 1.89-21.10) in terms of marital status of the household head, and seeking traditional healthcare (AOR: 2.47, CI: 1.60-3.81).

Conclusion

This study revealed that there was significant inequality in financial hardship of health expenditure across household wealth categories. The incidences of CHE and IHE were higher. The wealth status of the household, insurance status, marital status of the household head, chronic illness, and seeking traditional healthcare were the key determinant factors of CHE. Therefore, policymakers should focus on underprivileged households to ensure effective healthcare financial risk protection (FRP).

Cost of hospitalization and length of stay of hypoglycemic events in hospitalized patients with diabetes mellitus: A cross-sectional study

This study aims to assess the length of stay and cost per hypoglycemia episode, as well as to determine the factors that influence the length of stay, intensive care unit (ICU) admission, and hospitalization costs among patients with diabetes mellitus. This is a retrospective cross-sectional study conducted on a cohort of diabetic individuals who experienced confirmed hypoglycemia episodes. The data pertaining to these patients were obtained from their respective hospital medical records, covering the period from January 2021 to December 2022. King Fahd Medical City was selected as the site of data collection for this study. A total of 396 patients were involved in this study. The median duration of stay for the patients was 7.0 (2.0-16.0) days. Only 3.0% of the patients had a previous hypoglycemia admission history. Around 53.3% of the patients were admitted to the ICU. The median duration of ICU admission stay was 1.0 (0.0-1.0) days. The highest cost driver for patients with hypoglycemia was ICU stay with a median cost of 9000.0 (1125.0-15750.0) Saudi Arabia riyal (SAR) (2399.6 (300.0-4199.2) United States dollar (USD)). The total median cost associated with hypoglycemia hospitalization was 4696.0 (886.5-12789.5) SAR (1252.0 (236.4-3410.0) USD). Ex-smokers were more likely to have higher hospitalization costs for hypoglycemia (4.4-folds) (P < .001). Being admitted to the ICU increased the likelihood of having a longer length of hospitalization by 2.6-folds (P < .001). Patients with longer diabetes duration (above 9 years) were more likely to be admitted to the ICU by 2.9-folds (P = .008). Understanding the factors that affect hypoglycemia hospitalization cost and length is essential for improving diabetes care and resource usage. Identifying high-risk patients and implementing efficient preventative strategies can lower the economic burden of DM and accompanying hypoglycemic episodes and enhance DM management.

Attributable one-year healthcare cost of incident type 2 diabetes: A population-wide difference-in-differences study in Denmark

AIM

The aim of this study is to estimate the causally attributable one-year healthcare costs for individuals getting a type 2 diabetes diagnosis compared to a matched sample and show the incurred costs of medication and in primary and secondary healthcare.

METHODS

Causal estimation using a difference-in-differences design to estimate the one-year health care costs attributable to type 2 diabetes. Danish registry data consisting of the entire population in years 2016-2019. Newly diagnosed individuals with type 2 diabetes in 2018 were identified using a validated method. Sociodemographic and historical health data were used to identify a matched control group. Individuals were followed for two years before and one year after the date of diagnosis using. Three cost components were analysed: medication and primary and secondary healthcare costs.

RESULTS

A total of 18,133 individuals were diagnosed with type 2 diabetes in 2018 and matched successfully 1:1 to a control group. The total attributable one-year cost of type 2 diabetes was EUR 1316. The main cost component was hospital care (EUR 1004) and primary care (EUR 167). The total attributable cost of incident diabetes in Denmark in 2018 was approx. EUR 24 million.

CONCLUSIONS

The majority of the first year health care cost of incident diabetes is incurred at the hospital level followed by primary care and medication. Our yearly cost estimate per newly diagnosed is considerably lower than estimates from the US and Australia.

Systematic Scoping Review of Socioeconomic Burden and Associated Psychosocial Impact in Patients With Rare Kidney Diseases and Their Caregivers

Introduction

Rare kidney diseases constitute a significant public health challenge but have attracted limited research investment. The evidence about the socioeconomic burden of rare kidney diseases has not been systematically examined. Such evidence is critical for generating the advocacy and awareness necessary to impel scientific and policy investment in targeted care in health systems worldwide. We aimed to evaluate the socioeconomic burden borne by patients with rare kidney diseases, their families, and caregivers, and the related psychosocial impact.

Methods

We undertook a systemic scoping review of the recent evidence of the socioeconomic and psychosocial burden of rare kidney diseases, to identify gaps in the understanding of this burden across contexts and factors influencing them. Three databases and the grey literature were searched for relevant studies published in the 10 years before April 30, 2023.

Results

Fifty-three articles met the inclusion criteria; one-quarter of these articles included rare disease cohorts in which the kidney was the primary organ affected, and 91% of studies were conducted in high-income countries. Evidence of substantial life-long socioeconomic burden emerged across the following 4 main categories: education (n = 17 articles [32%]), work and employment (n = 40 [75%] articles), psychosocial and emotional impact (n = 17 [32%]), and out-of-pocket expenses (n = 15 [28%]).

Conclusion

Significant gaps in our understanding of the socioeconomic burden remain, particularly in lower-resource health systems, among traditionally marginalized populations, and for rare diseases for which kidney is the primary affected organ. Further exploration of socioeconomic burden within these populations is vital to inform effectively targeted investment in advocacy and health care innovation for affected individuals.

Multimorbidity characteristics in older adults and their associated factors in complex networks: a cross-sectional study

Background

Multimorbidity of chronic diseases has become an increasingly serious public health problem. However, the research on the current situation of multimorbidity in the older adults in Jiangsu, China is relatively lacking.

Methods

We surveyed a total of 229,926 inpatients aged above 60 and with two or more chronic diseases in the First Affiliated Hospital with Nanjing Medical University from January 1, 2015 to December 31, 2021. The Apriori algorithm was used to analyze the association rules of the multimorbidity patterns in old adults.

Results

The mean age of these patients was 72.0 ± 8.7 years, and the male-to-female ratio was 1: 1.53. These patients during the COVID-19 period (from 2020 to 2021) displayed younger, higher male rate, shorter median length of hospital stay, higher ≥6 multimorbidities rate and lower median cost than those not during the COVID-19 period (from 2015 to 2019). In all of these patients, the top 5 chronic diseases were "Hypertensive diseases (I10-I15)," "Other forms of heart disease (I30-I52)," "Diabetes mellitus (E10-E14)," "ischaemic heart diseases (I20-I25)" and "Cerebrovascular diseases (I60-I69)." The complex networks of multimorbidity showed that Hypertensive diseases had a higher probability of co-occurrence with multiple diseases in all these patients, followed by diabetes mellitus, other forms of heart disease, and ischaemic heart diseases (I20-I25).

Conclusion

In conclusion, the patterns of multimorbidity among the aged varied by COVID-19. Our results highlighted the importance of control of hypertensive diseases, diabetes, and heart disease in most periods. However, during the pandemic period, we should pay more attention to diseases that require urgent treatment, such as malignant tumors. For different periods, the spectrum of diseases we focus on should change accordingly.

Magnitude, risk factors and economic impacts of diabetic emergencies in developing countries: A systematic review

BACKGROUND

Diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar syndrome (HHS) and severe hypoglycemia are considered as the life-threatening diabetic emergencies of diabetic patients worldwide. As the prevalence of diabetes grows in developing countries, so too does the impact of these costly human and economic complications. Noticeable scarcity of data concerning the magnitude, the cost expenditures as well as well unidentified predictors of these complications made the management more difficult in the resource limited health care settings. Thus, this systematic review aimed to assess the magnitude, risk factors and economic impacts of diabetes emergencies among diabetic patients in the developing countries.

METHODS

Following PRISMA (2020) guidelines, databases of PubMed, EMBASE, Cochrane and Scopus were searched for studies reporting on prevalence, risk factors, and direct costs of diabetes emergencies published in English from 2000 to 2023. Forty eligible studies were extracted and retrieved using manual data extraction form and automation tools. Studies were analyzed and combined in a narrative synthesis. The estimations of direct cost expenditure were standardized to 2023 USD.

RESULT

A comprehensive examination was conducted on the 40 eligible studies, with the majority originating from African sources. The review shows the prevalence of diabetic emergencies; DKA episodes in the range of (3.8%-73.4%), HHS (0.9%-58%) and Severe hypoglycemia (3.3%-64.7%) per year in the developing countries. Infection, new onset of the diabetes, and non-compliance to medications and diets were reported as the most common risk factors of theses diabetic emergencies. Besides, the costs of hospitalization taken from the patients' perspective, that were associated per one diabetic emergency event per patient was reported in the range of 105-230 USD in the developing countries.

CONCLUSION

The rising prevalence of diabetic emergencies in poor nations, where infections, non-compliance, and new onset of diabetes are major causes, highlighted the urgent need for preventative interventions. Identifying high-risk individuals is crucial for implementing tailored strategies to reduce emergency visits and hospital admissions. The significant economic burden of these emergencies exacerbates the strain on already limited healthcare resources. In order to enhance health outcomes and lessen the financial strain on healthcare systems in these areas, preventive strategies must be incorporated into diabetes management programs.

