Centre d'Atenció Primària La Mina, Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain.
DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain.
Diabetes Care. 2020 Apr;43(4):751-758. doi: 10.2337/dc19-0573. Epub 2020 Feb 6.
To analyze the differences in health care costs according to glycemic control in people with type 2 diabetes.
Data on health care resource utilization from 100,391 people with type 2 diabetes were extracted from the electronic database used at the Catalan Health Institute. Multivariate regression models were carried out to test the impact of glycemic control (HbA) on total health care, hospital admission, and medication costs; model 1 adjusted for a variety of covariates, and model 2 also included micro- and macrovascular complications. Glycemic control was classified as good for HbA <7%, fair for ≥7% to <8%, poor for ≥8% to <10%, and very poor for ≥10%.
Mean per patient annual direct medical costs were €3,039 ± SD €6,581. Worse glycemic control was associated with higher total health care costs: compared with good glycemic control, health care costs increased by 18% (€509.82) and 23% (€661.35) in patients with very poor and poor glycemic control, respectively, when unadjusted and by €428.3 and €395.1, respectively, in model 2. Medication costs increased by 12% in patients with fair control and by 28% in those with very poor control (model 2). Patients with poor control had a higher probability of hospitalization than those with good control (5% in model 2) and a greater average cost when hospitalization occurred (€811).
Poor glycemic control was directly related to higher total health care, hospitalization, and medication costs. Preventive strategies and good glycemic control in people with type 2 diabetes could reduce the economic impact associated with this disease.
分析 2 型糖尿病患者血糖控制差异对医疗费用的影响。
从加泰罗尼亚健康研究所使用的电子数据库中提取了 100391 名 2 型糖尿病患者的医疗资源利用数据。采用多元回归模型检验血糖控制（HbA）对总医疗费用、住院和药物费用的影响；模型 1 调整了多种协变量，模型 2 还包括微血管和大血管并发症。血糖控制分为 HbA<7%为良好、≥7%至<8%为一般、≥8%至<10%为差、≥10%为很差。
每位患者的年直接医疗费用平均为 3039 欧元±6581 欧元。较差的血糖控制与较高的总医疗费用相关：与良好的血糖控制相比，未经调整时，血糖控制很差和很差的患者的总医疗费用分别增加 18%（509.82 欧元）和 23%（661.35 欧元），在模型 2 中分别增加 428.3 欧元和 395.1 欧元；一般控制的患者药物费用增加 12%，而血糖控制很差的患者增加 28%（模型 2）。控制不佳的患者住院的可能性高于控制良好的患者（模型 2 中的 5%），住院时的平均费用也更高（811 欧元）。
较差的血糖控制与较高的总医疗费用、住院和药物费用直接相关。预防策略和 2 型糖尿病患者的良好血糖控制可以降低与该疾病相关的经济影响。
