Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
Curr Med Res Opin. 2011 Apr;27(4):809-19. doi: 10.1185/03007995.2011.554806. Epub 2011 Feb 10.
This study examined progression to type 2 diabetes and compared healthcare utilization and costs among patients with pre-diabetes, with or without comorbid hypertension.
This study drew from a large national claims database (2003-2008). Patients were ≥18 years of age with a medical claim or lab value indicating the presence of pre-diabetes. The index date was the first pre-diabetes diagnosis (ICD-9 codes 790.21, 790.22, 790.29) or qualifying lab value of fasting plasma glucose or impaired glucose intolerance. All patients had ≥12-month data pre- and post- index date. Multivariate analysis was conducted to identify risk factors affecting progression to type 2 diabetes, and to estimate the impact of hypertension status and diabetes progression on healthcare utilization and cost.
144,410 patients met study criteria, with an average follow-up of 802 (SD 344) days. Among participants, 30.7% progressed to diabetes, with a mean 288 (SD 340) days from pre-diabetes identification to diabetes diagnosis. Compared with patients who did not progress, the total adjusted medical costs for patients who developed diabetes increased by $1429 in 1 year, $2451 in 2 years, and $3621 in 3 years (p < 0.001). Patients with concomitant hypertension were significantly more likely to progress to type 2 diabetes, and had higher total medical costs compared to patients without hypertension ($476 higher in 1 year, $949 in 2 years, $1378 in 3 years).
Patients with pre-diabetes who progressed to type 2 diabetes had higher healthcare utilization and costs compared with patients who did not. The presence of hypertension substantially increased costs and was associated with higher likelihood of diabetes progression. Blood pressure, lifestyle intervention, body mass index, and other factors cannot be examined due to the limitations of the data. Results may not be generalizable to patients with insurance other than commercial or Medicare.
本研究旨在探讨糖尿病前期患者向 2 型糖尿病进展的情况，并比较合并或不合并高血压的糖尿病前期患者的医疗保健利用和成本。
本研究从一个大型全国索赔数据库（2003-2008 年）中提取数据。患者年龄≥18 岁，有医疗索赔或实验室检查结果表明存在糖尿病前期。指数日期为首次诊断为糖尿病前期（ICD-9 编码 790.21、790.22、790.29）或空腹血糖或葡萄糖耐量受损的合格实验室值。所有患者在指数日期前和后均有≥12 个月的数据。采用多变量分析确定影响向 2 型糖尿病进展的危险因素，并估计高血压状况和糖尿病进展对医疗保健利用和成本的影响。
144410 名患者符合研究标准，平均随访 802（SD 344）天。在参与者中，30.7%进展为糖尿病，从糖尿病前期诊断到糖尿病诊断的平均时间为 288（SD 340）天。与未进展的患者相比，发生糖尿病的患者在 1 年内的总调整医疗费用增加了 1429 美元，在 2 年内增加了 2451 美元，在 3 年内增加了 3621 美元（p<0.001）。合并高血压的患者向 2 型糖尿病进展的可能性显著更高，与无高血压的患者相比，总医疗费用更高（1 年内高出 476 美元，2 年内高出 949 美元，3 年内高出 1378 美元）。
向 2 型糖尿病进展的糖尿病前期患者与未进展的患者相比，医疗保健利用率和费用更高。高血压的存在显著增加了成本，并与糖尿病进展的可能性更高相关。由于数据的限制，无法检查血压、生活方式干预、体重指数和其他因素。结果可能不适用于除商业保险或医疗保险以外的其他保险的患者。
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