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Chen Y, Lundeen EA, Koyama AK, Kompaniyets L, Andes LJ, Benoit SR, Imperatore G, Rolka DB. Prevalence of Testing for Diabetes Among US Adults With Overweight or Obesity, 2016-2019. Prev Chronic Dis 2023; 20:E116. [PMID: 38154119 PMCID: PMC10756652 DOI: 10.5888/pcd20.230173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
Introduction Screening for prediabetes and type 2 diabetes may allow earlier detection, diagnosis, and treatment. The US Preventive Services Task Force recommends screening every 3 years for abnormal blood glucose among adults aged 40 to 70 years with overweight or obesity. Using IQVIA Ambulatory Electronic Medical Records, we estimated the proportion of adults aged 40 to 70 years with overweight or obesity who received blood glucose testing within 3 years from baseline in 2016. Methods We identified 1,338,509 adults aged 40 to 70 years with overweight or obesity in 2016 and without pre-existing diabetes. We included adults whose records were present in the data set for at least 2 years before their index body mass index (BMI) in 2016 and 3 years after the index BMI (2017-2019), during which we examined the occurrence of blood glucose testing. We calculated the unadjusted and adjusted prevalence of receiving blood glucose testing. Results The unadjusted prevalence of receiving blood glucose testing was 33.4% when it was defined as having a hemoglobin A1c or fasting plasma glucose measure. The unadjusted prevalence was 74.3% when we expanded the definition of testing to include random plasma glucose and unspecified glucose measures. Adults with obesity were more likely to receive the test than those with overweight. Men (vs women) and adults aged 50 to 59 years (vs other age groups) had higher testing rates. Conclusion Our findings could inform clinical and public health promotion efforts to improve screening for blood glucose levels among adults with overweight or obesity.
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Affiliation(s)
- Yu Chen
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341
| | - Elizabeth A Lundeen
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alain K Koyama
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyudmyla Kompaniyets
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Linda J Andes
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen R Benoit
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deborah B Rolka
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
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2
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Gharipour M, Nezafati P, Sadeghian L, Eftekhari A, Rothenberg I, Jahanfar S. Precision medicine and metabolic syndrome. ARYA ATHEROSCLEROSIS 2022; 18:1-10. [PMID: 36817343 PMCID: PMC9937665 DOI: 10.22122/arya.2022.26215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/09/2021] [Indexed: 02/24/2023]
Abstract
Metabolic syndrome (MetS) is one of the most important health issues around the world and a major risk factor for both type 2 diabetes mellitus (T2DM) and cardiovascular diseases. The etiology of MetS is determined by the interaction between genetic and environmental factors. Effective prevention and treatment of MetS notably decreases the risk of its complications such as diabetes, obesity, hypertension, and dyslipidemia. According to recent genome-wide association studies, multiple genes are involved in the incidence and development of MetS. The presence of particular genes which are responsible for obesity and lipid metabolism, affecting insulin sensitivity and blood pressure, as well as genes associated with inflammation, can increase the risk of MetS. These molecular markers, together with clinical data and findings from proteomic, metabolomic, pharmacokinetic, and other methods, would clarify the etiology and pathophysiology of MetS and facilitate the development of personalized approaches to the management of MetS. The application of personalized medicinebased on susceptibility identified genomes would help physicians recommend healthier lifestyles and prescribe medications to improve various aspects of health in patients with MetS. In recent years, personalized medicine by genetic testing has helped physicians determine genetic predisposition to MetS, prevent the disease by behavioral, lifestyle-related, or therapeutic interventions, and detect, diagnose, treat, and manage the disease. Clinically, personalized medicine is providing effective strategies for the prevention and treatment of MetS by reducing the time, cost, and failure rate of pharmaceutical clinical trials. It is also eliminating trial-and-error inefficiencies that inflate health care costs and undermine patient care.
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Affiliation(s)
- Mojgan Gharipour
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Mojgan Gharipour; Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan
University of Medical Sciences, Isfahan, Iran;
| | - Pouya Nezafati
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ladan Sadeghian
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ava Eftekhari
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medicine Sciences, Isfahan, Iran
| | - Irwin Rothenberg
- Laboratory Quality Advisor/Technical Writer at COLA Resources Inc., Washington, Columbia, USA
| | - Shayesteh Jahanfar
- Health Sciences Building, Central Michigan University, Mount Pleasant, MI, USA
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Kirley K, Khan T, Aquino G, Brown A, Meier S, Chambers N, O'Connell C. Using a certified electronic health record technology platform to screen, test and refer patients with prediabetes. JAMIA Open 2021; 4:ooab101. [PMID: 34870108 PMCID: PMC8634514 DOI: 10.1093/jamiaopen/ooab101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022] Open
Abstract
The objective of this study was to determine if certified electronic health record technology (CEHRT) can be used to identify and refer patients with prediabetes to lifestyle change programs (LCPs) recognized by the National Diabetes Prevention Program (DPP). This pilot utilized a prediabetes registry, patient portal, and clinical decision support to increase referrals. Data from 36 primary care providers showed 4930 patients were eligible for DPP LCP, 293 referrals were generated, compared to 20 referrals in the baseline period, and 116 patients enrolled. Referral to enrollment conversion rates were 41% in the study period and 69% in the post-study 1-year period. CEHRT functionalities can support systematic identification and management of prediabetes. The referral rate increased 7-fold compared to the baseline period, with high referral to enrollment conversion rates. CEHRT coupled with active provider engagement can serve as a tool to identify prediabetes patients and facilitate LCP referrals and enrollment.
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Affiliation(s)
- Kate Kirley
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Tamkeen Khan
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Gina Aquino
- Henry Ford Health System, Detroit, Michigan, USA
| | | | - Scott Meier
- Henry Ford Health System, Detroit, Michigan, USA
| | - Nadene Chambers
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
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Drobek N, Sowa P, Jankowski P, Haberka M, Gąsior Z, Kosior D, Czarnecka D, Pająk A, Szostak-Janiak K, Krzykwa A, Setny M, Kozieł P, Paniczko M, Jamiołkowski J, Kowalska I, Kamiński K. Undiagnosed Diabetes and Prediabetes in Patients with Chronic Coronary Syndromes-An Alarming Public Health Issue. J Clin Med 2021; 10:1981. [PMID: 34063006 PMCID: PMC8124594 DOI: 10.3390/jcm10091981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023] Open
Abstract
Dysglycemia is a public health challenge for the coming decades, especially in patients with chronic coronary syndromes (CCS). We want to assess the prevalence of undiagnosed diabetes mellitus (DM) and prediabetes, as well as identify factors associated with the development of dysglycaemia in patients with CCS. In total, 1233 study participants (mean age 69 ± 9 years), who, between 6 and 18 months earlier were hospitalized for acute coronary syndrome or elective revascularization, were examined (71.4% men). The diagnosis of DM, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) have been made according to World Health Organization (WHO) criteria. Based on the oral glucose tolerance test (OGTT) results, DM has been newly diagnosed in 28 (5.1%, mean age 69.9 ± 8.4 years) patients, 75% were male (n = 21). Prediabetes has been observed in 395 (72.3%) cases. IFG was found in 234 (42.9%) subjects, 161 (29.5%) individuals had IGT. According to multinomial logistic regression, body mass index (BMI) and high-density lipoprotein cholesterol (HDL-C) should be considered when assessing risk of development of dysglycaemia after discharge from the hospital. Among people with previously diagnosed DM, a significantly higher percentage were willing to change their lifestyles after the index event compared to other patients. Patients with chronic coronary syndromes suffer a very high frequency of dysglycaemia. Most patients with chronic coronary syndromes, especially those with high BMI or low HDL-C, should be considered for screening for dysglycemia using OGTT within the first year after hospitalization. A higher percentage of patients who were aware of their diabetic status changed their lifestyles, which added the benefit of timely diagnosis and treatment of diabetes.
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Affiliation(s)
- Natalia Drobek
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-089 Białystok, Poland; (N.D.); (P.S.); (M.P.); (J.J.)
