Pfeiffer Kathryn M, Sandberg Anna, Nikolajsen Annie, Brod Meryl
a The Brod Group , Mill Valley , CA , USA.
b Novo Nordisk, A/S , Søborg , Denmark.
J Med Econ. 2018 Jan;21(1):66-73. doi: 10.1080/13696998.2017.1377208. Epub 2017 Sep 26.
Postprandial glucose (PPG) control is a well-known challenge for diabetes management, yet there is limited research on how PPG affects healthcare resource utilization. This study investigated the association between PPG levels and healthcare resource utilization among adults with diabetes treated with basal-bolus insulin.
A web-based, cross-sectional survey (n = 940) of adults with type 1 or type 2 diabetes and treated with basal and bolus insulins was conducted in Italy, the UK, and the US. Descriptive analyses included frequencies, cross-tabulations, and comparison of means. Incidence-rate ratios (IRR) were calculated using negative binomial regression analysis to investigate the relationship between elevated PPG and healthcare resource utilization. Models controlled for demographic characteristics, duration of diabetes, and diabetes-related complications.
Among respondents who measured PPG regularly and reported their two highest PPG values in the past week (n = 691), the mean average highest PPG value was 11.9 mmol/L (SD = 4.0). On average, holding other variables constant at their means, a 1 mmol/L increase in PPG was associated with an increase in healthcare resource utilization related to diabetes and elevated PPG, including the expected number of healthcare provider (HCP) visits in the past 6 months (IRR [95% CI] = 1.14 [1.08-1.21], p < .001), the expected number of calls/emails to HCPs in the past 6 months (IRR [95% CI] = 1.12 [1.06-1.19], p < .001), and the expected number of overnight hospitalizations in the past year (IRR [95% CI] = 1.14 [1.07-1.23], p < .001).
The study relied on self-reported data, which may be subject to recall bias. Given the cross-sectional nature of the study, results should be interpreted with caution.
Increased PPG levels were significantly associated with increased healthcare resource utilization among adults with diabetes. Additional education regarding PPG monitoring may help improve the day-to-day management of diabetes and reduce healthcare costs.
餐后血糖（PPG）控制是糖尿病管理中一个众所周知的挑战，但关于PPG如何影响医疗资源利用的研究有限。本研究调查了基础 - 餐时胰岛素治疗的成年糖尿病患者PPG水平与医疗资源利用之间的关联。
在意大利、英国和美国对1型或2型糖尿病且接受基础和餐时胰岛素治疗的成年人进行了一项基于网络的横断面调查（n = 940）。描述性分析包括频率、交叉表和均值比较。使用负二项回归分析计算发病率比（IRR），以研究PPG升高与医疗资源利用之间的关系。模型对人口统计学特征、糖尿病病程和糖尿病相关并发症进行了控制。
在定期测量PPG并报告过去一周内两个最高PPG值的受访者中（n = 691），平均最高PPG值为11.9 mmol/L（标准差 = 4.0）。平均而言，在其他变量保持均值不变的情况下，PPG每升高1 mmol/L，与糖尿病和PPG升高相关的医疗资源利用增加有关，包括过去6个月内预期的医疗服务提供者（HCP）就诊次数（IRR [95%置信区间] = 1.14 [1.08 - 1.21]，p <.001）、过去6个月内预期的给HCP打电话/发电子邮件次数（IRR [95%置信区间] = 1.12 [1.06 - 1.19]，p <.001）以及过去一年中预期的过夜住院次数（IRR [95%置信区间] = 1.14 [1.07 - 1.23]，p <.001）。
本研究依赖自我报告数据，可能存在回忆偏差。鉴于研究的横断面性质，结果应谨慎解释。
PPG水平升高与成年糖尿病患者医疗资源利用增加显著相关。关于PPG监测的额外教育可能有助于改善糖尿病的日常管理并降低医疗成本。