Cost-of-illness study among patients with diabetes mellitus and coping mechanisms in Northern Ghana

Introduction

The increasing prevalence of diabetes globally imposes financial burden on individuals, societies and health systems. However, not much is known about the treatment costs of diabetes and the coping mechanisms patients adopt in seeking care in the northern part of Ghana. In this study, we assessed the annual direct, indirect and intangible costs of diabetes mellitus care and related coping mechanisms of patients at the Tamale Teaching Hospital's Diabetic Clinic.

Methods

This was a descriptive cross-sectional cost-of-illness study conducted between June and August 2023 among 385 patients with diabetes in the Tamale Teaching Hospital of Ghana. Participants were selected by systematic random sampling. Direct medical costs (summation of cost of medications, investigations and admissions) and direct non-medical costs (cost of food and water, and transportation during hospital visits) together made up direct costs per patient per year. Indirect costs (lost wages as a result of illness or hospital visits) were estimated using the human capital approach. Intangible costs were analysed using a 5-point Likert Scale. Cost-coping mechanisms were obtained from the perspectives of the participants.

Results

The mean direct cost per person per year was found to be US$159.70 (95% CI 126.70 to 193.04), with direct medical costs being on average US$186.04 and direct non-medical costs being on average US$15.59, while the mean indirect cost per person per year was US$130.72. Average total cost of illness per person per year was found to be US$290.44 (95% CI 248.64 to 334.70). The study participants often experienced intangible costs such as physical pain, easy fatiguability and diet changes as a result of diabetes and adopted a number of cost-coping mechanisms which included the use of savings, borrowing and reducing medication use.

Conclusion

The costs incurred for care of diabetes mellitus in Northern Ghana are substantial, especially in view of Ghana's low minimum wage which was US$1.35 in 2023. This results in the adoption of adverse-cost-coping mechanisms that can drive families into further poverty with detrimental effects on the treatment of diabetes.

Instrumental variables in the cost of illness featuring type 2 diabetes

OBJECTIVE

To ascertain how an instrumental variables (IV) model can improve upon the estimates obtained from traditional cost-of-illness (COI) models that treat health conditions as predetermined.

STUDY SETTING AND DESIGN

A simulation study based on observational data compares the coefficients and average marginal effects from an IV model to a traditional COI model when an unobservable confounder is introduced. The two approaches are then applied to real data, using a kinship-weighted family history as an instrument, and differences are interpreted within the context of the findings from the simulation study.

DATA SOURCES AND ANALYTIC SAMPLE

The case study utilizes secondary data on type 2 diabetes mellitus (T2DM) status to examine healthcare costs attributable to the disease. The data come from Utah residents born between 1950 and 1970 with medical insurance coverage whose demographic information is contained in the Utah Population Database. Those data are linked to insurance claims from Utah's All-Payer Claims Database for the analyses.

PRINCIPAL FINDINGS

The simulation confirms that estimated T2DM healthcare cost coefficients are biased when traditional COI models do not account for unobserved characteristics that influence both the risk of illness and healthcare costs. This bias can be corrected to a certain extent with instrumental variables. An IV model with a validated instrument estimates that 2014 costs for an individual age 45-64 with T2DM are 27% (95% CI: 2.9% to 51.9%) higher than those for an otherwise comparable individual who does not have T2DM.

CONCLUSIONS

Researchers studying the COI for chronic diseases should assess the possibility that traditional estimates may be subject to bias because of unobserved characteristics. Doing so may be especially important for prevention and intervention studies that turn to COI studies to assess the cost savings associated with such initiatives.

The effects of local calf vibration on balance, blood flow, and nerve conductivity in patients with diabetic peripheral neuropathy: a pilot study

OBJECTIVES

This study aimed to evaluate the effects of local calf vibration on balance, blood flow, and nerve conductivity in patients with diabetic peripheral neuropathy (DPN).

METHODS

An open-label controlled trial was designed. Patients with confirmed diagnoses of type 2 diabetes and DPN were enrolled in the study and underwent ten sessions of local calf vibration therapy for the dominant leg. The other leg was considered the control. Balance evaluation, nerve conduction studies, and color Doppler ultrasound were performed before and after the treatment course. The Wilcoxon signed rank test and the Mann-Whitney test were used to evaluate the differences between the test results before and after the intervention and between the intervention and control legs.

RESULTS

Seventeen patients with a mean age of 60.3 ± 5.6 years (11 males) participated in the study. Mean Brief BESTest total scores were significantly improved (14.06 vs. 17.35; P = .01, Cohen's d = 0.743). There were no significant differences between the treated and control legs regarding the nerve conduction and color Doppler ultrasound parameters before and after the intervention (P ≥ .054). Changes in the parameters were also not significantly different between legs (P ≥ .078), except for common peroneal nerve conduction velocity, for which there was a higher increase in its value in the treated legs compared to the control legs (4.17 vs. 0.9, P = .002).

CONCLUSION

Local calf vibration may positively affect balance and lower extremities nerve conduction in patients with DPN, and the findings of this study can be a basis for studies evaluating the efficacy of local calf vibration for treating DPN.

A systematic review of the economic burden of diabetes mellitus: contrasting perspectives from high and low middle-income countries

Introduction

Diabetes increases preventative sickness and costs healthcare and productivity. Type 2 diabetes and macrovascular disease consequences cause most diabetes-related costs. Type 2 diabetes greatly costs healthcare institutions, reducing economic productivity and efficiency. This cost of illness (COI) analysis examines the direct and indirect costs of treating and managing type 1 and type 2 diabetes mellitus.

Methodology

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Cochrane, PubMed, Embase, CINAHL, Scopus, Medline Plus, and CENTRAL were searched for relevant articles on type 1 and type 2 diabetes illness costs. The inquiry returned 873 2011-2023 academic articles. The study included 42 papers after an abstract evaluation of 547 papers.

Results

Most articles originated in Asia and Europe, primarily on type 2 diabetes. The annual cost per patient ranged from USD87 to USD9,581. Prevalence-based cost estimates ranged from less than USD470 to more than USD3475, whereas annual pharmaceutical prices ranged from USD40 to more than USD450, with insulin exhibiting the greatest disparity. Care for complications was generally costly, although costs varied significantly by country and problem type.

Discussion

This study revealed substantial heterogeneity in diabetes treatment costs; some could be reduced by improving data collection, analysis, and reporting procedures. Diabetes is an expensive disease to treat in low- and middle-income countries, and attaining Universal Health Coverage should be a priority for the global health community.

The Economic Burden of Diabetic Retinopathy in Jordan: Cost Analysis and Associated Factors

Objective

Diabetic retinopathy (DR) is the leading cause of visual loss worldwide in patients with diabetes mellitus (DM). The aims of our study are to describe the costs associated with (DR) and to evaluate its economic impact in Jordan.

Methods

Retrospectively, we included all patients with DM and classified them according to the severity of DR. Data regarding medical history, ophthalmic history, stage of DR, presence of DME, and the ophthalmic procedures and operations were collected. The total DR-related cost was measured as a direct medical cost for the outpatient and inpatient services.

Results

Two hundred and twenty-nine patients were included in the study. Only 49.7% of the patients presented without DR, and 21% presented with diabetic macular edema (DME) unilaterally or bilaterally. The DR-related cost was significantly associated with insulin-based regimens, longer duration of DM, higher HbA1c levels, worse stage of DR at presentation, the presence of DME at presentation, the presence of glaucoma, and increased mean number of intravitreal injections, laser sessions, and surgical operations. Multivariate analysis should the presenting stage of DR, presence of DME, and the presence of DME be the independent factors affecting the DR-related cost.

Conclusion

This study is the first study to be conducted in Jordan and encourages us to establish a screening program for DR for earlier detection and treatment. DM control and treatment compliance will reduce the heavy costs of the already exhausted healthcare and financial system.

Health system costs of providing outpatient care for diabetes in people with TB in the Philippines

BACKGROUND

Diabetes mellitus (DM) is a known risk factor for active TB. A key activity in the Philippines is to integrate TB services with other disease programmes, with a target of DM screening in 90% of TB cases. However, costs of providing DM outpatient services for TB patients are not well known.

METHODS

We estimated the costs of providing integrated DM outpatient services within TB services from the health system perspective. Resources for outpatient DM services were valued using the bottom-up approach for capital goods, staff time and consumables. Resource quantities were obtained by interviewing 60 healthcare professionals in 11 health facilities in the Philippines.

RESULTS

The mean cost per service ranged from USD0.53 for DM risk assessment to USD23.72 for oral glucose tolerance test. The cost per case detected for different algorithms varied from USD17.43 to USD80.81. The monthly cost per patient was estimated at USD8.95 to USD12.36.

CONCLUSION

Our study provides the first estimates of costs for providing integrated DM outpatient services and TB care in a low- and middle-income country. The costs of DM detection in TB patients suggests that it may be useful to further investigate the cost-effectiveness and affordability of service delivery.

Cost-of-illness studies of inherited retinal diseases: a systematic review

BACKGROUND

While health care and societal costs are routinely modelled for most diseases, there is a paucity of comprehensive data and cost-of-illness (COI) studies for inherited retinal diseases (IRDs). This lack of data can lead to underfunding or misallocation of resources. A comprehensive understanding of the COI of IRDs would assist governmental and healthcare leaders in determining optimal resource allocation, prioritizing funding for research, treatment, and support services for these patients.

