Healthcare Costs of Diabetes and Microvascular and Macrovascular Disease in Individuals with Incident Type 2 Diabetes Mellitus: A Ten-Year Longitudinal Study

The association between duration of metformin and sulfonylurea treatment and microvascular complications in patients with incident type 2 diabetes: a pooled cohort analysis

Objectives

The effect of the duration of medication with metformin and sulfonylurea (SUs) on microvascular complications based on the duration of type 2 diabetes (DM2) is unclear. The aim of this study was to investigate the association of medication time with metformin and SUs and microvascular complications in newly diagnosed DM2 patients.

Methods

In this prospective multi-cohort study, data from 3,904 newly diagnosed DM from three cohorts of the Tehran Lipid and Glucose Study (TLGS), the Multi-Ethnic Study of Atherosclerosis (MESA), and the Atherosclerosis Risk in Communities (ARIC) with a mean age of 59.6 ± 08 years were pooled. Metformin medication time alone, SUs alone, and a combination of both since drug initiation were defined as exposure. The incidence of microvascular complications (diabetic nephropathy or retinopathy) was defined as outcomes. The cumulative exposure to metformin, SUs, aspirin, statin, and anti-hypertensive medication was also determined using the same approach.

Results

Metformin alone, SUs alone, and the combination of both reduced the hazard of microvascular complications by 8%(HRAdj: 0.92, 95% CI: 0.89, 0.96, P: 0.001), 6%(HRAdj: 0.94, 95% CI: 0.92, 0.97, P: 0.004), and 9%(HRAdj: 0.91, 95% CI: 0.89, 0.94, P: 0.001) for each year of use, respectively (p < 0.05). The protective effect of metformin and SUs, individually or in combination, on microvascular complications started approximately five years after the initial treatment and continued until approximately 15 years after the initial treatment and then reached a plato.

Conclusion

long-term use of metformin and SUs individually and in combination was associated with a decrease in the risk of microvascular outcomes in newly diagnosed DM for up to about one decade. These findings highlight the importance of choosing an appropriate treatment regimen for new patients with type 2 diabetes. Appropriate oral therapy can minimize microvascular complications and improve overall well-being.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01577-w.

Diabetes diagnosis based on glucose control levels and time until diagnosis: a regression discontinuity approach to assess the effect on direct healthcare costs

We estimate the difference in direct healthcare costs of individuals diagnosed with diabetes depending on their glucose level, considering different timespans and subgroups. Using data from administrative registers of 285,450 individuals in Catalonia from 2013 to 2017, we used a fuzzy regression discontinuity design to estimate the causal effect of being diagnosed with diabetes at a given timespan (based on an average glucose value equal to or above 6.5%, the treated group) vs. not (having an average glucose level below the threshold, the control group) on healthcare costs across different timespans (6, 9, 12, 15, 18, 21, and 24 months after the first laboratory test) and distances, in days, between the laboratory test and the doctor's diagnosis. When average glucose level was the only independent parameter and the time until diagnosis was 30 days or less, at the cut-off value (6.5%) healthcare costs were between €3,887 and €5,789 lower for the treated group compared to the control group. Smaller differences were reported as the delay in diagnosis increased, even when additionally controlling for sociodemographic characteristics and health status. Our results highlight the importance of prompt diagnosis and might open the debate about the usefulness of the 6.5% reference value in the blood glucose level as the main diagnostic tool in diabetes.

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.

Impact of duration of treatments with metformin and sulfonylureas, individually or in combination, on diabetic retinopathy among newly diagnosed type 2 diabetic patients: a pooled cohort's analysis

BACKGROUND

This study aimed to evaluate the effect of metformin and sulfonylurea (SUs) medication time on Diabetic retinopathy (DR) among newly diagnosed patients with type 2 diabetes (T2DM) using a pooled analysis. This study aimed to evaluate the effect of metformin and SUs' medication time on DR among newly diagnosed T2DM using a pooled analysis.