- Department of Cardiology, University Hospital of Bialystok, 15-276 Białystok, Poland
| | - Paweł Sowa
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-089 Białystok, Poland; (N.D.); (P.S.); (M.P.); (J.J.)
| | - Piotr Jankowski
- Polish Mother’s Memorial Hospital Research Institute, 93-338 Łódź, Poland;
- Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (D.C.); (P.K.)
| | - Maciej Haberka
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland; (M.H.); (Z.G.); (K.S.-J.)
| | - Zbigniew Gąsior
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland; (M.H.); (Z.G.); (K.S.-J.)
| | - Dariusz Kosior
- Mossakowski Medical Research Centre, Polish Academy of Sciences, 01-224 Warsaw, Poland;
- Department of Cardiology and Hypertension with the Electrophysiological Lab, Central Clinical Hospital the Ministry of the Interior and Administration, 00-124 Warsaw, Poland; (A.K.); (M.S.)
| | - Danuta Czarnecka
- Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (D.C.); (P.K.)
| | - Andrzej Pająk
- Department of Clinical Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Karolina Szostak-Janiak
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland; (M.H.); (Z.G.); (K.S.-J.)
| | - Agnieszka Krzykwa
- Department of Cardiology and Hypertension with the Electrophysiological Lab, Central Clinical Hospital the Ministry of the Interior and Administration, 00-124 Warsaw, Poland; (A.K.); (M.S.)
| | - Małgorzata Setny
- Department of Cardiology and Hypertension with the Electrophysiological Lab, Central Clinical Hospital the Ministry of the Interior and Administration, 00-124 Warsaw, Poland; (A.K.); (M.S.)
| | - Paweł Kozieł
- Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (D.C.); (P.K.)
| | - Marlena Paniczko
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-089 Białystok, Poland; (N.D.); (P.S.); (M.P.); (J.J.)
| | - Jacek Jamiołkowski
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-089 Białystok, Poland; (N.D.); (P.S.); (M.P.); (J.J.)
| | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Białystok, 15-089 Białystok, Poland;
| | - Karol Kamiński
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-089 Białystok, Poland; (N.D.); (P.S.); (M.P.); (J.J.)
- Department of Cardiology, University Hospital of Bialystok, 15-276 Białystok, Poland
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Khan T, Yang J, Wozniak G. Trends in Medical Expenditures Prior to Diabetes Diagnosis: The Early Burden of Diabetes. Popul Health Manag 2020; 24:46-51. [PMID: 32013762 PMCID: PMC7875131 DOI: 10.1089/pop.2019.0143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Diabetes is a costly chronic condition in the United States. The incremental increase in costs of the disease can begin and accelerate prior to first diagnosis. This study conducts a retrospective analysis of claims data from Truven Health MarketScan® Commercial Claims Database to track per capita annual medical expenditures among a single panel of commercially insured patients for 5 years preceding a new diabetes diagnosis. Case subjects, defined as individuals newly diagnosed with diabetes in 2014, are compared to control subjects, defined as individuals who do not have a diabetes diagnosis. Arithmetic means, compound annual growth rates, and propensity score matching models are used to track the differential in expenditures across health care sectors. This analysis finds that the incremental rise in costs of diabetes are shown to begin at least 5 years before diagnosis of the disease and accelerate immediately after diagnosis. Results of the matching model suggest that the newly diagnosed case subjects spent $8941 more than control subjects not diagnosed with diabetes over the span of 5 years, with approximately $4828 in the year of diagnosis. The compounded annual growth rate in per capita annual medical expenditures between 2010–2014 was almost 9% higher among case subjects at 14.3% in the matched models. Results show that the rise in medical spending associated with diabetes begins well in advance of the first diabetes diagnosis and support the need to encourage physicians to implement timely identification and prevention efforts to reduce the economic burden of the disease.
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Affiliation(s)
- Tamkeen Khan
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Jianing Yang
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Gregory Wozniak
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
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6
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Shrestha SS, Zhang P, Hora IA, Gregg EW. Trajectory of Excess Medical Expenditures 10 Years Before and After Diabetes Diagnosis Among U.S. Adults Aged 25-64 Years, 2001-2013. Diabetes Care 2019; 42:62-68. [PMID: 30455325 PMCID: PMC6393199 DOI: 10.2337/dc17-2683] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 10/12/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We assessed the excess medical expenditures for adults newly diagnosed with diabetes, for up to 10 years before and after diabetes diagnosis. RESEARCH DESIGN AND METHODS Using the 2001-2013 MarketScan data, we identified people with newly diagnosed diabetes among adults aged 25-64 years (diabetes cohort) and matched them with people who did not have diagnosed diabetes (control cohort) using 1:1 propensity score matching. We followed these two cohorts up to ±10 years from the index date, with annual matched cohort sizes ranging from 3,922 to 39,726 individuals. We estimated the yearly and cumulative excess medical expenditures of the diabetes cohorts before and after the diagnosis of diabetes. RESULTS The per capita annual total excess medical expenditure for the diabetes cohort was higher for the entire 10 years prior to their index date, ranging between $1,043 in year -10 and $4,492 in year -1. Excess expenditure spiked in year 1 ($8,109), declined in year 2, and then increased steadily, ranging from $4,261 to $6,162 in years 2-10. The cumulative excess expenditure for the diabetes cohort during the entire 20 years of follow-up was $69,177 ($18,732 before and $50,445 after diagnosis). CONCLUSIONS People diagnosed with diabetes had higher medical expenditures compared with their counterparts, not only after diagnosis but also up to 10 years prior to diagnosis. Managing risk factors for type 2 diabetes and cardiovascular disease before diagnosis, and for diabetes-related complications after diagnosis, could alleviate medical expenditure in people with diabetes.
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Affiliation(s)
- Sundar S Shrestha
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Israel A Hora
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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7
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Nhim K, Khan T, Gruss SM, Wozniak G, Kirley K, Schumacher P, Luman ET, Albright A. Primary Care Providers' Prediabetes Screening, Testing, and Referral Behaviors. Am J Prev Med 2018; 55:e39-e47. [PMID: 29934016 PMCID: PMC6241213 DOI: 10.1016/j.amepre.2018.04.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/16/2018] [Accepted: 04/10/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Intensive behavioral counseling is effective in preventing type 2 diabetes, and insurance coverage for such interventions is increasing. Although primary care provider referrals are not required for entry to the Centers for Disease Control and Prevention (CDC)-recognized National Diabetes Prevention Program lifestyle change program, referral rates remain suboptimal. This study aims to assess the association between primary care provider behaviors regarding prediabetes screening, testing, and referral and awareness of the CDC-recognized lifestyle change program and the Prevent Diabetes STAT: Screen, Test, and Act Today™ toolkit. Awareness of the lifestyle change program and the STAT toolkit, use of electronic health records, and the ratio of lifestyle change program classes to primary care physicians were hypothesized to be positively associated with primary care provider prediabetes screening, testing, and referral behaviors. METHODS Responses from primary care providers (n=1,256) who completed the 2016 DocStyles cross-sectional web-based survey were analyzed in 2017 to measure self-reported prediabetes screening, testing, and referral behaviors. Multivariate logistic regression was used to estimate the effects of primary care provider awareness and practice characteristics on these behaviors, controlling for provider characteristics. RESULTS Overall, 38% of primary care providers were aware of the CDC-recognized lifestyle change program, and 19% were aware of the STAT toolkit; 27% screened patients for prediabetes using a risk test; 97% ordered recommended blood tests; and 23% made referrals. Awareness of the lifestyle change program and the STAT toolkit was positively associated with screening and referring patients. Primary care providers who used electronic health records were more likely to screen, test, and refer. Referring was more likely in areas with more lifestyle change program classes. CONCLUSIONS This study highlights the importance of increasing primary care provider awareness of and referrals to the CDC-recognized lifestyle change program.
