Icks A, Strassburger K, Baechle C, Rosenbauer J, Giani G, Beyer P, Holl R W
Department of Public Health, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Germany.
Exp Clin Endocrinol Diabetes. 2013 Jan;121(1):58-9. doi: 10.1055/s-0032-1312639. Epub 2012 Jun 11.
Recently, medical expenditures were found to be 2-fold increased in paediatric patients with diabetic ketoacidotic events (DKA) in the U.S., in particular due to hospitalization. Aim of our study was to analyse DKAs and associated costs in Germany, where structured diabetes care including education is available for all patients.
For all 12,001 diabetic patients 0-19 years of age (52.6% male, mean age (SD) 12.6 (3.9) years) documented in a German-wide database, all DKAs were assessed, as well as costs for diabetes-related treatment. Associations between costs and DKA were estimated using log-linear models.
457 (3.8%) patients had at least 1 DKA during 2007. Total annual costs for patients without, with 1, or ≥ 2 DKAs were € 3,330 (95%-CI 3,292-3,368), € 6,935 (CI 6,627-7,244), and € 10,728 (CI 9,813-11,644), respectively, with largest differences for hospitalization costs (€ 693, € 4,145, € 8,092). Age-sex-diabetes duration-adjusted cost ratios for patients with 1, or ≥ 2 DKAs compared to patients without DKA were 2.2 (CI 2.1-2.3) and 3.6 (CI 3.1-4.1), respectively.
In Germany, paediatric diabetic patients with DKA had up to 3.6-fold higher diabetes-related costs compared to those without DKA. This cost excess was higher compared to a U.S. study, however, the proportion of patients with DKA was much lower (3.8% versus 14.9%). The lower frequency of DKA in Germany may be due to a higher access to and utilization of diabetes education. Interventions should reduce DKA and resulting hospital admission in pediatric patients in order to reduce costs and improve quality of life.
最近发现，美国患有糖尿病酮症酸中毒事件（DKA）的儿科患者的医疗支出增加了两倍，特别是由于住院治疗。我们研究的目的是分析德国的DKA及其相关成本，在德国，所有患者都可获得包括教育在内的结构化糖尿病护理。
对于德国范围内数据库中记录的所有12,001名0至19岁的糖尿病患者（男性占52.6%，平均年龄（标准差）12.6（3.9）岁），评估了所有DKA以及糖尿病相关治疗的成本。使用对数线性模型估计成本与DKA之间的关联。
2007年期间，457名（3.8%）患者至少发生了1次DKA。无DKA、有1次或≥2次DKA的患者每年的总成本分别为3330欧元（95%置信区间3292 - 3368欧元）、6935欧元（置信区间6627 - 7244欧元）和10728欧元（置信区间9813 - 11644欧元），住院成本差异最大（693欧元、4145欧元、8092欧元）。与无DKA的患者相比，有1次或≥2次DKA的患者经年龄 - 性别 - 糖尿病病程调整后的成本比分别为2.2（置信区间2.1 - 2.3）和3.6（置信区间3.1 - 4.1）。
在德国，患有DKA的儿科糖尿病患者的糖尿病相关成本比未患DKA的患者高出3.6倍。与美国的一项研究相比，这种成本超额更高，然而，患有DKA的患者比例要低得多（3.8%对14.9%）。德国DKA发生率较低可能是由于糖尿病教育的可及性和利用率更高。干预措施应减少儿科患者的DKA及由此导致的住院，以降低成本并改善生活质量。