METHODS

The data of 4,068 newly diagnosed DM individuals(mean age, 60.2 ± 0.85 years) from three prospective cohorts of Tehran Sugar and Lipid Study (TLGS), Multi-Ethnic Study of Atherosclerosis (MESA), and Atherosclerosis Risk in Communities (ARIC) with a mean age of 59.6 ± 08 years were pooled. The cumulative exposure to metformin, SUs, aspirin, statin, and anti-hypertensive medication was also determined using the same approach. The Cox proportional hazards (CPH) model was used to calculate the hazard ratio (HR) (95% CI) for the outcomes while adjusting for confounding factors such as fasting Blood Sugar (FBS), age, statin, aspirin, and anti-hypertensive medications.

RESULTS

During follow-up, DR occurred in 519 DM. Metformin alone, SUs alone, and the combination of both reduced the hazard of DR by 10%, 7%, and 11% for each year of use, respectively (p < 0.05). The protective effect of metformin and SUs, individually or in combination, on DR started approximately five years after the initial treatment and continued until approximately 15 years after the initial treatment and then reached a plato.

CONCLUSION

Long-term treatment with metformin and SUs, individually and in combination, was associated with a reduced risk of DR in people with newly diagnosed diabetes for up to a decade compared with no treatment. These findings highlight the protective role of metformin and sulfonylureas as inexpensive and readily available drugs to prevent DR in people with newly diagnosed diabetes.

Cellular Senescence: A Bridge Between Diabetes and Microangiopathy

Cellular senescence is a state of permanent cell cycle arrest and plays an important role in many vascular lesions. This study found that the cells of diabetic patients have more characteristics of senescence, which may cause microvascular complications. Cell senescence, as one of the common fates of cells, links microangiopathy and diabetes. Cell senescence in a high-glucose environment can partially elucidate the mechanism of diabetic microangiopathy, and various types of cellular senescence induced by it can promote the progression of diabetic microangiopathy. Still, the molecular mechanism of microangiopathy-related cellular senescence has not yet been clearly studied. Building on recent research evidence, we herein summarize the fundamental mechanisms underlying the development of cellular senescence in various microangiopathies associated with diabetes. We gradually explain how cellular senescence serves as a key driver of diabetic microangiopathy. At the same time, the treatment of basic senescence mechanisms such as cellular senescence may have a great impact on the pathogenesis of the disease, may be more effective in preventing the development of diabetic microangiopathy, and may provide new ideas for the clinical treatment and prognosis of diabetic microangiopathy.

The effectiveness of telemedicine in the management of type 2 diabetes: A systematic review

Background

Type 2 diabetes, a lifestyle-related disease demanding daily self-management, is a significant health concern. In this context, the use of telemedicine as a management tool is a relatively new and promising approach. This study aims to contribute to the growing body of knowledge by identifying the effectiveness of telemedicine in managing type 2 diabetes through a systematic review approach.

Methods

Four databases were searched including PubMed, Virtual Health Library, Global Health Library, and Google Scholar on 27 July 2022. Additionally, a manual search was performed to identify any relevant articles that may have been missed. The quality of the included articles was rigorously assessed using the Study Quality Assessment Tools of the National Institute of Health.

Results

We analyzed data from 134 articles. All 134 studies were published between 2002 and 2022, including 103 controlled intervention trials, 13 cohort studies, 7 before-after (pre-post) studies with no control group, 1 initial trial, 1 case study, 1 pilot study, and 8 two-arm studies that did not report the study design. Accordingly, most studies show positive changes in glycemic index in every group using telemedicine. Overall, although the BMI and weight indices in the studies improved at the end of the course, the improvement values were considered insignificant.

Conclusion

Telemedicine may be a valuable solution for blood sugar management in patients with type 2 diabetes. However, the effectiveness of telemedicine in improving BMI and quality of life is unclear.