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Affiliation(s)
- Kunthea Nhim
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | - Stephanie M Gruss
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Kate Kirley
- American Medical Association, Chicago, Illinois
| | - Patricia Schumacher
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth T Luman
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ann Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kamble PS, Collins J, Harvey RA, Prewitt T, Kimball E, Deluzio T, Allen E, Bouchard JR. Understanding Prediabetes in a Medicare Advantage Population Using Data Adaptive Techniques. Popul Health Manag 2018; 21:477-485. [PMID: 29648934 DOI: 10.1089/pop.2017.0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The objective was to identify individuals with undiagnosed prediabetes from administrative data using adaptive techniques. The data source was a national Medicare Advantage Prescription Drug (MAPD) plan administrative data set. A retrospective, cross-sectional study developed and evaluated data adaptive logistic regression, decision tree, neural network, and ensemble predictive models for metabolic syndrome and prediabetes using 3 mutually exclusive cohorts (N = 279,903). The misclassification rate (MCR), average squared error (ASE), c-statistics, sensitivity (SN), and false positive (FP) rates were compared to select the final predictive models. MAPD individuals with continuous enrollment from 2013 to 2014 were included. Metabolic syndrome and prediabetes were defined using clinical guidelines, diagnosis, and laboratory data. A total of 512 variables identified through subject matter expertise in addition to utilizing all data available were evaluated for the modeling. The ensemble model demonstrated better discrimination (c-statistics, MCR, and ASE of 0.83, 0.24, and 0.16, respectively), high SN, and low FP rate in predicting metabolic syndrome than the individual data adaptive modeling techniques. Logistic regression demonstrated better discrimination (c-statistics, MCR, and ASE of 0.67, 0.13, and 0.11 respectively), high SN, and low FP rate in predicting prediabetes than the other adaptive modeling techniques or ensemble methods. The scored data predicted prediabetes in 44% of the MAPD population, which is comparable to 2005-2006 National Health and Nutrition Examination Survey prediabetes rates of 41%. The logistic regression model demonstrated good performance in predicting undiagnosed prediabetes in MAPD individuals.
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Affiliation(s)
- Pravin S Kamble
- 1 Comprehensive Health Insights, Inc. , Louisville, Kentucky
| | - Jenna Collins
- 1 Comprehensive Health Insights, Inc. , Louisville, Kentucky
| | | | | | - Ed Kimball
- 3 Novo Nordisk, Inc. , Plainsboro, New Jersey
| | | | - Elsie Allen
- 3 Novo Nordisk, Inc. , Plainsboro, New Jersey
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Khan T, Tsipas S, Wozniak G. Medical Care Expenditures for Individuals with Prediabetes: The Potential Cost Savings in Reducing the Risk of Developing Diabetes. Popul Health Manag 2017; 20:389-396. [PMID: 28192030 PMCID: PMC5649409 DOI: 10.1089/pop.2016.0134] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The United States has 86 million adults with prediabetes. Individuals with prediabetes can prevent or delay the development of type 2 diabetes through lifestyle modifications such as participation in the National Diabetes Prevention Program (DPP), thereby mitigating the medical and economic burdens associated with diabetes. A cohort analysis of a commercially insured population was conducted using individual-level claims data from Truven Health MarketScan® Lab Database to identify adults with prediabetes, track whether they develop diabetes, and compare medical expenditures for those who are newly diagnosed with diabetes to those who are not. This study then illustrates how reducing the risk of developing diabetes by participation in an evidence-based lifestyle change program could yield both positive net savings on medical care expenditures and return on investment (ROI). Annual expenditures are found to be nearly one third higher for those who develop diabetes in subsequent years relative to those who do not transition from prediabetes to diabetes, with an average difference of $2671 per year. At that cost differential, the 3-year ROI for a National DPP is estimated to be as high as 42%. The results show the importance and economic benefits of participation in lifestyle intervention programs to prevent or delay the onset of type 2 diabetes.
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Affiliation(s)
- Tamkeen Khan
- American Medical Association , Chicago, Illinois
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10
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McCoy RG, Nori VS, Smith SA, Hane CA. Development and Validation of HealthImpact: An Incident Diabetes Prediction Model Based on Administrative Data. Health Serv Res 2016; 51:1896-918. [PMID: 26898782 DOI: 10.1111/1475-6773.12461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To develop and validate a model of incident type 2 diabetes based solely on administrative data. DATA SOURCES/STUDY SETTING Optum Labs Data Warehouse (OLDW), a national commercial administrative dataset. STUDY DESIGN HealthImpact model was developed and internally validated using nested case-control study design; n = 473,049 in training cohort and n = 303,025 in internal validation cohort. HealthImpact was externally validated in 2,000,000 adults followed prospectively for 3 years. Only adults ≥18 years were included. DATA COLLECTION/EXTRACTION METHODS Patients with incident diabetes were identified using HEDIS rules. Control subjects were sampled from patients without diabetes. Medical and pharmacy claims data collected over 3 years prior to index date were used to build the model variables. PRINCIPAL FINDINGS HealthImpact, scored 0-100, has 48 variables with c-statistic 0.80815. We identified HealthImpact threshold of 90 as identifying patients at high risk of incident diabetes. HealthImpact had excellent discrimination in external validation cohort (c-statistic 0.8171). The sensitivity, specificity, positive predictive value, and negative predictive value of HealthImpact >90 for new diagnosis of diabetes within 3 years were 32.35, 94.92, 22.25, and 96.90 percent, respectively. CONCLUSIONS HealthImpact is an efficient and effective method of risk stratification for incident diabetes that is not predicated on patient-provided information or laboratory tests.
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Affiliation(s)
- Rozalina G McCoy
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN. .,Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
| | | | - Steven A Smith
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN.,Division of Endocrinology Diabetes Metabolism & Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
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Katoh S, Peltonen M, Zeniya M, Kaji M, Sakamoto Y, Utsunomiya K, Tuomilehto J. Analysis of the Japanese Diabetes Risk Score and fatty liver markers for incident diabetes in a Japanese cohort. Prim Care Diabetes 2016; 10:19-26. [PMID: 26303223 DOI: 10.1016/j.pcd.2015.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 07/22/2015] [Accepted: 07/30/2015] [Indexed: 01/07/2023]
Abstract
AIMS We examined the effectiveness of the Japanese Diabetes Risk Score (JPDRISC) and fatty liver markers for predicting incident diabetes. METHODS We created the JPDRISC. The study periods I and II were January 2007 to May 2009 and June 2009 to December 2011, respectively. A total of 2084 people (1389 men, 695 women; mean age: 46 years) were included. People with diabetes in the Period I and those with ethanol intake >140 g/week were excluded. A total of 1515 people were included. Fatty liver using ultrasonography scores (FLUS) were assigned. RESULTS The mean observation period was 26.3 months, and 24 people had developed diabetes between the Periods I and II. In logistic regression analysis, the JPDRISC (OR=1.197, 95% C.I.: 1.062-1.350, p=0.003) and FLUS (OR=2.591, 95% C.I.: 1.411-4.758, p=0.002) in the Period I were independent determinants of incident diabetes. In receiver operating characteristic analysis, sensitivity and specificity for incident diabetes were 0.885 and 0.536, respectively, in people with both FLUS≥1 and the total JPDRISC≥6 in the Period I. The sensitivity was better than the JPDRISC alone (sensitivity 0.696) and FLUS alone (sensitivity 0.750). CONCLUSIONS JPDRISC and FLUS were independently associated with incident diabetes and their combination is useful.
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Affiliation(s)
- Shuichi Katoh
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan; Jikei University Harumi Triton Clinic, Jikei University School of Medicine, 1-8-8 W3 Harumi, Chuo-ku, Tokyo, 104-0053, Japan.
| | - Markku Peltonen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Mannerheimintie 164A, FI-00271, Helsinki, Finland.
| | - Mikio Zeniya
- Jikei University Harumi Triton Clinic, Jikei University School of Medicine, 1-8-8 W3 Harumi, Chuo-ku, Tokyo, 104-0053, Japan; Health-Care Center, Gastroenterology & Division of Oncology, Institute of DNA Medicine, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Masanobu Kaji
- Jikei University Harumi Triton Clinic, Jikei University School of Medicine, 1-8-8 W3 Harumi, Chuo-ku, Tokyo, 104-0053, Japan.
| | - Yoichi Sakamoto
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan; Jikei University Harumi Triton Clinic, Jikei University School of Medicine, 1-8-8 W3 Harumi, Chuo-ku, Tokyo, 104-0053, Japan.
| | - Kazunori Utsunomiya
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Jaakko Tuomilehto
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Mannerheimintie 164A, FI-00271, Helsinki, Finland; Instituto de Investigacion Sanitaria del Hospital Universario LaPaz (IdiPAZ), Hospital Universitario La Paz, Paseo de la Castellana, 261, 28048, Madrid, Spain; Centre for Vascular Prevention, Danube-University Krems, Doktor-Karl-Dorrek-Straße 30, A-3500, Krems, Austria; King Abdulaziz University, Jeddah, Saudi Arabia.
