Lee Seung-Mi, Song Inmyung, Suh David, Chang Chongwon, Suh Dong-Churl
College of Pharmacy, Chung-Ang University, Seoul, Korea.
School of Public Health, Columbia University, New York, NY, USA.
J Obes Metab Syndr. 2018 Dec;27(4):238-247. doi: 10.7570/jomes.2018.27.4.238. Epub 2018 Dec 30.
We aimed to estimate the proportion of patients with diabetes who achieved target glycemic control, to estimate diabetes-related costs attributable to poor control, and to identify factors associated with them in the United Arab Emirates.
This retrospective cohort study used administrative claims data handled by Abu Dhabi Health Authority (January 2010 to June 2012) to determine glycemic control and diabetes-related treatment costs. A total of 4,058 patients were matched using propensity scores to eliminate selection bias between patients with glycosylated hemoglobin (HbA1c) <7% and HbA1c ≥7%. Diabetes-related costs attributable to poor control were estimated using a recycled prediction method. Factors associated with glycemic control were investigated using logistic regression and factors associated with these costs were identified using a generalized linear model.
During the 1-year follow-up period, 46.6% of the patients achieved HbA1c <7%. Older age, female sex, better insurance coverage, non-use of insulin in the index diagnosis month, and non-use of antidiabetic medications during the follow-up period were significantly associated with improved glycemic control. The mean diabetes-related annual costs were $2,282 and $2,667 for patients with and without glycemic control, respectively, and the cost attributable to poor glycemic control was $172 (95% confidence interval [CI], $164-180). The diabetes-related costs were lower with mean HbA1c levels <7% (cost ratio, 0.94; 95% CI, 0.88-0.99). The costs were significantly higher in patients aged ≥65 years than those aged ≤44 years (cost ratio, 1.45; 95% CI, 1.25-1.70).
More than 50% of patients with diabetes had poorly controlled HbA1c. Poor glycemic control may increase diabetes-related costs.
我们旨在估计在阿拉伯联合酋长国实现血糖控制目标的糖尿病患者比例，估计因控制不佳导致的糖尿病相关费用，并确定与之相关的因素。
这项回顾性队列研究使用了阿布扎比卫生局处理的行政索赔数据（2010年1月至2012年6月）来确定血糖控制情况和糖尿病相关治疗费用。使用倾向得分匹配了总共4058名患者，以消除糖化血红蛋白（HbA1c）<7%和HbA1c≥7%患者之间的选择偏倚。使用循环预测方法估计因控制不佳导致的糖尿病相关费用。使用逻辑回归研究与血糖控制相关的因素，并使用广义线性模型确定与这些费用相关的因素。
在1年的随访期内，46.6%的患者HbA1c<7%。年龄较大、女性、保险覆盖较好、在索引诊断月未使用胰岛素以及在随访期间未使用抗糖尿病药物与血糖控制改善显著相关。血糖控制良好和未控制的患者平均每年糖尿病相关费用分别为2282美元和2667美元，血糖控制不佳导致的费用为172美元（95%置信区间[CI]，164 - 180美元）。平均HbA1c水平<7%时糖尿病相关费用较低（费用比，0.94；95% CI，0.88 - 0.99）。65岁及以上患者的费用显著高于44岁及以下患者（费用比，1.45；95% CI，1.25 - 1.70）。
超过50%的糖尿病患者HbA1c控制不佳。血糖控制不佳可能会增加糖尿病相关费用。