Diabetic microvascular complications and associated factors in patients with type 2 diabetes in Southern Ethiopia

Background

Microvascular complications are long-term complications that affect small blood vessels, usually developed in diabetes, and are primary causes of end-stage renal disease, several painful neuropathies, and blindness. Thus, this study aimed to determine diabetic microvascular complications and factors associated with them among patients with type 2 diabetes.

Methods

An institution-based cross-sectional study was conducted among 378 type 2 diabetes patients. The presence of at least one diabetic microvascular complications diagnosed by physicians and found on the record was considered to have microvascular complications. The data was collected by reviewing the medical records of T2DM patients who were on follow-up from January 1, 2012, to December 31, 2021. The collected data was entered into EpiData version 3.1 and analyzed by Stata version 14. Bivariate and multivariable logistic regression were used to identify statistically significant risk factors for diabetic microvascular complications at p-value < 0.05.

Results

Patients with type 2 diabetes mellitus had a prevalence of diabetic microvascular complications of 26.5% (95% CI: 22.0%, 30.9%). Diabetic neuropathy was the highest (13.2%), followed by diabetic nephropathy (12.4%), and diabetic retinopathy (6.4%). Increasing age, poor glycemic control, hypertension comorbidity, anemia, positive proteinuria, a longer duration of type 2 diabetes mellitus, and hypercholesterolemia were significantly associated factors with diabetic microvascular complications.

Conclusion

Diabetic microvascular complications were highly prevalent. Therefore, the study suggests that interventional strategies should be taken for poor glycemic control, hypertension comorbidity, anemia, positive proteinuria, and hypercholesterolemia to control the development of diabetic microvascular complications in patients with type 2 diabetes.

Cost-Savings Associated with Multi-Disciplinary Team Approach for Reducing Macrovascular and Microvascular Complications in Patients with Type 2 Diabetes: A Predictive Model

Purpose

This study aims to predict the expected cost savings associated with implementing a multidisciplinary team (MDT) approach to reduce macrovascular and microvascular complications among patients with type 2 diabetes mellitus (T2DM).

Methods

This economic evaluation study was conducted in Riyadh First Health Cluster, Saudi Arabia as a predictive model conceptualized by the authors based on models used in previous studies, particularly the CORE Diabetes Model. Our model was designed based on 1) the level of glycemic control among 24,755 T2DM patients served by MDTs; 2) the expected incidence of diabetes-related complications without intervention; 3) the predicted risk reduction of developing diabetes-related complications with MDTs. Costs of complications and cost savings were then calculated and expressed as mean incremental annual cost savings adjusted for a 1% reduction in HbA1c, and a 10 mmHg reduction in systolic blood pressure (SBP).

Results

Along with the expected reduction in all diabetes-related complications, the average incremental cost savings per diabetic patient is predicted to be ($38,878) with approximately ($11,108) in the year of complication onset and ($27,770) over the subsequent post-index 10-years. On adjustment of cost savings, the average incremental cost savings are predicted to be ($22,869) for each 1% reduction in HbA1c per diabetic patient and ($27,770) for every 10 mmHg reduction in SBP per diabetic patient.

Conclusion

MDT as a model of care is effective in glycemic control among T2DM patients with a predicted significant reduction of all diabetes-related complications and in turn, a predicted significant cost savings.

Cost per Patient Achieving Treatment Targets and Number Needed to Treat with Tirzepatide Versus Semaglutide 1 mg in Patients with Type 2 Diabetes in the United States

INTRODUCTION

Achieving glycemic control can help reduce complications of type 2 diabetes (T2D). This study compared the pharmacy cost per responder and number needed to treat (NNT) of tirzepatide 5 mg, 10 mg, and 15 mg versus semaglutide 1 mg to achieve glycemic, weight loss, and composite treatment endpoints in patients with T2D in the United States.

