Impact of type 2 diabetes mellitus on hospitalization costs in older patients with acute myocardial infarction

A Systematic Review of Direct Cardiovascular Event Costs: An International Perspective

INTRODUCTION

There is a lack of comprehensive cost information for cardiovascular events since 2013.

OBJECTIVE

A systematic review on the contemporary cost of cardiovascular events was therefore undertaken.

METHODS

Methods complied with those recommended by the Cochrane Collaboration and the Centre for Reviews and Dissemination. Studies were unrestricted by language, were from 2013 to 23 December 2017, and included cost-of-illness data in adults with the following cardiovascular conditions: myocardial infarction (MI), stroke, transient ischaemic attack (TIA), heart failure (HF), unstable angina (UA), coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), or peripheral artery disease (PAD). Seven electronic databases were searched, namely Embase (Ovid), MEDLINE (Ovid), MEDLINE In-Process Citations and Daily Update (Ovid), NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) database, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed. The included studies reported data from a variety of years (sometimes prior to 2013), so costs were inflated and converted to $US, year 2018 values, for standardization.

RESULTS

After de-duplication, 29,945 titles and abstracts and then 403 full papers were screened; 82 studies (88 papers) were extracted. Year 1 average cost ranges were as follows: MI ($11,970 in Sweden to $61,864 in the USA), stroke ($10,162 in Spain to $46,162 in the USA), TIA ($6049 in Sweden to $25,306 in the USA), HF ($4456 in China to $49,427 in the USA), UA ($11,237 in Sweden to $31,860 in the USA), PCI ($17,923 in Italy to $45,533 in the USA), CABG ($17,972 in the UK to $76,279 in the USA). One Swedish study reported PAD costs in a format convertible to $US, 2018 values, with a mean annual cost of $15,565.

CONCLUSIONS

There was considerable unexplained variation in contemporary costs for all major cardiovascular events. One emerging theme was that average costs in the USA were considerably higher than anywhere else.

Renal Protective Effects of a Diet and Exercise Intervention in Type 2 Diabetic Rats

Purpose:

Diabetic nephropathy (DN) is one of the most common diabetic microvascular complications. Inflammatory factors participate in each stage of DN, and nuclear factor (NF)-κB and monocyte chemoattractant protein-1(MCP-1) play important mediation roles. The purpose of this study was to investigate the renal protective effects of a diet and exercise intervention in a rat model of Type 2 diabetes mellitus (T2DM).

Method:

Control rats (Group A, n = 10) were fed a normal diet, while 30 rats were fed a high-glucose, high-fat diet and given an intraperitoneal injection of streptozocin to establish the T2DM model. Model rats ( n = 8 per group) were randomized into Groups B, C, and D. Groups C and D were treated with glibenclamide, and Group D received an 8-week diet and exercise intervention. Blood, 12-hr urine, and kidney tissue samples were collected postintervention for detecting blood glucose and lipid levels, expression of MCP-1 and NF-κB, and renal function indices.

Results:

Postintervention, blood glucose, and lipid levels in Groups C and D were lower than those in Group B, with decreases in Group D significantly greater than in Group C. Every index of renal protection showed greater improvement in Group D than in Group C ( p < .05). The expression of NF-κB and MCP-1 was lower in Group D than in Group C ( p < .05).

Conclusions:

The diet and exercise intervention reduced the inflammatory reaction and delayed T2DM and DN progression by inhibiting the activation of NF-κB and downregulating the expression of MCP-1.