METHODS

Following PRISMA guidelines, a literature search was conducted using Medline, EMBASE and Cochrane databases, from database inception up to 30 Jun 2023, to identify COI studies related to IRD. Original studies in English, primarily including patients with IRDs, and whose main study objective was the estimation of the costs of IRDs and had sufficiently detailed methodology to assess study quality were eligible for inclusion. To enable comparison across countries and studies, all annual costs were standardized to US dollars, adjusted for inflation to reflect their current value and recalculated on a "per patient" basis wherever possible. The review protocol was registered in PROSPERO (registration number CRD42023452986).

RESULTS

A total of nine studies were included in the final stage of systematic review and they consistently demonstrated a significant disease burden associated with IRDs. In Singapore, the mean total cost per patient was roughly US$6926/year. In Japan, the mean total cost per patient was US$20,833/year. In the UK, the mean total cost per patient with IRD ranged from US$21,658 to US$36,549/year. In contrast, in the US, the mean total per-patient costs for IRDs ranged from about US$33,017 to US$186,051 per year. In Canada, these mean total per-patient costs varied between US$16,470 and US$275,045/year. Non-health costs constituted the overwhelming majority of costs as compared to healthcare costs; 87-98% of the total costs were due to non-health costs, which could be attributed to diminished quality of life, poverty, and increased informal caregiving needs for affected individuals.

CONCLUSION

IRDs impose a disproportionate societal burden outside health systems. It is vital for continued funding into IRD research, and governments should incorporate societal costs in the evaluation of cost-effectiveness for forthcoming IRD interventions, including genomic testing and targeted therapies.

The Effectiveness of Digital Health Lifestyle Interventions on People With Prediabetes: Protocol for a Systematic Review, Meta-Analysis, and Meta-Regression

BACKGROUND

There has been an increasing interest in the use of digital health lifestyle interventions for people with prediabetes, as these interventions may offer a scalable approach to preventing type 2 diabetes. Previous systematic reviews on digital health lifestyle interventions for people with prediabetes had limitations, such as a narrow focus on certain types of interventions, a lack of statistical pooling, and no broader subgroup analysis of intervention characteristics. The identified limitations observed in previous systematic reviews substantiate the necessity of conducting a comprehensive review to address these gaps within the field. This will enable a comprehensive understanding of the effectiveness of digital health lifestyle interventions for people with prediabetes.

OBJECTIVE

The objective of this systematic review, meta-analysis, and meta-regression is to systematically investigate the effectiveness of digital health lifestyle interventions on prediabetes-related outcomes in comparison with any comparator without a digital component among adults with prediabetes.

METHODS

This systematic review will include randomized controlled trials that investigate the effectiveness of digital health lifestyle interventions on adults (aged 18 years or older) with prediabetes and compare the digital interventions with nondigital interventions. The primary outcome will be change in body weight (kg). Secondary outcomes include, among others, change in glycemic status, markers of cardiometabolic health, feasibility outcomes, and incidence of type 2 diabetes. Embase, PubMed, CINAHL, and CENTRAL (Cochrane Central Register of Controlled Trials) will be systematically searched. The data items to be extracted include study characteristics, participant characteristics, intervention characteristics, and relevant outcomes. To estimate the overall effect size, a meta-analysis will be conducted using the mean difference. Additionally, if feasible, meta-regression on study, intervention, and participant characteristics will be performed. The Cochrane risk of bias tool will be applied to assess study quality, and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach will be used to assess the certainty of evidence.

RESULTS

The results are projected to yield an overall estimate of the effectiveness of digital health lifestyle interventions on adults with prediabetes and elucidate the characteristics that contribute to their effectiveness.

CONCLUSIONS

The insights gained from this study may help clarify the potential of digital health lifestyle interventions for people with prediabetes and guide the decision-making regarding future intervention components.

TRIAL REGISTRATION

PROSPERO CRD42023426919; http://tinyurl.com/d3enrw9j.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50340.

A Systematic Review of the Economic Burden of Diabetes in Eastern Mediterranean Region Countries

Diabetes Mellitus (DM) is a highly prevalent non-communicable disease with high mortality and morbidity, which imposes a significant financial impact on individuals and the healthcare system. The identification of various cost components through cost of illness analysis could be helpful in health-care policymaking. The current systematic review aims to summarize the economic burden of DM in the Eastern Mediterranean Region (EMR) countries. The original studies published in the English language between January 2010 and June 2023 reported the cost of DM was identified by searching four different databases (Google Scholar, PubMed, Science Direct, and Cochrane Central). Two reviewers independently screened the search results and extracted the data according to a predefined format, whereas the third reviewer's opinion was sought to resolve any discrepancies. The costs of DM reported in the included studies were converted to USD dates reported in the studies. After the systematic search and screening process, only 10 articles from EMR countries met the eligibility criteria to be included in the study. There are substantial variations in the reported costs of DM and the methodologies used in the included studies. The mean annual cost per patient of DM (both direct and indirect cost) ranged from 555.20 USD to 1707.40 USD. The average annual direct cost ranged from 155.8 USD to 5200 USD and indirect cost ranged from 93.65 USD to 864.8 USD per patient. The studies included in the review obtained a median score of 8.65 (6.5 ─ 11.5) on the quality assessment tool based on Alison's checklist for evaluation of cost of illness studies. There is a significant economic burden associated with DM, which directly affects the patients and healthcare system. Future research should focus on refining cost estimation methodologies, improving the understanding of study findings, and making it easier to compare studies.

Metformin Monotherapy Alters the Human Plasma Lipidome Independent of Clinical Markers of Glycemic Control and Cardiovascular Disease Risk in a Type 2 Diabetes Clinical Cohort

Type 2 diabetes (T2D) is a rising pandemic worldwide. Diet and lifestyle changes are typically the first intervention for T2D. When this intervention fails, the biguanide metformin is the most common pharmaceutical therapy. Yet its full mechanisms of action remain unknown. In this work, we applied an ultrahigh resolution, mass spectrometry-based platform for untargeted plasma metabolomics to human plasma samples from a case-control observational study of nondiabetic and well-controlled T2D subjects, the latter treated conservatively with metformin or diet and lifestyle changes only. No statistically significant differences existed in baseline demographic parameters, glucose control, or clinical markers of cardiovascular disease risk between the two T2D groups, which we hypothesized would allow the identification of circulating metabolites independently associated with treatment modality. Over 3000 blank-reduced metabolic features were detected, with the majority of annotated features being lipids or lipid-like molecules. Altered abundance of multiple fatty acids and phospholipids were found in T2D subjects treated with diet and lifestyle changes as compared with nondiabetic subjects, changes that were often reversed by metformin. Our findings provide direct evidence that metformin monotherapy alters the human plasma lipidome independent of T2D disease control and support a potential cardioprotective effect of metformin worthy of future study. SIGNIFICANCE STATEMENT: This work provides important new information on the systemic effects of metformin in type 2 diabetic subjects. We observed significant changes in the plasma lipidome with metformin therapy, with metabolite classes previously associated with cardiovascular disease risk significantly reduced as compared to diet and lifestyle changes. While cardiovascular disease risk was not a primary outcome of our study, our results provide a jumping-off point for future work into the cardioprotective effects of metformin, even in well-controlled type 2 diabetes.

Leaving no one behind in health: Financial hardship to access health care in Ethiopia

BACKGROUND

Financial hardship (of health care) is a global and a national priority area. All people should be protected from financial hardship to ensure inclusive better health outcome. However, financial hardship of healthcare has not been well studied in Ethiopia in general and in Debre Tabor town in particular. Therefore, this study aimed to assess the incidence of financial hardship of healthcare and associated factors among households in Debre Tabor town.

METHODS

Community based cross sectional study was conducted, from May 24/2022 to June 17/2022, on 423 (selected through simple random sampling) households. Financial hardship was measured through catastrophic (using 10% threshold level) and impoverishing (using $1.90 poverty line) health expenditures. Patient perspective bottom up and prevalence based costing approach were used. Indirect cost was estimated through human capital approach. Bi-variable and multiple logistic regressions were used.

RESULTS

The response rate was 95%. The mean household annual healthcare expenditure was Ethiopian birr 12050.64 ($227.37). About 37.1% (95%CI: 32, 42%) of the households spend catastrophic health expenditure with a 10% threshold level and 10.4% of households were impoverished with $1.90 per day poverty line. Being old, with age above 60, (AOR: 4.21, CI: 1.23, 14.45), being non-insured (AOR: 2.19, CI: 1.04, 4.62), chronically ill (AOR: 7.20, CI: 3.64, 14.26), seeking traditional healthcare (AOR: 2.63, CI: 1.37. 5.05) and being socially unsupported (AOR: 2.77, CI: 1.25, 6.17) were statistically significant factors for catastrophic health expenditure.

CONCLUSION

The study showed that significant number of households was not yet protected from financial hardship of healthcare. The financial hardship of health care is stronger among the less privileged populations: non-insured, the chronically diseased, the elder and socially unsupported. Therefore, financial risk protection strategies should be strengthened by the concerned bodies.