METHODS

The proportions of patients achieving glycemic, weight loss, and composite treatment endpoints were obtained from the phase 3 SURPASS-2 randomized clinical trial which compared tirzepatide 5 mg, 10 mg, and 15 mg to semaglutide 1 mg. Annual pharmacy costs were calculated using 2022 wholesale acquisition costs. Cost per responder and NNT were calculated along with 95% confidence intervals and tests for statistical significance (P ≤  0.05).

RESULTS

Tirzepatide had a lower cost per responder to achieve glycated hemoglobin A1c (HbA1c) endpoints of ≤ 6.5% (10 mg and 15 mg doses) and < 5.7% (all doses) and weight loss endpoints of ≥ 5% (10 mg and 15 mg doses), ≥ 10% (all doses), and ≥ 15% (all doses). The cost per responder to achieve HbA1c < 7% (all doses of tirzepatide) and ≤ 6.5% (5 mg tirzepatide) were not statistically significantly different between tirzepatide and semaglutide 1 mg. The cost per patient to achieve the composite endpoints (HbA1c < 7.0%, ≤ 6.5%, or < 5.7%/weight loss ≥ 10%/no hypoglycemia) was statistically significantly lower for all doses of tirzepatide than for semaglutide 1 mg. The NNTs for all doses of tirzepatide were statistically significantly lower than that for semaglutide 1 mg to achieve all individual and composite endpoints, with the exception of the 5 mg dose for HbA1c < 7.0% and HbA1c ≤ 6.5%, where tirzepatide had numerically lower NNTs that were not statistically significant.

CONCLUSION

Tirzepatide is a novel glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist (RA) that may offer the potential to achieve stringent glycemic goals, weight loss targets, and composite treatment goals at a lower cost per responder compared to semaglutide 1 mg among people with T2D.

A Comprehensive Review of the Vascular Consequences of Diabetes in the Lower Extremities: Current Approaches to Management and Evaluation of Clinical Outcomes

Diabetes mellitus is a global health concern characterized by chronic hyperglycemia, and its vascular consequences in the lower extremities pose significant challenges for individuals living with the condition. This comprehensive review delves into the multifaceted landscape of diabetes-related vascular complications in the lower limbs, with a primary focus on current strategies for management and the evaluation of clinical outcomes. This review achieves several critical objectives by synthesizing existing knowledge and research findings. It elucidates the intricate pathophysiological mechanisms underpinning these complications, shedding light on the cellular and molecular processes involved. Additionally, it outlines clinical assessment and diagnostic strategies used to identify and stratify risk, ranging from cutting-edge imaging techniques to clinical examinations. The review comprehensively examines current management strategies, encompassing lifestyle modifications, pharmacological interventions, surgical procedures, and wound care practices. Moreover, it assesses and analyzes clinical outcomes, including limb salvage rates, amputation rates, and overall quality of life for individuals undergoing treatment. In addressing the challenges faced in managing these complications, this review aims to contribute to improved patient care. It proposes future research directions to enhance the management and outcomes of diabetes-related vascular consequences in the lower extremities.

Weight loss and modeled cost savings in a digital diabetes prevention program

Background

Participation in the National Diabetes Prevention Program (DPP) can improve individual health through reduced risk of type 2 diabetes and save the healthcare system substantial medical costs associated with a diagnosis of type 2 diabetes and its associated complications. There is less evidence of outcomes and cost savings associated with a fully digital delivery of the DPP.

Methods

This study assessed 13,593 members who provided an initial digital weight and subsequently achieved various weight loss and engagement outcomes during their participation in a digital DPP. Analyzed data included both complete observations and missing observations imputed using maximum likelihood estimation. Findings include members' behavioral correlates of weight loss and a literature-based cost-savings estimate associated with achieving three mutually exclusive weight loss or engagement benchmarks: ≥5% weight loss, >2% but <5% weight loss, and completion of ≥4 educational lessons.

