Boye Kristina S, Lage Maureen J, Thieu Vivian T
Eli Lilly and Company, 893 Delaware Street, Indianapolis, IN, 46225, USA.
HealthMetrics Outcomes Research, 17 Benton's Knoll, Guilford, CT, 06437, USA.
Diabetes Ther. 2022 Feb;13(2):367-377. doi: 10.1007/s13300-022-01212-4. Epub 2022 Feb 7.
The American Diabetes Association (ADA) has identified a target hemoglobin A1c (HbA1c) < 7% as appropriate for most adults with type 2 diabetes (T2D). This research examines US diabetes-related healthcare costs for adults with T2D for individuals with glycemic control (HbA1c < 7%) compared to poor glycemic control (HbA1c ≥ 7%).
The Optum Clinformatics Data Mart database from 2016 to 2020 was used to identify a cohort of adults with T2D who had a recorded HbA1c test (with first such date identified as the index date) and continuous insurance from 1 year prior through 1 year post index date. Patients with glycemic control were propensity matched to patients with poor glycemic control. Generalized linear models and two-part models examined diabetes-related outpatient, drug, acute care, and total costs over the 1-year post-period.
There were 34,538 propensity matched individuals included in the study. Results indicate that glycemic control (HbA1c < 7%), compared to poor glycemic control (HbA1c ≥ 7%) ,was associated with statistically significantly lower annual diabetes-related acute ($5671 ± $4216 vs $6138 ± $4211), outpatient ($6051 ± $4216 vs $7259 ± $7771), drug ($3739 ± $4581 vs $4288 ± $4788), and total costs care ($13,704 ± $10,635 vs $16,460 ± $10,885) (all P < 0.0001). Sensitivity analyses also examined results based upon alternative HbA1c thresholds which were chosen on the basis of expert guidelines and prior clinical trial thresholds (< 6%, ≤ 6.5%, < 8%, and ≤ 9%). In all cases, being below threshold was associated with statistically significantly lower diabetes-related total costs and component costs. Results also illustrate that, in general, higher HbA1c thresholds are associated with higher diabetes-related costs.
Glycemic control was found to be associated with significantly lower annual diabetes-related component and total costs. Results suggest economic benefits associated with having HbA1c at or below target.
美国糖尿病协会（ADA）已确定大多数2型糖尿病（T2D）成年患者的糖化血红蛋白（HbA1c）目标值<7%是合适的。本研究调查了血糖控制良好（HbA1c<7%）与血糖控制不佳（HbA1c≥7%）的T2D成年患者在美国的糖尿病相关医疗费用。
使用2016年至2020年的Optum临床信息数据集市数据库，确定一组有HbA1c检测记录（将首次此类日期确定为索引日期）且从索引日期前1年到索引日期后1年持续参保的T2D成年患者。血糖控制良好的患者与血糖控制不佳的患者进行倾向评分匹配。广义线性模型和两部分模型研究了索引日期后1年期间的糖尿病相关门诊、药物、急性护理和总费用。
该研究纳入了34538例倾向评分匹配的个体。结果表明，与血糖控制不佳（HbA1c≥7%）相比，血糖控制良好（HbA1c<7%）与年度糖尿病相关急性费用（5671±4216美元对6138±4211美元）、门诊费用（6051±4216美元对7259±7771美元）、药物费用（3739±4581美元对4288±4788美元）和总护理费用（13704±10635美元对16460±10885美元）在统计学上显著降低相关（所有P<0.0001）。敏感性分析还根据基于专家指南和先前临床试验阈值（<6%、≤6.5%、<8%和≤9%）选择的替代HbA1c阈值检查了结果。在所有情况下，低于阈值与糖尿病相关总费用和组成费用在统计学上显著降低相关。结果还表明，一般来说，较高的HbA1c阈值与较高的糖尿病相关费用相关。
发现血糖控制与年度糖尿病相关组成费用和总费用显著降低相关。结果表明将HbA1c控制在目标值或以下具有经济效益。