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12
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Olson DE, Zhu M, Long Q, Barb D, Haw JS, Rhee MK, Mohan AV, Watson-Williams PI, Jackson SL, Tomolo AM, Wilson PWF, Narayan KMV, Lipscomb J, Phillips LS. Increased cardiovascular disease, resource use, and costs before the clinical diagnosis of diabetes in veterans in the southeastern U.S. J Gen Intern Med 2015; 30:749-57. [PMID: 25608739 PMCID: PMC4441670 DOI: 10.1007/s11606-014-3075-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 08/26/2014] [Accepted: 09/28/2014] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Screening for diabetes might be more widespread if adverse associations with cardiovascular disease (CVD), resource use, and costs were known to occur earlier than conventional clinical diagnosis. OBJECTIVE The purpose of this study was to determine whether adverse effects associated with diabetes begin prior to clinical diagnosis. DESIGN Veterans with diabetes were matched 1:2 with controls by follow-up, age, race/ethnicity, gender, and VA facility. CVD was obtained from ICD-9 codes, and resource use and costs from VA datasets. SETTING VA facilities in SC, GA, and AL. PARTICIPANTS Patients with and without diagnosed diabetes. MAIN OUTCOME MEASURES Diagnosed CVD, resource use, and costs. RESULTS In this study, the 2,062 diabetic patients and 4,124 controls were 63 years old on average, 99 % male, and 29 % black; BMI was 30.8 in diabetic patients vs. 27.8 in controls (p<0.001). CVD prevalence was higher and there were more outpatient visits in Year -4 before diagnosis through Year +4 after diagnosis among diabetic vs. control patients (all p<0.01); in Year -2, CVD prevalence was 31 % vs. 24 %, and outpatient visits were 22 vs. 19 per year, respectively. Total VA costs/year/veteran were higher in diabetic than control patients from Year -4 ($4,083 vs. $2,754) through Year +5 ($8,347 vs. $5,700) (p<0.003) for each, reflecting underlying increases in outpatient, inpatient, and pharmacy costs (p<0.05 for each). Regression analysis showed that diabetes contributed an average of $1,748/year to costs, independent of CVD (p<0.001). CONCLUSIONS AND RELEVANCE VA costs per veteran are higher--over $1,000/year before and $2,000/year after diagnosis of diabetes--due to underlying increases in outpatient, inpatient, and pharmacy costs, greater number of outpatient visits, and increased CVD. Moreover, adverse associations with veterans' health and the VA healthcare system occur early in the natural history of the disease, several years before diabetes is diagnosed. Since adverse associations begin before diabetes is recognized, greater consideration should be given to systematic screening in order to permit earlier detection and initiation of preventive management. Keeping frequency of CVD and marginal costs in line with those of patients before diabetes is currently diagnosed has the potential to save up to $2 billion a year.
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13
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Katoh S, Peltonen M, Wada T, Zeniya M, Sakamoto Y, Utsunomiya K, Tuomilehto J. Fatty liver and serum cholinesterase are independently correlated with HbA1c levels: cross-sectional analysis of 5384 people. J Int Med Res 2014; 42:542-53. [PMID: 24595150 DOI: 10.1177/0300060513517485] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To examine the association between glycosylated haemoglobin (HbA1c) and fatty liver markers. METHODS This cross-sectional analysis stratified subjects into quintiles based on HbA1c. Fatty liver using ultrasonography scores (FLUS) were assigned as follows: 2 points, moderate or severe fatty liver; 1 point, mild fatty liver; and 0 points, normal liver. Subjects with viral hepatitis, alcohol intake >175 g/week or receiving hypoglycaemic treatment were excluded. RESULTS The study included 5384 subjects. Serum cholinesterase (ChE) and FLUS showed a significant graded increase with increasing HbA1c. In linear regression analysis stratified by body mass index (BMI) and age, ChE and FLUS were significantly associated with lower (1 + 2) and higher (3 + 4 + 5) HbA1c quintiles, respectively, independent of BMI and age. CONCLUSIONS The findings show that both ChE and FLUS are significantly correlated with HbA1c, independent of BMI and age.
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Affiliation(s)
- Shuichi Katoh
- Jikei University Harumi Triton Clinic, Jikei University School of Medicine, Tokyo, Japan
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14
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Esteghamati A, Etemad K, Koohpayehzadeh J, Abbasi M, Meysamie A, Noshad S, Asgari F, Mousavizadeh M, Rafei A, Khajeh E, Neishaboury M, Sheikhbahaei S, Nakhjavani M. Trends in the prevalence of diabetes and impaired fasting glucose in association with obesity in Iran: 2005-2011. Diabetes Res Clin Pract 2014; 103:319-27. [PMID: 24447808 DOI: 10.1016/j.diabres.2013.12.034] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 11/08/2013] [Accepted: 12/21/2013] [Indexed: 01/25/2023]
Abstract
AIMS To estimate the prevalence and trends of diabetes mellitus (DM) and impaired fasting glucose (IFG), 2005-2011, and to determine the contribution of obesity to DM prevalence. PATIENTS AND METHODS Data from Surveillance of Risk Factors of Non-communicable Diseases (SuRFNCD) conducted in 2005, 2007, and 2011 were gathered. DM was defined as presence of self-reported previous diagnosis or a fasting plasma glucose (FPG)≥7 mmol/L. IFG was diagnosed with FPG levels between 5.6 and 6.9 mmol/L. Prevalence rates for 2011 and trends for 2005-2011 were determined by extrapolating survey results to Iran's adult population. Population attributable fraction (PAF) of obesity was also calculated. RESULTS In 2011, IFG and total DM prevalence rates were 14.60% (95%CI: 12.41-16.78) and 11.37% (95%CI: 9.86-12.89) among 25-70 years, respectively. DM was more common in older age (p < 0.0001), in women (p = 0.0216), and in urban-dwellers (p = 0.0001). In 2005-2011, trend analysis revealed a 35.1% increase in DM prevalence (OR: 1.04, 95%CI: 1.01-1.07, p = 0.011); albeit, IFG prevalence remained relatively unchanged (OR: 0.98, 95%CI: 0.95-1.00, p = 0.167). In this period, DM awareness improved; undiagnosed DM prevalence decreased from 45.7% to 24.7% (p < 0.001). PAF analysis demonstrated that 33.78%, 10.25%, and 30.56% of the prevalent DM can be attributed to overweight (BMI≥25kg/m(2)), general obesity (BMI≥30 kg/m(2)), and central obesity (waist circumference≥90 cm), respectively. Additionally, the DM increase rate in 2005-2011, was 20 times higher in morbidly obese compared with lean individuals. CONCLUSION More than four million Iranian adults have DM which has increased by 35% over the past seven years, owing in large part, to expanding obesity epidemic.