Results

11,976 members (88%) provided a weight after 2 months of participation, enabling calculation of their weight nadir. Considering complete data, 97% of members maintained or lost weight. Using the imputed data for these calculations, 32.0% of members achieved ≥5%, 32.4% achieved >2% but <5%, 32.0% maintained ±2%, and 3.6% gained weight. Members who lost the most weight achieved their weight nadir furthest into the program (mean day = 189, SE = 1.4) and had the longest active engagement (mean days = 268, SE = 1.4), particularly compared to members who gained weight (mean nadir day = 119, SE = 3.7; active engagement mean days = 199, SE = 4.9) (both p ≤ 0.0001). Modeled 1-year cost-savings estimates ranged from $11,229,160 to $12,960,875.

Conclusions

Members of a fully digital DPP achieved clinical and engagement outcomes during their participation in the program that confer important health benefits and cost savings.

Retrospective Analysis of the Burden of Illness of Eosinophilic Granulomatosis With Polyangiitis (EGPA) Versus Asthma in Commercially Insured US Patients

Background and aim Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare inflammatory disorder associated with the presence of blood and tissue eosinophilia, extravascular granulomas, and asthma. Currently, the burden of EGPA on the patient and the healthcare system is not well characterized. This study aimed to assess the real-world clinical and economic burden of disease in adult patients with EGPA compared with matched patients with asthma without EGPA. Methods This retrospective cohort study used medical, pharmacy, enrolment, and demographic data from a US administrative claims database (PharMetrics Plus). Patients ≥18 years old, with ≥six months of continuous health plan enrolment in the baseline period, and ≥12 months of continuous health plan enrolment in the follow-up period were eligible for this analysis. Patients with EGPA and patients with asthma without EGPA were identified using diagnosis codes and were subsequently matched 1:5 (e.g., one patient with EGPA matched with five patients with asthma, without EGPA) based on baseline characteristics. The primary outcome measure was all-cause healthcare costs; secondary outcomes included healthcare resource utilization, medication usage, and clinical characteristics. Results In the final matched cohorts, there were 7183 patients with EGPA and 35,915 patients with asthma without EGPA. During the follow-up period, mean total all-cause healthcare costs were significantly higher in patients with EGPA than in those with asthma without EGPA (mean {standard deviation}: $44,405 {$82,060} vs $24,487 {$54,691}; p<0.0001). Patients with EGPA had mean total all-cause healthcare costs that were 73.9% greater than those in patients with asthma without EGPA, even after applying a multivariable analysis to adjust for differences in demographic and clinical characteristics. Medication usage was consistently higher in the EGPA population than in the asthma population (excepting short-acting β2-agonists). The majority of patients in the EGPA population (83.1%) also experienced ≥one relapse during the study period, with 26.3% of patients in the EGPA population experiencing a major relapse. Conclusions There is a significantly greater economic and clinical burden associated with EGPA compared with asthma without EGPA in adults. These results underscore the unmet need in this patient population for improved disease control strategies that will reduce the burden of EGPA on patients and the healthcare system.

Impact of cardiovascular disease on health care economic burden and resource utilization: a retrospective cohort study in adults in the United States with type 2 diabetes with or without stroke, myocardial infarction, and peripheral arterial disease

OBJECTIVES

To evaluate incidence of stroke, myocardial infarction (MI), and peripheral artery disease (PAD) in patients with type 2 diabetes mellitus (T2DM) and assess associated health care resource utilization (HCRU) and costs in the United States.

METHODS

Patients ≥18 years of age with a T2DM diagnosis, with or without incident stroke/MI/PAD, were indexed between 1 January 2012 and 31 December 2020, from the deidentified Optum Clinformatics Data Mart claims database. Incidence of stroke, MI, and PAD was evaluated in the year following T2DM. HCRU and costs were measured in the 12 months following study entry in patients with T2DM + stroke, T2DM + MI, and T2DM + PAD (experimental cohorts) and compared to HCRU and costs in patients with T2DM alone (control cohorts).