Looking at Diabetes-Related Distress through a New Lens: The Socio-Ecological Health Model

Diabetes-related distress (DRD) is defined as an emotional state experienced by people with diabetes (PWD) who are worried about their disease management, the emotional burden from the condition, and/or potential difficulties accessing care or support. The psychosocial aspect of diabetes management is a factor that directly influences patients’ well-being as well as the chronic management of the condition yet is not a primary clinical problem being addressed within the healthcare setting. This review advocates for a re-evaluation and subsequent adjustment of the current DRD screening methodology by implementing the five primary components (Intrapersonal, Interpersonal, Organizational, Community, and Public Policy) of the Socio-Ecological Model of Health (SEMH), bridging the gaps from a public-health perspective. We searched two electronic databases for studies published in the United States from 1995 to 2020 reporting the effects of social determinants of health (SDOH) on DRD. Articles that contained at least one of the five elements of the SEMH and focused on adults aged 18 years or older were included. SDOH, which include circumstances where individuals grow, work, and age, are highly influenced by external factors, such as the distribution of wealth, power, and resources. Current DRD screening tools lack the capacity to account for all major components of SDOH in a comprehensive manner. By applying the SEMH as a theory-based framework, a novel DRD screening tool addressing sex, ethnicity, and socioeconomic background should be implemented to better improve diabetes management outcomes. By exploring the relationships between each level of the SEMH and DRD, healthcare professionals will be better equipped to recognize potential stress-inducing factors for individuals managing diabetes. Further efforts should be invested with the goal of developing a novel screening tool founded on the all-encompassing SEMH in order to perpetuate a more comprehensive diabetes treatment plan to address barriers within the SDOH framework.

An economic evaluation of diabetes mellitus in India: A systematic review

BACKGROUND

Approximately 88 million people throughout Southeast Asia have diabetes, of which 77 million reside in India. India had an annual estimated diabetes treatment cost of Rs.10,000 to 12,000 crore in 2003, which is likely to rise to as high as Rs. 1,26,000 crores by 2025.

AIM

To assess the annual mean expenditure for an individual with diabetes mellitus.

METHODS

We used search terms and Boolean operators to identify studies on the economic burden of diabetes mellitus patients in India between 2015 and 2020. Thereafter, we used the checklists of STROBE, as well as the PRISMA, Drummonds and down, and Black criteria, to assess the quality of included studies. Then, Meta xl was used to calculate the weighted means and weighted proportion based on the quality assessment findings.

RESULTS

Mean expenditure with a maximum weightage of 100% was found in a community-based study, whereas the lowest weightage obtained was 20%. The mean expenditure on diabetes and its complications was calculated as INR 15,535/-(USD 209.3) per year, with a pooled mean of INR 17, 080(USD 230.1)per year. On average, the OPD charges were 3%-5% of the total annual income of the individual. However, when there were complications and hospitalization, the average expenditure was higher (21%) which averages to around 11,000 INR.

CONCLUSIONS

While patients spent 3% of their annual income on only OPD charges on average, complications substantially increased the total cost by more than 10%, which amounts to catastrophic health expenditure.

A procurement-based classification of pharmaceutical supplies for diabetes disease management

Background and Aims

Diabetes is among the most prevalent noncommunicable chronic diseases globally and carries a substantial expense in worldwide health care. Pharmaceutical supplies related to diabetes management account for 20%-40% of the disease's management cos, and this percentage continues to increase. This study examines the pharmaceutical expenses associated with one of the most common chronic diseases: diabetes. Specifically, we measure the extent to which patient health and demographic factors drive the annual cost of pharmaceutical supplies for diabetes management. Second, the study applied a procurement-centric classification scheme to pharmaceutical items involved in diabetes treatment.

Methods

Data on 98,648 pharmaceutical-dispensing transactions (related to 2828 patients) over 1 year were collected from a specialized diabetes health center. Pharmaceutical prices from the sample were compared internationally to ensure that the findings apply to other countries. The association between the item cost and the number of unique patients prescribed pharmaceutical products was estimated at the category and subcategory levels.

Results

Approximately 80% of total pharmaceutical expenditures were attributed to 20% of patients. Two of 20 pharmaceutical categories-anti-diabetes drugs and insulin-accounted for 34% of products dispensed and 57% of total pharmaceutical expenditures. Age, body mass index, and diabetes type were essential factors in predicting supply cost per patient.

Conclusion

Applying the portfolio purchasing model also suggested that some clinically similar items, like insulin types, are best procured through divergent procurement strategies or vendors for optimal cost efficiency. A better understanding of the diverse array of diabetes supplies can reveal opportunities for better strategic supply management. This supply classification approach can also be applied in other supply-intensive specialties, such as orthopedics.

Direct and indirect costs of heart failure in relation to diabetes status - A nationwide study

BACKGROUND AND AIM

Heart failure (HF) and diabetes mellitus (DM) are burdensome chronic diseases with high lifetime risks and numerous studies indicate associations between HF and DM. The objective of this study was to investigate the direct and indirect costs of HF patients with and without DM.

METHODS AND RESULTS

Patients with a first-time diagnosis of HF from 1998 to 2016 were identified through nationwide Danish registries and stratified according to DM status into HF with or without DM. The economic healthcare cost analysis was based on both direct costs, including hospitalization, procedures, medication and indirect costs including social welfare and lost productivity. The economic burden was investigated prior to, at, and following diagnosis of HF. Patients with concomitant HF and DM were younger (median age 74 vs. 77), had more comorbidities and fewer were female as compared to patients with HF but without DM. The socioeconomic burden of concomitant HF and DM compared to HF alone was substantially higher; 45% in direct costs (€16,237 vs. €11,184), 35% in home care costs (€3123 vs. €2320), 8% in social transfer income (€17,257 vs. €15,994) and they had 27% lower income (€10,136 vs. €13,845). The economic burden peaked at year of diagnosis, but the difference became increasingly pronounced in the years following the HF diagnosis.

CONCLUSION

Patients with concomitant HF and DM had a significantly higher economic burden compared to patients with HF but without DM.

Long non-coding RNA screening and identification of potential biomarkers for type 2 diabetes

BACKGROUND

To investigate new lncRNAs as molecular markers of T2D.

METHODS

We used microarrays to identify differentially expressed lncRNAs and mRNAs from five patients with T2D and paired controls. Through bioinformatics analysis, qRT-PCR validation, ELISA, and receiver operating characteristic (ROC) curve analysis of 100 patients with T2D and 100 controls to evaluate the correlation between lncRNAs and T2D, and whether lncRNAs could be used in the diagnosis of T2D patients.

RESULTS

We identified 68 and 74 differentially expressed lncRNAs and mRNAs, respectively. The top five upregulated lncRNAs are ENST00000381108.3, ENST00000515544.1, ENST00000539543.1, ENST00000508174.1, and ENST00000564527.1, and the top five downregulated lncRNAs are TCONS_00017539, ENST00000430816.1, ENST00000533203.1, ENST00000609522.1, and ENST00000417079.1. The top five upregulated mRNAs are Q59H50, CYP27A1, DNASE1L3, GRIP2, and lnc-TMEM18-12, and the top five downregulated mRNAs are GSTM4, PODN, GLYATL2, ZNF772, and CLTC. Examination of lncRNA-mRNA interaction pairs indicated that the target gene of lncRNA XR_108954.2 is E2F2. Multiple linear regression analysis showed that XR_108954.2 (r = 0.387, p < 0.01) and E2F2 (r = 0.368, p < 0.01) expression levels were positively correlated with glucose metabolism indicators. Moreover, E2F2 was positively correlated with lipid metabolism indicators (r = 0.333, p < 0.05). The area under the ROC curve was 0.704 (95% CI: 0.578-0.830, p = 0.05) for lncRNA XR_108954.2 and 0.653 (95% CI: 0.516-0.790, p = 0.035) for E2F2.

CONCLUSIONS

This transcriptome analysis explored the aberrantly expressed lncRNAs and identified E2F2 and lncRNA XR_108954.2 as potential biomarkers for patients with T2D.

A health economics study of long-acting injectable once-monthly paliperidone palmitate in schizophrenia: a one-year mirror-image study in China

Schizophrenia is ranked among the top 25 leading causes of disability worldwide in 2013 which resulting in social and economic burden. By observing patients with schizophrenia one year before and after switching from oral antipsychotics (OAPs) to once-monthly paliperidone palmitate (PP1M), we can better understand the change of total costs in schizophrenic patients, including direct costs and indirect costs, after switching treatment patterns.A total of 100 schizophrenic (ICD-10) patients from Shandong Mental Health Center were collected from December 2016 to June 2019. Treatment modalities, health care resource utilization and costs were compared before and after switching directly from oral antipsychotics to PP1M.Of the 82 patients included in the main analyses, treatment with PP1M resulted in an increase in direct costs of 31.92% (P < 0.01), an increase in medicine costs of approximately 142% (P < 0.01), and a reduction in hospital costs of 68.15% (P > 0.05). There was no significant increase in total costs (P = 0.25), while 31.92% increase in direct costs (P < 0.01), and 35.62% decrease in indirect costs (P < 0.01) after conversion to PP1M. Compared with before administration of PP1M, patients with ≥ 1 inpatient stay in 1 year Pre-PP1M treatment with OAPs (n = 32) had a 20.16% decrease in direct costs (P < 0.01), a 144% increase in medicine costs (P < 0.01), and a significant 72.02% decrease in hospital costs (P < 0.01). The observed reduction in the number of hospitalizations (t = 2.56, P ≤ 0.01) and inpatient stays (t = 1.73, P < 0.05) and after transition to PP1M resulted in a reduction in hospitalization costs (P < 0.01).Switching from OAPs to PP1M decreased the household workforce burden without increasing clinical healthcare costs. Direct costs were significantly reduced in patients with ≥ 1 inpatient stay in 1 year pre-PP1M treatment with OAPs after the switch, which decreased by improving adherence to therapy and reducing the number and length of hospital stays, suggesting that those patients may benefit after switching to PP1M.