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Affiliation(s)
- Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | | | | | - Mehrshad Abbasi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Alipasha Meysamie
- Department of Preventive Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sina Noshad
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Mostafa Mousavizadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Rafei
- Center for Disease Control, Tehran, Iran.
| | - Elias Khajeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohamadreza Neishaboury
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sara Sheikhbahaei
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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15
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Icks A, Claessen H, Strassburger K, Waldeyer R, Chernyak N, Jülich F, Rathmann W, Thorand B, Meisinger C, Huth C, Rückert IM, Schunk M, Giani G, Holle R. Patient time costs attributable to healthcare use in diabetes: results from the population-based KORA survey in Germany. Diabet Med 2013; 30:1245-9. [PMID: 23796224 DOI: 10.1111/dme.12263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 05/23/2013] [Accepted: 06/18/2013] [Indexed: 11/29/2022]
Abstract
AIMS Patient time costs have been described to be substantial; however, data are highly limited. We estimated patient time costs attributable to outpatient and inpatient care in study participants with diagnosed diabetes, previously undetected diabetes, impaired glucose regulation and normal glucose tolerance. METHODS Using data of the population-based KORA S4 study (55-74 years, random sample of n = 350), we identified participants' stage of glucose tolerance by oral glucose tolerance test. To estimate mean patient time costs per year (crude and standardized with respect to age and sex), we used data regarding time spent with ambulatory visits including travel and waiting time and with hospital stays (time valued at a 2011 net wage rate of €20.63/h). The observation period was 24 weeks and data were extrapolated to 1 year. RESULTS Eighty-nine to 97% of participants in the four groups (diagnosed diabetes, undetected diabetes, impaired glucose regulation and normal glucose tolerance.) had at least one physician contact and 4-14% at least one hospital admission during the observation period. Patient time [h/year (95% CI)] was 102.0 (33.7-254.8), 53.8 (15.0-236.7), 59.3 (25.1-146.8) and 28.6 (21.1-43.7), respectively. Age-sex standardized patient time costs per year (95% CI) were €2447.1 (804.5-6143.6), €880.4 (259.1-3606.7), €1151.6 (454.6-2957.6) and €589.2 (435.8-904.8). CONCLUSIONS Patient time costs were substantial--even higher than medication costs in the same study population. They are higher in participants with diagnosed diabetes, but also in those with undetected diabetes and impaired glucose regulation compared with those with normal glucose tolerance. Research is needed in larger populations to receive more precise and certain estimates that can be used in health economic evaluation.
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Affiliation(s)
- A Icks
- Department of Public Health, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany; Institute of Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine-University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany
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16
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Chatterjee R, Narayan KMV, Lipscomb J, Jackson SL, Long Q, Zhu M, Phillips LS. Screening for diabetes and prediabetes should be cost-saving in patients at high risk. Diabetes Care 2013; 36:1981-7. [PMID: 23393215 PMCID: PMC3687271 DOI: 10.2337/dc12-1752] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 12/16/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although screening for diabetes and prediabetes is recommended, it is not clear how best or whom to screen. We therefore compared the economics of screening according to baseline risk. RESEARCH DESIGN AND METHODS Five screening tests were performed in 1,573 adults without known diabetes--random plasma/capillary glucose, plasma/capillary glucose 1 h after 50-g oral glucose (any time, without previous fast, plasma glucose 1 h after a 50-g oral glucose challenge [GCTpl]/capillary glucose 1 h after a 50-g oral glucose challenge [GCTcap]), and A1C--and a definitive 75-g oral glucose tolerance test. Costs of screening included the following: costs of testing (screen plus oral glucose tolerance test, if screen is positive); costs for false-negative results; and costs of treatment of true-positive results with metformin, all over the course of 3 years. We compared costs for no screening, screening everyone for diabetes or high-risk prediabetes, and screening those with risk factors based on age, BMI, blood pressure, waist circumference, lipids, or family history of diabetes. RESULTS Compared with no screening, cost-savings would be obtained largely from screening those at higher risk, including those with BMI >35 kg/m(2), systolic blood pressure ≥130 mmHg, or age >55 years, with differences of up to -46% of health system costs for screening for diabetes and -21% for screening for dysglycemia110, respectively (all P < 0.01). GCTpl would be the least expensive screening test for most high-risk groups for this population over the course of 3 years. CONCLUSIONS From a health economics perspective, screening for diabetes and high-risk prediabetes should target patients at higher risk, particularly those with BMI >35 kg/m(2), systolic blood pressure ≥130 mmHg, or age >55 years, for whom screening can be most cost-saving. GCTpl is generally the least expensive test in high-risk groups and should be considered for routine use as an opportunistic screen in these groups.
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Affiliation(s)
- Ranee Chatterjee
- Department of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
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17
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Racial and ethnic differences in cardio-metabolic risk in individuals with undiagnosed diabetes: National Health and Nutrition Examination Survey 1999-2008. J Gen Intern Med 2012; 27:893-900. [PMID: 22415867 PMCID: PMC3403154 DOI: 10.1007/s11606-012-2023-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 01/11/2012] [Accepted: 02/10/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although early recognition and treatment of diabetes may be essential to prevent complications, roughly one-fifth of diabetes remains undiagnosed. OBJECTIVE Examine cardio-metabolic risk factors and their control in non-Hispanic white (NHW), non-Hispanic black (NHB) and Mexican American (MA) individuals with undiagnosed diabetes. DESIGN Nationally representative cross-sectional study of participants in the National Health and Nutrition Examination Survey (NHANES) continuous cycles conducted 1999 through 2008. PARTICIPANTS Of 22,621 non-pregnant individuals aged ≥20 years, 2521 had diagnosed diabetes. Of the remaining 20,100 individuals, 17,963 had HbA1c measured, 551 of whom were classified as having undiagnosed diabetes and comprise the study population. MAIN MEASURES Undiagnosed diabetes was defined as HbA1c ≥ 6.5% without a self-report of physician diagnosed diabetes. Cardio-metabolic risk factor control was examined using regression methods for complex survey data. KEY RESULTS Among individuals with undiagnosed diabetes, mean HbA1c level was 7.7% (95% CI: 7.5, 7.9), 19.3% (95% CI: 14.2, 24.3) smoked, 59.7% (95% CI: 54.5, 64.8%) had hypertension and 96.5% (95% CI: 94.6, 98.4%) had dyslipidemia. Lipid profiles were remarkably different across racial-ethnic groups: NHB had the highest LDL- and HDL-cholesterol, but the lowest triglycerides, while MA had the highest triglycerides and the lowest LDL-cholesterol. After adjusting for age, sex, NHANES examination cycle and use of either blood pressure or lipid medication, the odds of having blood pressure ≥130/80 mmHg was higher in NHB [1.92 (95% CI: 1.09, 3.55)] than NHW, while the odds of having LDL-cholesterol >100 mg/dl was higher in NHW[2.93 (95% CI: 1.37, 6.24)] and NHB[3.34 (95% CI: 1.08, 10.3)] than MA. CONCLUSIONS In a nationally representative sample of individuals with undiagnosed diabetes, cardio-metabolic risk factor levels were high across all racial/ethnic groups, but NHB and MA had poorer control compared to NHW. Interventions that target identification of diabetes and treatment of cardio-metabolic risk factors are needed.
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Abstract
AIMS We investigated if there are substantial differences in the prevalence of diabetes between members of different health insurance funds in Germany and, if so, which variables might explain these differences. METHODS Ten representative surveys (conducted between 2004 and 2008) of the Bertelsmann Healthcare Monitor, comprising 15 089 participants aged 18-79 years, were analysed. Our main independent variable was membership in one of eight health insurance funds. We first estimated the crude prevalence of diabetes stratified by these funds. We further fitted logistic regression models and stepwise adjusted for age and sex, further co-morbidities and anthropometric measures and factors influencing health awareness and lifestyle. RESULTS The overall prevalence of diabetes was 6.9%. Stratified by health insurance funds, prevalences ranged between 3.9% within the Innungskrankenkassen to 11.4% within the Allgemeine Ortskrankenkassen. Adjusting for age and sex only led to minor changes. After controlling for all mentioned variables, these differences remained. Compared with those who were privately insured, persons within the Allgemeine Ortskrankenkassen (OR 1.73; 95% CI 1.30-2.29), the Betriebskrankenkassen (OR 1.54; 95% CI 1.15-2.07) and the Barmer (OR 1.39; 95% CI 1.01-1.91) had a higher prevalence. CONCLUSIONS We found considerable differences in diabetes prevalence between German health insurance funds that remained after controlling for several relevant variables.
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Affiliation(s)
- F Hoffmann
- University of Bremen, Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research, Bremen, Germany.
