Treatment of Type 2 diabetes mellitus in Chongqing of China: unaffordable care for the poor

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.

Development and Validation of a Novel Model for Predicting the 5-Year Risk of Type 2 Diabetes in Patients with Hypertension: A Retrospective Cohort Study

Background

Hypertension is now common in China. Patients with hypertension and type 2 diabetes are prone to severe cardiovascular complications and poor prognosis. Therefore, this study is aimed at establishing an effective risk prediction model to provide early prediction of the risk of new-onset diabetes for patients with a history of hypertension.

Methods

A LASSO regression model was used to select potentially relevant features. Univariate and multivariate Cox regression analyses were used to determine independent predictors. Based on the results of multivariate analysis, a nomogram of the 5-year incidence of T2D in patients with hypertension in mainland China was established. The discriminative capacity was assessed by Harrell's C-index, AUC value, calibration plot, and clinical utility.

Results

After random sampling, 1273 and 415 patients with hypertension were included in the derivation and validation cohorts, respectively. The prediction model included age, body mass index, FPG, and TC as predictors. In the derivation cohort, the AUC value and C-index of the prediction model are 0.878 (95% CI, 0.861-0.895) and 0.862 (95% CI, 0.830-0.894), respectively. In the validation cohort, the AUC value and C-index of the prediction model were 0.855 (95% CI, 0.836-0.874) and 0.841 (95% CI, 0.817-0.865), respectively. The calibration plots demonstrated good agreement between the estimated probability and the actual observation. Decision curve analysis shows that nomograms are clinically useful.

Conclusion

Our nomogram can be used as a simple, affordable, reasonable, and widely implemented tool to predict the 5-year T2D risk of hypertension patients in mainland China. This application helps timely intervention to reduce the incidence of T2D in patients with hypertension in mainland China.

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.

Case management of patients with Type 2 diabetes mellitus: a cross-sectional survey in Chongqing, China

Background

Type 2 diabetes mellitus has been identified as one of the priority diseases and included in the essential public health service package in China. This study investigated the frequency of follow-up visits and contents of care for case management of patients with Type 2 diabetes in Chongqing located in the western China, in terms of the regional practice guideline; and analyzed factors associated with the use of care.

Methods

A cross-sectional survey was conducted with patients diagnosed with Type 2 diabetes in two areas in Chongqing. Total 502 participants (out of 664 people eligible) completed the interview. The outcome measures included at least four follow-up visits in a year, annual HbA1c test, blood lipid test and diabetic screening for nephropathy and eyes. Logistic regression analysis was applied to examine the association between participants’ demographic and socio-economic characteristics and outcome measures.

Results

Over the one-year study period, 65% of participants had four or more follow-up visits. In light of the recommended tests, the proportions of having HbA1c test, blood lipid test and screening for nephropathy and eyes annually were 8, 54, 45 and 44%, respectively. After adjusting for study sites, age, sex, education, type of residence, level of income, the patients who were covered by Urban Employee Basic Medical Insurance, were enrolled in the targeted disease reimbursement program, and lived with diabetes more than five years were more likely to have regular follow-up visits and the recommended tests.

Conclusions

Case management for patients with Type 2 diabetes mellitus was not effectively implemented in terms of frequency of follow-up visits and recommended tests over one-year period, as indicated in the regional practice guideline.