An update on the economic burden of type 2 diabetes mellitus in China

OBJECTIVES

This study aims to update the statistics on the economic burden of T2DM and to identify the factors affecting the economic costs of T2DM in China.

METHODS

This study conducts a systematic review of the existing literature that has reported on the direct economic costs (mainly the direct medical resource consumption) and indirect economic costs (mainly non-medical costs and intangible costs) of T2DM as of 31 May 2019.

RESULTS

The total expenditure on diabetes in China's western region is still relatively low. Additionally, the mean direct costs of T2DM are high in China's northern urban areas. However, compared to urban areas, in rural areas, the largest proportion of the total economic costs of T2DM is the mean indirect costs. Furthermore, age, sex, type and number of complications, type of medical insurance, diabetes duration, level of education, and income are the primary factors that influence the economic burden of T2DM.

CONCLUSION

There is a considerable economic burden associated with T2DM in China. Therefore, to address the economic burden of T2DM, it is vital to take measures to reduce the prevalence rate of diabetes.

Health professionals’ views of the first national GP payment scheme for structured type 2 diabetes care in Ireland: a qualitative study

Background: Payment schemes are widely used to improve chronic disease management in general practice. Although stakeholder views of such schemes could provide valuable learning regarding aspects that work and those which are more difficult to implement, there is a paucity of such data. We explored health professionals’ views of the implementation of the first national general practice payment scheme for type 2 diabetes (T2DM) care in Ireland, the ‘cycle of care’. Methods: Qualitative data were drawn from a multiple case study evaluating the implementation of a National Clinical Programme for Diabetes, collected from April 2016 to June 2017. Interview and focus group transcripts from participants involved in providing diabetes management in general practice and who referenced the cycle of care were eligible for inclusion in the current analysis. Data were analysed using reflective thematic analysis. Results: We analysed data from 28 participants comprising general practitioners (GPs) (n=8), practice nurses (n=9) and diabetes nurse specialists (DNS) (n=11). Participants perceived the cycle of care as “not adequate, but…a good start” to improve T2DM care in general practice in Ireland. Perceived benefits were greater financial viability for T2DM management in general practice, fostering a more proactive approach to T2DM care, delivery of T2DM care closer to patients’ homes, and increased use of other community diabetes services e.g., DNS and podiatry. Participants identified the limited resource for practice nurse time, inflexibility to provide care based on patient need and issues with data submission as drawbacks of the cycle of care. Conclusions: The cycle of care was viewed as a positive first step to increase and improve T2DM care delivered in general practice in Ireland. The implementation issues identified in this study should be considered in the design of future payment schemes targeting chronic disease management in general practice.

A review of simulation models for the long-term management of type 2 diabetes in low-and-middle income countries

INTRODUCTION

The burden of type 2 diabetes is steadily increasing in low-and-middle-income countries, thereby posing a major threat from both a treatment, and funding standpoint. Although simulation modelling is generally relied upon for evaluating long-term costs and consequences associated with diabetes interventions, no recent article has reviewed the characteristics and capabilities of available models used in low-and-middle-income countries. We review the use of computer simulation modelling for the management of type 2 diabetes in low-and-middle-income countries.

METHODS

A search for studies reporting computer simulation models of the natural history of individuals with type 2 diabetes and/or decision models to evaluate the impact of treatment strategies on these populations was conducted in PubMed. Data were extracted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed using modelling checklists. Publications before the year 2000, from high-income countries, studies involving animals and analyses that did not use mathematical simulations were excluded. The full text of eligible articles was sourced and information about the intervention and population being modelled, type of modelling approach and the model structure was extracted.

RESULTS

Of the 79 articles suitable for full text review, 44 studies met the inclusion criteria. All were cost-effectiveness/utility studies with the majority being from the East Asia and Pacific region (n = 29). Of the included studies, 34 (77.3%) evaluated the cost-effectiveness of pharmacological interventions and approximately 75% of all included studies used HbA1c as one of the treatment effects of the intervention. 32 (73%) of the publications were microsimulation models, and 29 (66%) were state-transition models. Most of the studies utilised annual cycles (n = 29, 71%), and accounted for costs and outcomes over 20 years or more (n = 38, 86.4%).

CONCLUSIONS

While the use of simulation modelling in the management of type 2 diabetes has been steadily increasing in low-and-middle-income countries, there is an urgent need to invest in evaluating therapeutic and policy interventions related to type 2 diabetes in low-and-middle-income countries through simulation modelling, especially with local research data. Moreover, it is important to improve transparency and credibility in the reporting of input data underlying model-based economic analyses, and studies.

The effect of real-time monitoring of physical activity intensity in diabetic patients

AIM

To evaluate the effects of an intensity display type accelerometer on diabetic patients' physical activity.

METHODS

This was a two-arm, non-randomized controlled study. Both groups received information about the recommendation of 150 min/week moderate-to-vigorous physical activity (MVPA). The intervention group used an intensity display type accelerometer to monitor their physical activity intensity for 10 days at baseline and 3 months later. We compared intervention and control groups after 3 and 6 months. Primary outcomes were MVPA and number of steps over 7 days. Secondary outcomes were glycosylated hemoglobin (HbA1c), body mass index, and self-management.

RESULTS

Of 62 participants, 30 and 32 were included in the intervention and control groups, respectively. Mean age in each group was 59.7 ± 10.8 and 58.8 ± 10.2 years, and mean HbA1c was 6.9 ± 0.9% and 6.9 ± 0.8%, respectively. There were no significant differences between the intervention and control groups at either time point, and no outcomes showed significant changes. In a subgroup analysis by physical activity intensity, MVPA of active individuals in the control group significantly decreased at 6 months from baseline. MVPA and number of steps among inactive individuals in the intervention group significantly increased at 6 months from baseline. Self-management of the intervention group showed a trend toward improvement, but HbA1c and body mass index showed no significant change.

CONCLUSIONS

Monitoring physical activity intensity led to increased MVPA of inactive patients and maintained MVPA of active patients with diabetes mellitus. This straightforward intervention could be applied in clinical practice.

Cost of illness of diabetes mellitus in Indonesia: a systematic review

OBJECTIVES

Diabetes Mellitus (DM) is a group of insulin metabolism disorder that affects the socio-economic conditions of the community. The cost of treating diabetes in 2019 was USD 760 billion and by 2045 there are predicted to be 700 million people living with diabetes. The purpose of this systematic review was to provide an overview of the economic burden caused by Diabetes Mellitus for the government, health care providers, and for the community.

METHODS

This systematic review was carried out by considering the related studies about the cost of illness, evaluation of disease costs, or therapeutic costs for various types of diabetes mellitus that were published in both English and Indonesian. The search engines PUBMED, DOAJ, SCOPUS, SCIENCE DIRECT, and GOOGLE SCHOLAR were used without date published restrictions.

RESULTS

A systematic search identifies 18 eligible studies conducted in various regions in Indonesia. The study was retrospective with variation in their perspectives and methods to estimate the diabetes cost. Drug cost was the major contributor to direct medical cost followed by complications cost while other cost was affected by transportation cost, productivity losses, and time spent by family accompanying patients.

CONCLUSIONS

Diabetes mellitus creates a significant financial burden and affects the health care system as well as the individual and society as a whole. Research about the cost of diabetes in the future should be carried out on a large scale in order to get a more specific cost estimation.

The impact of diabetes on the productivity and economy of Bangladesh

AIMS

To estimate the impact of type 2 diabetes in terms of mortality, years of life lost (YLL) and productivity-adjusted life years (PALY) lost in Bangladesh.

METHODS

A life table model was constructed to estimate the productivity of the Bangladeshi population of current working age (20-59 years) with diabetes. Follow-up to 60 years (retirement age) was simulated. The life table analysis was then repeated assuming that the cohort did not have diabetes, with subsequent improvement in productivity. Differences in the results of the two analyses reflected the impact of diabetes on health and productivity. Demographic and the prevalence of diabetes data were sourced from the International Diabetes Foundation estimates for 2017 and mortality data were based on the 2017 Global Burden of Disease study. Relative risk and productivity indices were based on an Indian and Bangladeshi study, respectively. The cost of each PALY was assumed to be equivalent to gross domestic product (GDP) per equivalent full-time worker (US$8763). Future costs and years of life, and PALYs lived were discounted at an annual rate of 3%.

RESULTS

Assuming a follow-up of this population (aged 20-59 years) until age 60 years or death, an estimated 813 807 excess deaths, loss of 4.0 million life years (5.5%) and 9.2 million PALYs (20.4%) were attributable to having diabetes. This was equivalent to 0.7 YLL, and 1.6 PALYs lost per person. The loss in PALYs equated to a total of US$97.4 billion lost (US$16 987 per person) in GDP. The results of the scenario analysis showed that the estimation was robust.