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Echouffo-Tcheugui JB, Ali MK, Griffin SJ, Narayan KMV. Screening for type 2 diabetes and dysglycemia. Epidemiol Rev 2011; 33:63-87. [PMID: 21624961 DOI: 10.1093/epirev/mxq020] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) and dysglycemia (impaired glucose tolerance and/or impaired fasting glucose) are increasingly contributing to the global burden of diseases. The authors reviewed the published literature to critically evaluate the evidence on screening for both conditions and to identify the gaps in current understanding. Acceptable, relatively simple, and accurate tools can be used to screen for both T2DM and dysglycemia. Lifestyle modification and/or medication (e.g., metformin) are cost-effective in reducing the incidence of T2DM. However, their application is not yet routine practice. It is unclear whether diabetes-prevention strategies, which influence cardiovascular risk favorably, will also prevent diabetic vascular complications. Cardioprotective therapies, which are cost-effective in preventing complications in conventionally diagnosed T2DM, can be used in screen-detected diabetes, but the magnitude of their effects is unknown. Economic modeling suggests that screening for both T2DM and dysglycemia may be cost-effective, although empirical data on tangible benefits in preventing complications or death are lacking. Screening for T2DM is psychologically unharmful, but the specific impact of attributing the label of dysglycemia remains uncertain. Addressing these gaps will inform the development of a screening policy for T2DM and dysglycemia within a holistic diabetes prevention and control framework combining secondary and high-risk primary prevention strategies.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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20
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Sullivan SD, Garrison LP, Rinde H, Kolberg J, Moler EJ. Cost-effectiveness of risk stratification for preventing type 2 diabetes using a multi-marker diabetes risk score. J Med Econ 2011; 14:609-16. [PMID: 21740291 DOI: 10.3111/13696998.2011.602160] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Personalized medicine requires diagnostic tests that stratify patients into distinct groups that may differentially benefit from targeted treatment approaches. This study compared the costs and benefits of two approaches for identifying those at high risk of developing type 2 diabetes for entry into a diabetes prevention program. The first approach identified high risk patients using impaired fasting glucose (IFG). The second approach used the PreDx Diabetes Risk Score (DRS) to further stratify IFG patients into high-risk and moderate-risk groups. METHODS A Markov model was developed to simulate the incidence and disease progression of diabetes and consequent costs and quality-adjusted life expectancy (QALY), comparing alternative approaches for identifying high-risk patients. We modeled direct medical costs, including the costs of the stratification testing, over a 10-year time horizon from a US payer perspective. RESULTS Stratification of IFG patients by the DRS method leads to improved identification and prevention among those at highest risk. At 5 years, the number needed to treat (NNT) in the IFG-only approach was 39 patients to prevent one case of diabetes compared to an NNT of 15 in the IFG + DRS approach. When compared to IFG alone, the IFG + DRS approach results in an incremental cost-effectiveness ratio (ICER) of $17,100/QALY gained at 5 years and would become cost saving in 10 years. In contrast and as compared to no stratification, the IFG-only approach would produce an ICER of $235,500/QALY gained at 5 years and $94,600/QALY gained at 10 years. The study findings are limited by the generalizability of the DRS validation study and uncertainty regarding the long-term effectiveness of diabetes prevention. CONCLUSIONS The analysis indicates that the cost-effectiveness of diabetes prevention can be improved by better identification of patients at highest risk for diabetes using the DRS.
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Nichols GA, Moler EJ. Metabolic syndrome components are associated with future medical costs independent of cardiovascular hospitalization and incident diabetes. Metab Syndr Relat Disord 2010; 9:127-33. [PMID: 21166586 DOI: 10.1089/met.2010.0105] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Higher medical care costs have been associated with the number of metabolic syndrome components present, but the association with future medical costs has not been described. Furthermore, the independent cost contribution of each component alone and in combination with other components is unknown. METHODS We identified 57,420 nondiabetic adults aged ≥30 with all metabolic syndrome components measured in 2003-2004 and with 5 years of follow-up data available. We calculated and compared total annualized direct medical costs across the number of metabolic syndrome components present and for all possible combinations of metabolic syndrome components. The independent contribution to costs of each component was isolated by adjusting for age, sex, the other metabolic syndrome components, incident diabetes, number of years with diabetes, cardiovascular (CVD) hospitalization, and years after hospitalization. RESULTS Annualized age- and sex-adjusted medical costs incurred over follow-up increased with each additional metabolic syndrome component present. After full adjustment, hypertension ($550), obesity ($366), low high-density lipoprotein (HDL) ($363), and high triglycerides ($317) were significantly associated with higher annual costs (P < 0.001 for all), but impaired fasting glucose was not. Further analysis indicated that costs were significantly elevated for each of these components only among those who did not develop diabetes or were not hospitalized for CVD. CONCLUSIONS Incident diabetes or CVD hospitalizations accounted for the association between each metabolic syndrome component and future costs when these events occurred, but the elevated costs associated with metabolic syndrome components were observed even when these events did not occur. Further research is needed to understand the underlying morbidity that is driving the increased costs.
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Affiliation(s)
- Gregory A Nichols
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA.
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22
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Ide R, Hoshuyama T, Wilson DJ, Takahashi K, Higashi T. Relationships between diabetes and medical and dental care costs: findings from a worksite cohort study in Japan. INDUSTRIAL HEALTH 2010; 48:857-863. [PMID: 20616460 DOI: 10.2486/indhealth.ms1158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The purpose of this study was to evaluate the relationships between diabetes and medical and dental care costs from a 5-yr prospective observation of Japanese workers. The data were derived from health and dental examinations and health insurance claims of 4,086 workers aged 40-54 yr. At baseline, the subjects were assigned to four categories: known diabetes; undiagnosed diabetes; impaired fasting glucose (IFG); and non-diabetic. The differences in health care costs among the non-diabetics, IFG and undiagnosed diabetes groups were not seen at baseline, but the costs incurred by the subjects with undiagnosed diabetes substantially increased thereafter. Over 5 yr of the study period, compared with the non-diabetic group, subjects with known diabetes incurred 3.9- and 2.9-fold higher annual inpatient and outpatient costs, respectively, while subjects in the undiagnosed diabetes group incurred 3.0- and 1.6-fold higher costs, respectively. There were no significant associations between annual dental care costs and diabetic status. The excess costs of medical care among subjects with diabetes were attributable to diabetes itself, heart disease and cerebrovascular disease, but not cancer. Among middle-aged workers, diabetics incurred significantly greater medical care costs than non-diabetics, whereas IFG was not associated with higher costs.
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Affiliation(s)
- Reiko Ide
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.
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Chatterjee R, Narayan KMV, Lipscomb J, Phillips LS. Screening adults for pre-diabetes and diabetes may be cost-saving. Diabetes Care 2010; 33:1484-90. [PMID: 20587721 PMCID: PMC2890345 DOI: 10.2337/dc10-0054] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The economic costs of hyperglycemia are substantial. Early detection would allow management to prevent or delay development of diabetes and diabetes-related complications. We investigated the economic justification for screening for pre-diabetes/diabetes. RESEARCH DESIGN AND METHODS We projected health system and societal costs over 3 years for 1,259 adults, comparing costs associated with five opportunistic screening tests. All subjects had measurements taken of random plasma and capillary glucose (RPG and RCG), A1C, and plasma and capillary glucose 1 h after a 50 g oral glucose challenge test without prior fasting (GCT-pl and GCT-cap), and a subsequent diagnostic 75 g oral glucose tolerance test (OGTT). RESULTS Assuming 70% specificity screening cutoffs, Medicare costs for testing, retail costs for generic metformin, and costs for false negatives as 10% of reported costs associated with pre-diabetes/diabetes, health system costs over 3 years for the different screening tests would be GCT-pl $180,635; GCT-cap $182,980; RPG $182,780; RCG $186,090; and A1C $192,261; all lower than costs for no screening, which would be $205,966. Under varying assumptions, projected health system costs for screening and treatment with metformin or lifestyle modification would be less than costs for no screening as long as disease prevalence is at least 70% of that of our population and false-negative costs are at least 10% of disease costs. Societal costs would equal or exceed costs of no screening depending on treatment type. CONCLUSIONS Screening appears to be cost-saving compared to no screening from a health system perspective, and potentially cost-neutral from a societal perspective. These data suggest that strong consideration should be given to screening-with preventive management-and that use of GCTs may be cost-effective.
