Health Care Utilization and Costs of Diabetes

People with diabetes visit physician offices and emergency rooms more frequently than people without diabetes and are more likely to be admitted to the hospital and nursing homes and to receive home health care. In 2010, 29.9 million office-based physician visits had a primary diagnosis of diabetes, and 51.1 million office-based physician visits had diabetes as any listed diagnosis. In 2011, almost half of all people with diabetes in the United States had six or more office-based physician visits. Only 4% of people with diabetes did not have any office-based physician visits compared to 13% of people in the general U.S. population. People with diabetes were also more likely to visit the emergency room, with 30% having at least one visit compared to 20% of the general population. Fifty-three percent of people with diabetes had a dental visit in the past year, but 21% had not visited a dentist in more than 5 years. Ten percent of people with diabetes had phone contact with their physician’s office in the past 2 weeks, 5% used email to communicate with their physician, and 34% looked up health information on the internet. In 2010, 6.76 million hospitalizations listed diabetes as one of the discharge diagnoses; these accounted for 34.67 million hospital days. Diabetes was the primary discharge diagnosis for 622,000 hospitalizations. People with diabetes were 2.6 times more likely to be hospitalized in the past year than people without diabetes (21% vs. 8%). Having complications of diabetes was associated with hospitalization. Comorbid diabetic ketoacidosis, cardiovascular disease, and cardiac procedures were frequently present. Multiple hospitalizations were also common. In 2011, almost 30% of people with diabetes who were hospitalized had two or more hospitalizations. In 2004, 358,500 nursing home residents age ≥55 years had diagnosed diabetes. They accounted for approximately 25% of the nursing home population. Residents with diabetes are more likely to be younger and nonwhite than residents without diabetes. More than 85% have comorbid cardiovascular disease, 63% have mental disorders, and 90% have two or more chronic conditions in addition to diabetes. Home health care agencies are an increasingly important source of long-term care, and 33% of people receiving home health care in 2007 had diabetes. The prevalence of diabetes is highest for home health care patients age 65–74 years. Home health care patients with diabetes are more likely to be middle-aged and nonwhite than patients without diabetes. More than 75% have comorbid cardiovascular disease, and 14% are receiving post-hospital aftercare. Seventy-two percent of home health care recipients have two or more chronic conditions in addition to diabetes, and limitations in activities of daily living are common. Because people with diabetes visit physician offices, hospital outpatient departments, and emergency rooms more frequently than people without diabetes and are more likely to be admitted to the hospital and nursing homes and to receive home health care, their medical costs are higher than for people without diabetes. Economic analyses performed by the American Diabetes Association in 2012 suggest that the excess economic costs attributable to diabetes in the United States were $245 billion, including $176 billion related to medical care for diabetes, its complications, and comorbidities and $69 billion related to time lost from work and usual activities due to illness, disability, and premature mortality. The costs of diabetes increased by approximately 200% from 2002 to 2012. While health care costs for inpatient and outpatient care attributable to diabetes have increased steadily over time, costs related to outpatient medications and supplies increased dramatically from 2007 to 2012. Americans with diabetes have direct medical costs 2.3 times higher than those without diabetes at an annual per capita excess cost of $7,888 attributable to their diabetes.