CONCLUSION

In Bangladesh, the impact of diabetes on productivity loss and the broader economy looms large, and poses a substantial risk to the country's future prosperity. This highlights the critical importance of health strategies aimed at the control of diabetes.

Excess costs of type 2 diabetes and their sociodemographic and clinical determinants: a cross-sectional study using data from the German Health Interview and Examination Survey for Adults (DEGS1)

OBJECTIVES

The objectives of this study were to estimate the direct and indirect excess costs of type 2 diabetes mellitus (T2D) using data representative for the German adult population and to investigate the association of sociodemographic and clinical determinants with these excess costs.

SETTING

We calculated mean annual costs for individuals with T2D and a control group without diabetes, using data on healthcare utilisation and productivity losses from the cross-sectional German Health Interview and Examination Survey for Adults. We adjusted for group differences using entropy balancing and estimated excess costs for total, direct, indirect costs and additional cost categories using generalised linear models. We performed subgroup analyses to investigate the association of sociodemographic (age, sex and education) and clinical determinants (diabetes duration, glycaemic index and complications) with excess costs.

PARTICIPANTS

The final study sample included n=325 individuals with T2D and n=4490 individuals without diabetes in the age between 18 and 79 years.

RESULTS

Total excess costs amounted to €927, of which €719 were attributable to direct and €209 to indirect excess costs. Total costs were significantly increased by 28% for T2D compared with controls. Group differences in direct, outpatient and medication costs were statistically significant. Medication costs were 88% higher for T2D and had the highest share in direct excess costs. With respect to specific determinants, direct excess costs ranged from €203 for 4-10 years diabetes duration to €1405 for diabetes complications. Indirect excess costs ranged from €-544 for >10 years diabetes duration to €995 for high education.

CONCLUSIONS

T2D was associated with high costs, mainly due to direct costs. As pointed out by our results, diabetes complications and comorbidities have a large impact on the costs, leaving medication costs as main contributor of T2D excess costs.

Cost-of-illness studies in rare diseases: a scoping review

OBJECTIVE

The aim of this scoping review was to overview the cost-of-illness studies conducted in rare diseases.

METHODS

We searched papers published in English in PubMed from January 2007 to December 2018. We selected cost-of-illness studies on rare diseases defined as those with prevalence lower than 5 per 10,000 cases. Studies were selected by one researcher and verified by a second researcher. Methodological characteristics were extracted to develop a narrative synthesis.

RESULTS

We included 63 cost-of-illness studies on 42 rare diseases conducted in 25 countries, and 9 systematic reviews. Most studies (94%) adopted a prevalence-based estimation, where the predominant design was cross-sectional with a bottom-up approach. Only four studies adopted an incidence-based estimation. Most studies used questionnaires to patients or caregivers to collect resource utilisation data (67%) although an important number of studies used databases or registries as a source of data (48%). Costs of lost productivity, non-medical costs and informal care costs were included in 68%, 60% and 43% of studies, respectively.

CONCLUSION

This review found a paucity of cost-of-illness studies in rare diseases. However, the analysis shows that the cost-of-illness studies of rare diseases are feasible, although the main issue is the lack of primary and/or aggregated data that often prevents a reliable estimation of the economic burden.

Cost-of-illness studies in rare diseases: a scoping review

OBJECTIVE

The aim of this scoping review was to overview the cost-of-illness studies conducted in rare diseases.

METHODS

We searched papers published in English in PubMed from January 2007 to December 2018. We selected cost-of-illness studies on rare diseases defined as those with prevalence lower than 5 per 10,000 cases. Studies were selected by one researcher and verified by a second researcher. Methodological characteristics were extracted to develop a narrative synthesis.

RESULTS

We included 63 cost-of-illness studies on 42 rare diseases conducted in 25 countries, and 9 systematic reviews. Most studies (94%) adopted a prevalence-based estimation, where the predominant design was cross-sectional with a bottom-up approach. Only four studies adopted an incidence-based estimation. Most studies used questionnaires to patients or caregivers to collect resource utilisation data (67%) although an important number of studies used databases or registries as a source of data (48%). Costs of lost productivity, non-medical costs and informal care costs were included in 68%, 60% and 43% of studies, respectively.

CONCLUSION

This review found a paucity of cost-of-illness studies in rare diseases. However, the analysis shows that the cost-of-illness studies of rare diseases are feasible, although the main issue is the lack of primary and/or aggregated data that often prevents a reliable estimation of the economic burden.

Association of diabetes type and chronic diabetes complications with early exit from the labour force: register-based study of people with diabetes in Finland

AIMS/HYPOTHESIS

Diabetes and diabetes complications are a cause of substantial morbidity, resulting in early exits from the labour force and lost productivity. The aim of this study was to examine differences in early exits between people with type 1 and 2 diabetes and to assess the role of chronic diabetes complications on early exit. We also estimated the economic burden of lost productivity due to early exits.

METHODS

People of working age (age 17-64) with diabetes in 1998-2011 in Finland were detected using national registers (Ntype 1 = 45,756, Ntype 2 = 299,931). For the open cohort, data on pensions and deaths, healthcare usage, medications and basic demographics were collected from the registers. The outcome of the study was early exit from the labour force defined as pension other than old age pension beginning before age 65, or death before age 65. We analysed the early exit outcome and its risk factors using the Kaplan-Meier method and extended Cox regression models. We fitted linear regression models to investigate the risk factors of lost working years and productivity costs among people with early exit.

RESULTS

The difference in median age at early exit from the labour force between type 1 (54.0) and type 2 (58.3) diabetes groups was 4.3 years. The risk of early exit among people with type 1 diabetes increased faster after age 40 compared with people with type 2 diabetes. Each of the diabetes complications was associated with an increase in the hazard of early exit regardless of diabetes type compared with people without the complication, with eye-related complications as an exception. Diabetes complications partly but not completely explained the difference between diabetes types. The mean lost working years was 6.0 years greater in the type 1 diabetes group than in the type 2 diabetes group among people with early exit. Mean productivity costs of people with type 1 diabetes and early exit were found to be 1.4-fold greater compared with people with type 2 diabetes. The total productivity costs of incidences of early exits in the type 2 diabetes group were notably higher compared with the type 1 group during the time period (€14,400 million, €2800 million).

CONCLUSIONS/INTERPRETATION

We found a marked difference in the patterns of risk of early exit between people with type 1 and type 2 diabetes. The difference was largest close to statutory retirement age. On average, exits in the type 1 diabetes group occurred at an earlier age and resulted in higher mean lost working years and mean productivity costs. The potential of prevention, timely diagnosis and management of diabetes is substantial in terms of avoiding reductions in individual well-being and productivity.

Are Ethiopian diabetic patients protected from financial hardship?

Background

Globally, diabetes mellitus exerts an economic burden on patients and their families. However, the economic burden of diabetes mellitus and its associated factors were not well studied in Ethiopia. Therefore, the aim of this study is to assess the economic burden of diabetes mellitus and its associated factors among diabetic patients in public hospitals of Bahir Dar city administration, Ethiopia.

Methods

Across sectional study was conducted on 422 diabetic patients. The patients were selected by simple random sampling method. The prevalence-based model was used to estimate the costs on patients’ perspective. Bottom up and human capital approaches were used to estimate the direct and indirect costs of the patients respectively. Wealth index was constructed using principal component analysis by SPSS. Forty percent of nonfood threshold level was used to measure catastrophic diabetic care expenditure of diabetic patients. Whereas, the World Bank poverty line (the $1.90-a-day poverty line) was used to measure impoverishment of patients due to expenses of diabetes mellitus care. Data were entered by Epi data version 3.1and exported to SPSS version 23 for analysis. Simple and multiple logistic regressions were used.

Results

Four hundred one respondents were interviewed with response rate of 95%. We found that 239 (59.6%) diabetic patients incurred catastrophic diabetic care expenditure at 40% nonfood threshold level. Whereas, 20 (5%) diabetic patients were impoverished by diabetic care spending at the $1.90-a-day poverty line. Educational status of respondent, educational status of the head of household, occupation and wealth status were statistically associated with the catastrophic diabetic care expenditure.

Conclusions

The study revealed that the economic burden of diabetic care is very disastrous among the less privileged populations: the less educated, the poorest and unemployed. Therefore, all concerned stakeholders should design ways that can reduce the financial hardship of diabetic care among diabetic patients.

Service integration for improved diabetic and dental care: exploring an effective model for optimising health outcomes

Purpose

This study identifies and synthesizes existing literature on the integration of diabetic and dental services and explores a service integration model for optimising diabetic patient health outcomes and improving healthcare systems in low and middle-income countries.

Design/methodology/approach

Peer-reviewed literature that analysed the integration of health services regarding dental and medical services were reviewed. The articles were identified using the Academic Search Complete, Business Source Complete, CINAHL Complete, Google Scholar and MEDLINE databases and screened using the PRISMA guidelines.

Findings

A total of 40 full-text articles were examined for eligibility out of which 26 were selected for analysis. Diabetes was shown to contribute significantly to the global disease burden and this is also reflected in most low and middle-income countries. It is found that the integration of medical and dental services could help alleviate this burden. Hence, locally adapted Rainbow-Modified Integrated Care model is proposed to fill this integration gap.