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Affiliation(s)
- Ranee Chatterjee
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
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Ademi Z, Liew D, Hollingsworth B, Steg PG, Bhatt DL, Reid CM. Predictors of Annual Pharmaceutical Costs in Australia for Community-Based Individuals with, or at Risk of, Cardiovascular Disease. Am J Cardiovasc Drugs 2010; 10:85-94. [DOI: 10.2165/11530670-000000000-00000] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Ariza MA, Vimalananda VG, Rosenzweig JL. The economic consequences of diabetes and cardiovascular disease in the United States. Rev Endocr Metab Disord 2010; 11:1-10. [PMID: 20191325 DOI: 10.1007/s11154-010-9128-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Diabetes-related care and complications constitute a significant proportion of the United States' (US) health care expenditure. Of these complications, cardiovascular disease (CVD) is a major component. Higher morbidity and mortality rates translate to higher costs of care in patients with diabetes compared to those who do not have the disease. Minorities bear a disproportionate burden of diabetes and CVD. We review this disparity and examine potential etiologies for it in Hispanics and African-Americans, the two largest minority groups in the US. We examine strategies in these populations that may improve outcomes in diabetes and CVD, potentially decreasing health care costs.
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Affiliation(s)
- Miguel A Ariza
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, 88 East Newton Street, Evans 201, Boston, MA 02118, USA
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Boudreau DM, Malone DC, Raebel MA, Fishman PA, Nichols GA, Feldstein AC, Boscoe AN, Ben-Joseph RH, Magid DJ, Okamoto LJ. Health care utilization and costs by metabolic syndrome risk factors. Metab Syndr Relat Disord 2009; 7:305-14. [PMID: 19558267 DOI: 10.1089/met.2008.0070] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND This study compared prevalent health utilization and costs for persons with and without metabolic syndrome and investigated the independent associations of the various factors that make up metabolic syndrome. METHODS Subjects were enrollees of three health plans who had all clinical measurements (blood pressure, fasting plasma glucose, body mass index, triglycerides, and high-density lipoprotein cholesterol) necessary to determine metabolic syndrome risk factors over the 2-year study period (n = 170,648). We used clinical values, International Classification of Diseases, Ninth Revision (ICD-9) diagnoses, and medication dispensings to identify risk factors. We report unadjusted mean annual utilization and modeled mean annual costs adjusting for age, sex, and co-morbidity. RESULTS Subjects with metabolic syndrome (n = 98,091) had higher utilization and costs compared to subjects with no metabolic syndrome (n = 72,557) overall, and when stratified by diabetes (P < 0.001). Average annual total costs between subjects with metabolic syndrome versus no metabolic syndrome differed by a magnitude of 1.6 overall ($5,732 vs. $3,581), and a magnitude of 1.3 when stratified by diabetes (diabetes, $7,896 vs. $6,038; no diabetes, $4,476 vs. $3,422). Overall, total costs increased by an average of 24% per additional risk factor (P < 0.001). Costs and utilization differed by risk factor clusters, but the more prevalent clusters were not necessarily the most costly. Costs for subjects with diabetes plus weight risk, dyslipidemia, and hypertension were almost double the costs for subjects with prediabetes plus similar risk factors ($8,067 vs. $4,638). CONCLUSIONS Metabolic syndrome, number of risk factors, and specific combinations of risk factors are markers for high utilization and costs among patients receiving medical care. Diabetes and certain risk clusters are major drivers of utilization and costs.
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Affiliation(s)
- D M Boudreau
- Group Health, Center for Health Studies, Seattle, Washington, USA.
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Chase JG, Andreassen S, Pielmeier U, Hann CE, McAuley KA, Mann J. A glucose-insulin pharmacodynamic surface modeling validation and comparison of metabolic system models. Biomed Signal Process Control 2009. [DOI: 10.1016/j.bspc.2009.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zhang Y, Dall TM, Chen Y, Baldwin A, Yang W, Mann S, Moore V, Le Nestour E, Quick WW. Medical cost associated with prediabetes. Popul Health Manag 2009; 12:157-63. [PMID: 19534580 DOI: 10.1089/pop.2009.12302] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this article, we estimate national health care resource use and medical costs in 2007 associated with prediabetes (PD), defined as either fasting plasma glucose between 100 and 125 or oral glucose tolerance test between 140 and 200. We use Poisson regression with medical claims for an adult population continuously insured between 2004 and 2006 to analyze patterns of health care resource use by PD status. Combining rate ratios that reflect health care use patterns with national PD prevalence rates from the National Health and Nutrition Examination Survey, we calculate etiological fractions to estimate the portion of national health resource use associated with PD. The findings suggest that PD is associated with statistically higher rates of ambulatory visits for hypertension; endocrine, metabolic, and renal complications; and general medical conditions. PD is associated with a slight increase in visit rates for neurological symptoms, peripheral vascular disease, and cardiovascular disease, but the increase is not statistically significant. There is no indication that PD is associated with an increase in emergency visits and inpatient days. Extrapolating these patterns to the 57 million adults with PD in 2007 suggests that national annual medical costs of PD exceed $25 billion, or an additional $443 for each adult with PD. PD is associated with excessive use of ambulatory services for comorbidities known to be related to diabetes. Our findings strengthen the business case for lifestyle interventions to prevent diabetes by adding additional economic benefits that potentially can be achieved by preventing or delaying PD.
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Affiliation(s)
- Yiduo Zhang
- The Lewin Group, Falls Church, Virginia, USA.
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Beaton SJ, Robinson SB, Von Worley A, Davis HT, Boscoe AN, Ben–Joseph R, Okamoto LJ. Cardiometabolic Risk and Health Care Utilization and Cost for Hispanic and Non-Hispanic Women. Popul Health Manag 2009; 12:177-83. [DOI: 10.1089/pop.2008.0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nichols GA, Koro CE, Kolatkar NS. The incidence of heart failure among nondiabetic patients with and without impaired fasting glucose. J Diabetes Complications 2009; 23:224-8. [PMID: 18413158 DOI: 10.1016/j.jdiacomp.2007.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 08/08/2007] [Accepted: 10/05/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to elucidate the relationship between fasting plasma glucose (FPG), development of diabetes, and incident heart failure (HF) in a large, community sample of nondiabetic subjects. RESEARCH DESIGN AND METHODS From Kaiser Permanente Northwest medical records, we identified 10,113 subjects with an FPG level of 100-125 mg/dl in 1997 or 1998 who were free of diabetes and HF and matched them to an equal number of subjects with an FPG level of <100 mg/dl on sex and 5-year age groups. Subjects were followed until a new diagnosis of HF was entered into the medical record, death, termination of health plan membership, or December 31, 2005, whichever came first. RESULTS After controlling for known HF risk factors, each 10 mg/dl increase in FPG was independently associated with an 8% increase in the risk of HF over a mean follow-up of 79 months [hazard ratio (HR)=1.08, 95% confidence interval (CI) 1.03-1.13, P=.003]. However, in a subsequent analysis that included only those HF cases that occurred prior to diabetes onset and censored follow-up at the time of diabetes development, FPG was not a significant predictor of HF risk (HR=1.01, 95% CI 0.96-1.07, P=.621). Age, male sex, body mass index, smoking, and cardiovascular disease were highly predictive of HF incidence. CONCLUSIONS Although the risk of HF is increased among subjects with higher FPG, the increased risk is explained by greater likelihood of developing diabetes. Risk factors other than FPG are much stronger independent predictors of incident HF.
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Affiliation(s)
- Gregory A Nichols
- Kaiser Permanente, Center for Health Research, Portland, OR 97227-1098, USA.