RESULTS

Incidence of stroke, MI, and PAD in patients with T2DM was 0.9% (n = 16,034), 0.7% (n = 13,681), and 4.1% (n = 68,479), respectively. Compared to matched patients with T2DM alone, patients with T2DM + stroke/MI/PAD had significantly higher total healthcare costs in the year post-index date (T2DM + stroke: +$5962 per patient per month [PPPM]; T2DM + MI: +$7932 PPPM; T2DM + PAD: +$2652 PPPM; p < .05). Patients with T2DM + stroke/MI/PAD had significantly higher mean HCRU than patients without stroke/MI/PAD in all categories measured.

CONCLUSION

Having stroke, MI, or PAD was associated with increases in HCRU and costs in patients with T2DM. Although PAD was associated with smaller per patient increases in total healthcare costs than patients with T2DM + stroke/MI, the higher frequency of incident PAD may make it more costly than MI or stroke in a large population of patients with T2DM.

Long-term clinical outcomes of oral antidiabetic drugs as fixed-dose combinations: A nationwide retrospective cohort study

AIM

To compare treatment patterns and clinical outcomes of single-pill fixed-dose combination (FDC) and two-pill combination (TPC) therapies using real-world data.

METHODS

We conducted a nationwide retrospective cohort study using South Korea's healthcare database (2002-2015). We identified two cohorts of incident patients with type 2 diabetes who initiated FDC or TPC therapy within 4 months of their first prescription for metformin or sulphonylurea. We examined persistence and adherence patterns and the clinical outcome of a composite endpoint of death or hospitalization for acute myocardial infarction, heart failure or stroke and compared the differences in treatment patterns and clinical outcomes using Cox models.

RESULTS

Of 5143 and 10 973 patients who initiated FDC and TPC therapy, respectively, we identified 5143 patient pairs after propensity score matching. The FDC group exhibited greater median time to treatment discontinuation (163 vs. 146 days), and proportion of days covered at 12 months (mean 0.60 vs. 0.57, P < .0001) and at 24 months (0.53 vs. 0.51, P = .014) than the TPC group. The FDC group, compared with the TPC group, had reduced risks of the composite clinical outcome (hazard ratio 0.86, 95% confidence intervals 0.77-0.97) and hospitalization for stroke (0.80, 0.67-0.96).

CONCLUSION

FDC therapy may provide favourable cardiovascular benefits, especially reducing the risk of hospitalization for stroke, and has better medication adherence among patients with type 2 diabetes.

Prevalence and risk factors of vascular complications in type 2 diabetes mellitus: Results from discover Middle East and Africa cohort

Background

We evaluated the prevalence of vascular complications and associated risk factors in individuals with type 2 diabetes mellitus (T2DM) initiating second-line glucose-lowering therapy from the Middle East and Africa (MEA) cohort of the 3-year prospective DISCOVER study involving 15,992 patients in 38 countries.

Methods

Baseline cross-sectional data collected from healthcare settings were used to assess micro and macrovascular complications prevalence as crude and age- and sex-standardised. The multi-variable analysis assessed factors associated with these complications.

Results

Of 3,525 enrolled patients (mean age: 54.3 ± 10.8 years), >40% had hypertension and hyperlipidaemia. Metformin monotherapy was the first-line therapy in 56.5%, followed by metformin+sulphonylurea (20.3%). Crude and standardised prevalence of microvascular complications were 17.7% and 16.9% (95% confidence interval [CI], 16.77-16.98) and macrovascular complications were 10.7% and 8.7% (95% CI, 8.59-8.76). Factors significantly (p<0.05) associated with micro and macrovascular complications (odds ratios [95% CI]) were age (1.24 [1.12-1.39] and 1.58 [1.35-1.84]), male sex (1.33 [1.04-1.70] and 1.71 [1.22-2.40]), hyperlipidaemia (1.33 [1.07-1.65] and 1.96 [1.46-2.63]) and hypertension (1.75 [1.40-2.19] and 2.84 [2.07-3.92]).