Originality

The integration of dental and medical services has been proven to be useful in improving diabetic patient outcomes. Hence, the need to facilitate cross-professional collaboration between dentists and physicians cannot be overemphasised and this can be extended and locally adapted by different health systems across the world.

Practice Implications

The integration of dental and diabetic services using models such as the Rainbow Model of Integrated Care is recommended to optimise health outcomes of diabetic patients and enhancing service delivery, especially in resource-poor healthcare systems.

Burden of disease of type 2 diabetes mellitus: cost of illness and quality of life estimated using the Maastricht Study

AIMS

To estimate the societal costs and quality of life of people with type 2 diabetes and to compare these results with those of people with normal glucose tolerance or prediabetes.

METHODS

Data from 2915 individuals from the population-based Maastricht Study were included. Costs were assessed through a resource-use questionnaire completed by the participants; cost prices were based on Dutch costing guidelines. Quality of life was expressed in utilities using the Dutch EuroQol 5D-3L questionnaire and the SF-36 health survey. Based on normal fasting glucose and 2-h plasma glucose values, participants were classified into three groups: normal glucose tolerance (n = 1701); prediabetes (n = 446); or type 2 diabetes (n = 768).

RESULTS

Participants with type 2 diabetes had on average 2.2 times higher societal costs than those with normal glucose tolerance (€3,006 and €1,377 per 6 months, respectively) and had lower utilities (0.77 and 0.81, respectively). No significant differences were found between participants with normal glucose tolerance and those with prediabetes. Subgroup analyses showed that higher age, being female and having two or more diabetes-related complications resulted in higher costs (P < 0.05) and lower utilities.

CONCLUSIONS

This study showed that people with type 2 diabetes have substantially higher societal costs and lower quality of life than people with normal glucose tolerance. The results provide important input for future model-based economic evaluations and for policy decision-making.

Resource use and costs in patients with poorly controlled type 2 diabetes mellitus and obesity in routine clinical practice in Spain

OBJECTIVE

To compare healthcare resource use (HRU) and annual costs in type 2 diabetes mellitus (T2DM) patients with poor glycaemic control and obesity versus good glycaemic control without obesity.

METHODS

Observational retrospective study based on the analysis of electronic medical records from the BIG-PAC database, with one year of follow-up. T2DM patients aged ≥30 years who requested medical care during 2013 were included. Annual HRU and costs per patient were compared between a reference group (HbA1c ≥ 8%, BMI ≥30 kg/m², receiving ≥2 oral antidiabetic drugs [OADs]) and a control group (HbA1c < 7% and BMI <30 kg/m²). Direct and indirect costs (lost productivity) were analysed. Cost comparisons across groups were made using the analysis of covariance (ANCOVA) for each cost component, with age, sex, time from diagnosis, Charlson comorbidity index, OAD number and sex by group interaction as covariates.

RESULTS

During the follow-up, patients in the reference group (N = 2709) had a greater HRU than those in the control group (N = 5266), especially in the number of primary care (PC) visits (11.8 vs. 9.8; 95%CI: 11.5-12.1 vs. 9.6-10.0) and days of hospitalization (1.1 vs 0.6; 95%CI: 1.0-1.2 vs. 0.5-0.7). The main components of the total cost were hospital admissions (24.5%), productivity losses (16.3%), complementary tests (14.4%), PC visits (14.2%) and medication (13.6%) in the reference group and medication (19.6%), hospital admissions (18.7%) and PC visits (18.2%) in the control group. The corrected mean annual cost per patient was higher in the reference than in the control group: €1804 vs. €1309; p < .001.

CONCLUSIONS

Poor glycaemic control and obesity in T2DM patients were associated with increased HRU and costs in routine clinical practice.

A Systematic Review of the Economic Burden of Type 2 Diabetes in Malaysia

Diabetes causes significant disabilities, reduced quality of life and mortality that imposes huge economic burden on societies and governments worldwide. Malaysia suffers a high diabetes burden in Asia, but the magnitude of healthcare expenditures documented to aid national health policy decision-making is limited. This systematic review aimed to document the economic burden of diabetes in Malaysia, and identify the factors associated with cost burden and the methods used to evaluate costs. Studies conducted between 2000 and 2019 were retrieved using three international databases (PubMed, Scopus, EMBASE) and one local database (MyCite), as well as manual searches. Peer reviewed research articles in English and Malay on economic evaluations of adult type 2 diabetes conducted in Malaysia were included. The review was registered with PROSPERO (CRD42020151857), reported according to PRISMA and used a quality checklist adapted for cost of illness studies. Data were extracted using a data extraction sheet that included study characteristics, total costs, different costing methods and a scoring system to assess the quality of studies reviewed. The review identified twelve eligible studies that conducted cost evaluations of type 2 diabetes in Malaysia. Variation exists in the costs and methods used in these studies. For direct costs, four studies evaluated costs related to complications and drugs, and two studies were related to outpatient and inpatient costs each. Indirect and intangible costs were estimated in one study. Four studies estimated capital and recurrent costs. The estimated total annual cost of diabetes in Malaysia was approximately USD 600 million. Age, type of hospitals or health provider, length of inpatient stay and frequency of outpatient visits were significantly associated with costs. The most frequent epidemiological approach employed was prevalence-based (n = 10), while cost analysis was the most common costing approach used. The current review offers the first documented evidence on cost estimates of diabetes in Malaysia.

Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses

Objectives: To estimate the clinical and economic burden of type 2 diabetes (T2D) in established (EST) and emerging markets (EMG).Methods: Three systematic literature reviews were conducted in MEDLINE and Embase to capture all relevant publications reporting 1) the epidemiology of T2D and complications in T2D and 2) the economic burden of T2D and associated complications.Results: In total, 294 studies were included in this analysis. Evidence indicates a high and increasing overall prevalence of T2D globally, ranging up to 23% in EMG markets and 14% in EST markets. Undiagnosed cases were higher in EMG versus EST markets (up to 67% vs 38%), potentially due to a lack of education and disease awareness in certain regions, that could lead to important clinical and economic consequences. Poor glycemic control was associated with the development of several complications (e.g. retinopathy, cardiovascular diseases and nephropathy) that increase the risk of morbidity and mortality. Direct costs were up to 9-fold higher in patients with vs without T2D-related complications.Conclusions: The burden of T2D, related complications and inherent costs are higher in emerging versus established market countries. This review explores potential strategies to reduce costs and enhance outcomes of T2D treatment in developing countries.

Cost of hospitalisation and length of stay due to hypoglycaemia in patients with diabetes mellitus: a cross-sectional study

Objective:

This study aims to estimate the length of stay and hospitalisation cost of hypoglycaemia, and to identify determinants of variation in the length of stay and hospitalisation cost among individual patients with type 1 or 2 diabetes mellitus.

Methods:

A cross-sectional study was conducted using inpatients records for patients with diabetes mellitus who had been hospitalised due to hypoglycaemic events in two private hospitals in Amman, Jordan between January 2009 and May 2017. All hospitalisation costs were inflated to the equivalent costs in 2017. Hospitalisation cost was estimated from the patient’s perspective in Jordanian dinars (JOD). Descriptive analyses and correlation between sociodemographic or clinical characteristics with the cost and length of stay were explored. Predictors of hypoglycaemic hospitalisation cost and length of stay were determined using logistic regression.

Results:

During the study period a total of 126 patients with diabetes mellitus were hospitalised due to an incident of hypoglycaemia. The mean patient age was 64.2 (SD=19.6) years; half were male. Patients admitted for hypoglycaemia stayed in hospital for a median duration of two days (IQR=2 days). The median cost of hospitalisation for hypoglycaemia was 163.2 JOD (USD 230.1) (IQR=216.3 JOD). We found that the Glasgow coma score was positively associated with length of stay (0.345, p=0.008), and older age was correlated with higher hospitalisation cost (0.207, p=0.02). Patients with a family history of diabetes had higher hospitalisation costs and longer duration of stay (0.306 and 0.275, p<0.05). In addition, being a male patient (0.394, p<0.05) and with an absence of smoking history was associated with longer duration of stay (0.456, p<0.01), but not with higher hospitalisation cost.

Conclusions:

Costs associated with the incidence of hypoglycaemic events are not low and constitute a large cost component of managing and treating diabetes mellitus. Male patients and patients having a family history of diabetes should receive extra care and education on the prevention of hypoglycaemic events, and a treatment de-intensification approach should be considered if necessary, so we can prevent its associated hospitalisation costs and length of stay.

Direct non-medical and indirect costs of diabetes and its associated complications in Vietnam: an estimation using national health insurance claims from a cross-sectional survey

OBJECTIVE

The prevalence of diabetes in Vietnam has increased from 2.5% in 2007 to 5.5% in 2017, but the burden of direct non-medical and indirect costs is unknown. The objective of this study was to estimate the direct non-medical costs and indirect costs due to type 2 diabetes mellitus (T2DM) and its associated complications among Vietnam Health Insurance System (VHIS) enrollees in Vietnam.

DESIGN

The first phase was a cross-sectional survey of patients with T2DM. In the second phase, data from the previous phase were used to predict direct non-medical costs and presenteeism costs of VHIS enrollees diagnosed with T2DM based on demographic and clinical characteristics in 2017. The human-capital approach was used for the calculation of indirect costs.