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Janssen PGH, Gorter KJ, Stolk RP, Akarsubasi M, Rutten GEHM. Three years follow-up of screen-detected diabetic and non-diabetic subjects: who is better off? The ADDITION Netherlands study. BMC FAMILY PRACTICE 2008; 9:67. [PMID: 19087327 PMCID: PMC2626593 DOI: 10.1186/1471-2296-9-67] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 12/16/2008] [Indexed: 11/10/2022]
Abstract
Background People with non-diabetic hyperglycaemia might be at risk of lacking adequate control for cardiovascular risk factors. Our aim was to determine the extent of health care utilization and provision in primary care and to evaluate the risk of cardiovascular disease in persons with an elevated risk score in a stepwise diabetes screening programme. Methods A total of 56,978 non-diabetic patients, aged 50–70 years, from 79 practices in the Netherlands were invited to participate in a screening programme starting with a questionnaire. Those with an elevated score, underwent further glucose testing. Screened participants with type 2 diabetes (n = 64), impaired glucose tolerance (IGT) (n = 62), impaired fasting glucose (IFG) (n = 86), and normal glucose tolerance (NGT) (n = 142) were compared after three years regarding use of medication, care provider encounters and occurrence of CVD. Results In all glucose regulation categories cardiovascular medication was prescribed more frequently during follow-up with the strongest increase in diabetic patients. Number of practice visits was higher in diabetic patients compared to those in the other categories. Glucose, lipids, and blood pressure were measured most frequently in diabetic patients. Numbers of cardiovascular events in participants with NGT, IFG, IGT and diabetes were 16.7, 32.6, 17.3 and 15.7 per 1,000 person-years (non significant), respectively. Conclusion After three years of follow-up, screened non-diabetic participants with an elevated risk score had cardiovascular event rates comparable with diabetic patients. Screened non-diabetic persons are at risk of lacking optimal control for cardiovascular risk factors while screen-detected diabetic patients were controlled adequately.
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Affiliation(s)
- Paul G H Janssen
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands.
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Medical Care Costs One Year After Identification of Hyperglycemia Below the Threshold for Diabetes. Med Care 2008; 46:287-92. [DOI: 10.1097/mlr.0b013e31815b9772] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Curtis LH, Hammill BG, Bethel MA, Anstrom KJ, Liao L, Gottdiener JS, Schulman KA. Pancreatic beta-cell function as a predictor of cardiovascular outcomes and costs: findings from the Cardiovascular Health Study. Curr Med Res Opin 2008; 24:41-50. [PMID: 18021490 DOI: 10.1185/030079908x253573] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore relationships between beta-cell function and incident cardiovascular events, death, and medical costs among elderly individuals. RESEARCH DESIGN AND METHODS In a prospective, population-based cohort of 4555 elderly individuals, we examined the effect of beta-cell function on incident cardiovascular events and mortality. We also examined costs for 3715 of these individuals. We used the computer-based homeostasis model assessment (HOMA) to calculate indices of beta-cell function (HOMA-%B) and insulin sensitivity (HOMA-%S) using baseline fasting glucose and insulin levels. All subjects were followed from 1992/1993 for 6 years or until death. MAIN OUTCOME MEASURES Discrete-time survival model of the effects of beta-cell function on incident cardiovascular events and all-cause mortality; and semiparametric estimators for calculations of mean 6-year costs. RESULTS Controlling for HOMA-%S, a 20% decrease in HOMA-%B was associated with increased odds of incident cardiovascular events (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.05-1.14) and death (OR, 1.10; 95% CI, 1.07-1.14). The relationships persisted after controlling for clinical and sociodemographic confounders. A 20% decrease in HOMA-%B was also associated with increased costs (cost ratio, 1.03; 95% CI, 1.01-1.05). The significant association did not persist after controlling for confounders. LIMITATIONS The sample comprises relatively healthy elderly individuals and is based on data from 1992 through 1999, which may not reflect current experience. The measure of beta-cell function is an estimate generated from single measures of glucose and insulin. CONCLUSIONS Beta-cell function as measured by HOMA-%B is a significant predictor of incident cardiovascular events and mortality but not of costs, controlling for HOMA-%S and sociodemographic and clinical confounders.
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Affiliation(s)
- Lesley H Curtis
- Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27715, USA.
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Nichols GA, Koro CE, Kolatkar NS. The epidemiology of congestive heart failure in hyperglycemia below the threshold for diabetes: A critical review. Diabetes Metab Syndr 2007. [DOI: 10.1016/j.dsx.2007.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kitzmiller JL, Dang-Kilduff L, Taslimi MM. Gestational diabetes after delivery. Short-term management and long-term risks. Diabetes Care 2007; 30 Suppl 2:S225-35. [PMID: 17596477 DOI: 10.2337/dc07-s221] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- John L Kitzmiller
- Division of Maternal-Fetal Medicine, Santa Clara County Health System, San Jose, California, USA.
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Abstract
Rational decision-making regarding health care spending for weight management requires an understanding of the cost of care provided to obese patients and the potential cost-effectiveness or cost savings of interventions. The purpose of this review is to assist health plans and disease management leaders in making informed decisions for weight management services. Among the review's findings, obesity and severe obesity are strongly and consistently associated with increased health care costs. The cost-effectiveness of obesity-related interventions is highly dependent on the risk status of the treated population, as well as the length, cost, and effectiveness of the intervention. Bariatric surgery offers high initial costs and uncertain long-term cost savings. From the perspective of a payor, obesity management services are as cost-effective as other commonly offered health services, though not likely to offer cost savings. Behavioral health promotion interventions in the worksite setting provide cost savings from the employer's perspective, if decreased rates of absenteeism are included in the analysis.
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Affiliation(s)
- Keith H Bachman
- Kaiser Permanente's Care Management Institute, Weight Management Initiative, Oakland, California, USA.
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Ohmori-Matsuda K, Kuriyama S, Hozawa A, Nakaya N, Shimazu T, Tsuji I. The joint impact of cardiovascular risk factors upon medical costs. Prev Med 2007; 44:349-55. [PMID: 17289136 DOI: 10.1016/j.ypmed.2006.11.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Revised: 11/27/2006] [Accepted: 11/29/2006] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The joint impact of obesity, hypertension, and hyperglycemia upon medical costs is not well known. Our objective was to evaluate the joint impact of these cardiovascular risk factors upon medical costs in the rural Japanese population. METHODS The data were derived from a 6-year prospective observation of National Health Insurance beneficiaries in rural Japan. Data on blood chemistry tests, blood pressure, weight, and height were obtained from an annual health check-up provided by the local municipalities in 1995. We prospectively collected data on medical costs over a 6-year period for 12,340 subjects (5306 men and 7034 women) without prior histories of cardiovascular disease or cancer. RESULTS Mean medical costs for individuals being overweight/obese, hypertensive, and hyperglycemic were 91.0% higher than those for individuals without any of these three cardiovascular risk factors. In this cohort, 17.2% of total medical costs were attributable to these three risk factors. CONCLUSION Overweight/obesity, hypertension, and hyperglycemia could have a large impact on health care resources in rural Japan.
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Affiliation(s)
- Kaori Ohmori-Matsuda
- Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan.
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Nakamura K, Okamura T, Kanda H, Hayakawa T, Okayama A, Ueshima H. Medical costs of patients with hypertension and/or diabetes: A 10-year follow-up study of National Health Insurance in Shiga, Japan. J Hypertens 2006; 24:2305-9. [PMID: 17053555 DOI: 10.1097/01.hjh.0000249711.28769.80] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND METHODS A cohort study investigating medical costs associated with the combination of hypertension and diabetes was conducted. The participants included 4535 community-dwelling Japanese individuals, aged 40-69 years, who were classified into the following four categories: 'Neither hypertension nor diabetes', 'Hypertension alone', 'Diabetes alone' or 'Both hypertension and diabetes'. Medical costs per person per month were compared among the four categories. RESULTS AND CONCLUSION Of the study population, 1.3% had both hypertension and diabetes. During the 10-year follow-up period, participants with both hypertension and diabetes incurred higher medical costs, as compared with those without hypertension, diabetes or their combination, even after adjustment for other confounding factors.
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Affiliation(s)
- Koshi Nakamura
- Department of Health Science, Shiga University of Medical Science, Otsu City, Shiga, Japan.
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