Conclusion

A substantial burden of vascular complications with prominent risk factors in the MEA cohort calls for early preventive interventions.

Costs of multimorbidity: a systematic review and meta-analyses

BACKGROUND

Multimorbidity is a rising global phenomenon, placing strains on countries' population health and finances. This systematic review provides insight into the costs of multimorbidity through addressing the following primary and secondary research questions: What evidence exists on the costs of multimorbidity? How do costs of specific disease combinations vary across countries? How do multimorbidity costs vary across disease combinations? What "cost ingredients" are most commonly included in these multimorbidity studies?

METHODS

We conducted a systematic review (PROSPERO: CRD42020204871) of studies published from January 2010 to January 2022, which reported on costs associated with combinations of at least two specified conditions. Systematic string-based searches were conducted in MEDLINE, The Cochrane Library, SCOPUS, Global Health, Web of Science, and Business Source Complete. We explored the association between costs of multimorbidity and country Gross Domestic Product (GDP) per capita using a linear mixed model with random intercept. Annual mean direct medical costs per capita were pooled in fixed-effects meta-analyses for each of the frequently reported dyads. Costs are reported in 2021 International Dollars (I$).

RESULTS

Fifty-nine studies were included in the review, the majority of which were from high-income countries, particularly the United States. (1) Reported annual costs of multimorbidity per person ranged from I$800 to I$150,000, depending on disease combination, country, cost ingredients, and other study characteristics. (2) Our results further demonstrated that increased country GDP per capita was associated with higher costs of multimorbidity. (3) Meta-analyses of 15 studies showed that on average, dyads which featured Hypertension were among the least expensive to manage, with the most expensive dyads being Respiratory and Mental Health condition (I$36,840), Diabetes and Heart/vascular condition (I$37,090), and Cancer and Mental Health condition in the first year after cancer diagnosis (I$85,820). (4) Most studies reported only direct medical costs, such as costs of hospitalization, outpatient care, emergency care, and drugs.

CONCLUSIONS

Multimorbidity imposes a large economic burden on both the health system and society, most notably for patients with cancer and mental health condition in the first year after cancer diagnosis. Whether the cost of a disease combination is more or less than the additive costs of the component diseases needs to be further explored. Multimorbidity costing studies typically consider only a limited number of disease combinations, and few have been conducted in low- and middle-income countries and Europe. Rigorous and standardized methods of data collection and costing for multimorbidity should be developed to provide more comprehensive and comparable evidence for the costs of multimorbidity.

Glycosylated hemoglobin A1c predicts coronary artery disease in non-diabetic patients

Background

In primary care, there is a need for simple and cost‐effective tool that will allow the determination of the risk of coronary artery disease (CAD). We aimed to research the value of glycosylated hemoglobin (HbA1c) in the prediction of coronary artery disease.

Methods

Patients admitted to the outpatient clinic of the Cardiology for angiography were retrospectively screened. Patients with diabetes or with HbA1c of 6.5 or above were excluded. Comparative HbA1c data were obtained according to the stenosis groups. Logistic regression analysis was used to investigate the risk factors affecting stenosis positivity.

Results

Of the study group, 120 patients were without any stenosis in any coronary artery, 56 patients were with >50% stenosis in one coronary artery, and 71 patients were with >50% stenosis in more than one coronary artery. There was a statistically significant difference between HbA1c measurements according to the degree of stenosis (P = .001 and P < .01, respectively). The odd ratio for HbA1c was 6.260 (95% CI: 3,160‐12,401). According to the stenosis positivity, the cutoff point for HbA1c was found to be 5.6 and above. In the regression analysis, HbA1c was an independent risk factor for CAD. One unit increase in HbA1c level increases the risk of stenosis up to 12.4‐fold (95% CI: 5,990‐25,767).

Conclusion

The study showed HbA1c can be used as an independent marker in determining the probability and severity of coronary artery disease in non‐diabetic individuals and as a useful marker in primary care predicting CAD.