SETTING AND PARTICIPANTS

This study recruited 315 patients from a national hospital, a provincial hospital and a district hospital aged 18 or above, diagnosed with T2DM, enrolled in VHIS, and having at least one visit to hospitals between 1 June and 30 July 2018. The VHIS dataset contained 1,395,204 patients with T2DM.

OUTCOME MEASURES

The direct non-medical costs and presenteeism were collected from the survey. Absenteeism costs were estimated from the VHIS database. Costs of premature mortality were calculated based on the estimates from secondary sources.

RESULTS

The total direct non-medical and indirect costs were US$239 million in 2017. Direct non-medical costs were US$78 million, whereas indirect costs were US$161 million. Costs of absenteeism, presenteeism and premature mortality corresponded to 17%, 73% and 10% of the indirect costs. Patients incurred annual mean direct non-medical costs of US$56. Annual mean absenteeism and presenteeism costs for patients in working age were US$61 and US$267, respectively.

CONCLUSIONS

The impact of T2DM on direct non-medical and indirect costs on diabetes is substantial. Direct non-medical and absenteeism costs were higher in patients with complications.

Patients with Combination of Cardiovascular Diseases and Type 2 Diabetes in RECVASA and REGION Registries: Multimorbidity, Outcomes and Potential Effect of Dapagliflozin in the Russian Clinical Practice

Aim. To evaluate the structure of multimorbidity, outcomes and the potential effect of dapagliflozin in patients with a combination of cardiovascular disease (CVD) and type 2 diabetes in Russian clinical practice.

Material and methods. The data of 10 registries with the inclusion of 22957 people, including 4370 with type 2 diabetes in 6 regions of the Russian Federation, were analyzed. Scenarios for reducing mortality from all and cardiovascular causes and hospitalizations for CVD were simulated among groups of patients with diabetes combined with myocardial infarction (MI) and diabetes combined with heart failure with reduced ejection fraction (HFrEF) based on data from the Federal Registry of diabetes, the RECVASA and REGION registries, relative risks associated with analyzed adverse events from the DECLARE study.

Results. When analyzing the data of all 22957 patients with CVD included in the registries, it was found that the proportion of patients with comorbid diabetes was on average 19.0%. Of the various diagnoses of CVD, the combination with diabetes was most often recorded in patients that had MI – 2.0%, stroke – 22.5% and heart failure – 24.0%. In the RECVASA registry (Ryazan) for 4 years of follow-up of 699 patients with a combination of CVD and diabetes mortality from all causes was 20.9%, and from cardiovascular causes – 15.6%. The simulated number of potentially prevented cardiovascular deaths with dapagliflozin taking in patients with diabetes combined with MI for 4 years in Russia will be 39124, and 37440 cardiovascular hospitalizations. The number of potentially preventable deaths from all causes among patients with diabetes combined with HFrEF will be 4543, cardiovascular deaths in 1995, and the number of prevented cardiovascular hospitalizations will be 7072.

Conclusion. According to data from the registries of CVD patients in 6 regions of the Russian Federation, it was revealed that in real clinical practice the proportion of people with comorbid diabetes averaged 19% both at the outpatient and hospital stages. These subgroups of multimorbid patients have both the highest risk of developing fatal and non-fatal cardiovascular complications, and the largest number of indications for prescribing drugs that affect the prognosis due to effects on both CVD and diabetes.

Health economic assessment of a shift to active transport

Active transportation (walking or cycling) as a substitute for car trips still represents a small percentage of all daily travels in many European cities. This study aimed to estimate the health and economic co-benefits for the adult population of modal shift from driving to active travel in urban environments. Three scenarios were modelled for the case study, the city of Porto, Portugal, by comparing travel patterns of 2013 to hypothetical scenarios of modal shifts from driving to active transport, namely: i) SC1 - conservative scenario, with a change of 5% from driving to cycling and 10% from driving to walking; ii) SC2 - moderate scenario, with a shift of 10% and 15%, respectively; and iii) SC3 - optimistic scenario, with a shift of 15% and 20%, respectively. The mortality risk reduction for five health outcomes (colon and breast cancers, diabetes, ischemic heart disease, cerebrovascular disease) was assessed, including an estimation of traffic injury and air pollution exposure risks. Results were presented in Disability-Adjusted Life Years (DALYs) avoided. Economic valuation for each scenario was performed using a Willingness-to-Pay approach for morbimortality and a Cost of Illness approach for 2013 hospitalizations and work absenteeism. Significant health benefits were found in all modelled scenarios, ranging from 1657 (16%) to 2881 (28%) DALYs avoided. Total costs averted ranged from €3894 to €6769 million through the scenarios. Cardio and cerebrovascular diseases mortality presented the largest benefit, accounting for about 3/4 of all avoidable DALYs in all scenarios. Reductions in CO₂ and PM₁₀ emissions were calculated, showing a decrease from 31.6 to 73.7 kt of CO₂ and 7 to 16 t for PM₁₀, respectively. A modal shift towards active transportation could lead to significant health and economic benefits, indicating that the evaluation of health impacts should be included in the analysis of active transport interventions.

Medical Costs of Patients with Type 2 Diabetes in a Single Payer System: A Classification and Regression Tree Analysis

BACKGROUND AND OBJECTIVES

Many studies and systematic reviews have estimated the healthcare costs of diabetes using a cost-of-illness approach. However, in the studies based on this approach patients' heterogeneity is rarely taken into account. The aim of this study was to stratify patients with type 2 diabetes into homogeneous cost groups based on demographic and clinical characteristics.

METHODS

We conducted a retrospective cost-of-illness study by linking individual data on health services utilization retrieved from the administrative databases of Emilia-Romagna Region (Italy). Direct medical costs (either all-cause or diabetes-related) were calculated from the perspective of the regional health service, using tariffs for hospitalizations and outpatient services and the unit costs of prescriptions for drugs. The determinants of costs identified in a generalized linear regression model were used to characterize subgroups of patients with homogeneous costs in a classification and regression tree analysis.

RESULTS

The study population consisted of a cohort of 101,334 patients with type 2 diabetes, followed up for 1 year, with a mean age of 70.9 years. Age, gender, complications, comorbidities and living area accounted significantly for cost variability. The classification tree identified ten patient subgroups with different costs, ranging from a median of €483 to €39,578. The two subgroups with highest costs comprised dialysis patients, and the largest subgroup (57.9%) comprised patients aged ≥ 65 years without renal, cardiovascular and cerebrovascular complications.

CONCLUSIONS

Classification of patients into homogeneous cost subgroups can be used to improve the management of, and budget allocation for, patients with type 2 diabetes.

Risk of acute mesenteric ischemia in patients with diabetes: A population-based cohort study in Taiwan

BACKGROUND AND AIMS

Diabetes is a common and complex endocrine disorder that often results in hyperglycemia, which has been strongly implicated in several cardiovascular and cerebrovascular events that cause disability. Acute mesenteric ischemia (AMI) is a vascular emergency with high mortality rates. We conducted a population-based cohort study that utilizes data from medical claims databases to investigate whether diabetes increases the risk of AMI.

METHODS

Using claims data from Taiwan's National Health Insurance program, 66,624 diabetic patients were enrolled from 1998 to 2009, and a comparison group of 266,496 individually matched subjects without diabetes was selected. The two groups were followed up until diagnosis of AMI, death, or the end of 2011. Incidence rates of AMI were assessed in both groups. Cox proportional hazards models were used to estimate the hazard ratios of diabetes for AMI.

RESULTS

The diabetes cohort had a higher incidence rate than the comparison cohort for AMI (0.56 vs. 0.29 per 1,000 person-years). After adjusting for sex, age, comorbidity, and health system utilization, the adjusted hazard ratio of diabetes was 1.32 (95% confidence interval 1.11-1.56) for AMI. The risk of AMI associated with diabetes was greater in men (adjusted hazard ratio = 1.48, 95% confidence interval 1.17-1.87) than in women (adjusted hazard ratio = 1.17, 95% confidence interval 0.92-1.49).

CONCLUSIONS

There was an increased risk of AMI in patients with diabetes. However, further research is required to understand whether this association is causal or due to a common set of risk factors.

Analysis of providing medical care to patients with diabetes in foreign countries

The authors of the article analyzed the publications devoted to the prospects of medical care to diabetic patients abroad. The main attention is paid to gross observational pharmacoeconomical studies as the most effective tool for planning and organization of specialized medical care for patients with diabetes. There is a tendency to increase the role of outpatient care for sufferers, as well as to introduce the elements of standardization, modern information and communication technologies into clinical practice. The challenges of implementation of medical information systems (MIS) to manage the quality of medical care in clinical practice are also pointed out. Proper evaluation of quality parameters is impossible without a complex process of collecting primary medical data with the use of modern computer technology. To ensure the reliability and relevance of information, it is desirable that it is collected and entered into the database by the attending physician directly at the outpatient reception hours. AWPE DM (automated workplace of an endocrinologist for outpatient admission of patients with diabetes mellitus) is a computer program designed to collect medical data of outpatients without additional working time expenditures, followed by a printout of the formalized protocol. Its application in everyday practice allows to solve the local problem of formalization and informational support of primary care to diabetic patients, to systematize the processes of collecting primary medical information. In the future, data provided by AWPE DM can be exported to the Federal Register of Diabetes Mellitus (FRDM) in order to update its database.