The average five-year cost of caring for patients with diabetes is higher for those with abnormal kidney function, suboptimal glycemic control, and presence of proteinuria, according to research published online Dec. 13 in Diabetes Care.

Kerry A. McBrien, M.D., M.P.H., of the University of Calgary in Canada, and colleagues estimated the five-year costs of caring for people with diabetes, including physician visits, hospitalizations, ambulatory care, and drug costs for 138,662 adults with diabetes.

The researchers found that the average five-year cost per patient, excluding drug costs, was $26,978 in Canadian dollars. For people over the age of 65 years, the average five-year cost per patient, including drugs, was $44,511 in Canadian dollars. These costs increased as a patient’s kidney function declined, if proteinuria was present, or if glycemic control was suboptimal (defined as HbA1c levels above 7.9 percent). The costs also were higher for older people, Aboriginal people, those with lower socioeconomic status or comorbid conditions, and those who had diabetes for a longer period of time.

”We have generated updated values for the five-year cost of caring for patients with diabetes in a universal health care system, which will aid decision makers in planning future resource allocation,” the authors write. ”After controlling for clinical and demographic factors, we found that the cost of caring for people with diabetes increased with suboptimal glycemic control, proteinuria, and worsening kidney function.”

Abstract

Health Care Costs in People With Diabetes and Their Association With Glycemic Control and Kidney Function

    Kerry A. McBrien, MD, MPH1, et al

    Department of Medicine, University of Calgary, Calgary, Alberta, Canada
 

Abstract

OBJECTIVE To determine the association between laboratory-derived measures of glycemic control (HbA1c) and the presence of renal complications (measured by proteinuria and estimated glomerular filtration rate [eGFR]) with the 5-year costs of caring for people with diabetes.

RESEARCH DESIGN AND METHODS We estimated the cumulative 5-year cost of caring for people with diabetes using a province-wide cohort of adults with diabetes as of 1 May 2004. Costs included physician visits, hospitalizations, ambulatory care (emergency room visits, day surgery, and day medicine), and drug costs for people >65 years of age. Using linked laboratory and administrative clinical and costing data, we determined the association between baseline glycemic control (HbA1c), proteinuria, and kidney function (eGFR) and 5-year costs, controlling for age, socioeconomic status, duration of diabetes, and comorbid illness.

RESULTS We identified 138,662 adults with diabetes. The mean 5-year cost of diabetes in the overall cohort was $26,978 per patient, excluding drug costs. The mean 5-year cost for the subset of people >65 years of age, including drug costs, was $44,511 (Canadian dollars). Cost increased with worsening kidney function, presence of proteinuria, and suboptimal glycemic control (HbA1c >7.9%). Increasing age, Aboriginal status, socioeconomic status, duration of diabetes, and comorbid illness were also associated with increasing cost.

CONCLUSIONS The cost of caring for people with diabetes is substantial and is associated with suboptimal glycemic control, abnormal kidney function, and proteinuria. Future studies should assess if improvements in the management of diabetes, assessed with laboratory-derived measurements, result in cost reductions.

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