Journal of Obesity & Metabolic Syndrome

Korean Society for the Study of Obesity (대한비만학회)
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Treatment Costs and Factors Associated with Glycemic Control among Patients with Diabetes in the United Arab Emirates

  • Received : 2018.07.30
  • Accepted : 2018.10.25
  • Published : 2018.12.30
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Abstract

Background: 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. Methods: 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 ${\geq}7%$. 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. Results: 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 ${\geq}65$ years than those aged ${\leq}44$ years (cost ratio, 1.45; 95% CI, 1.25-1.70). Conclusion: More than 50% of patients with diabetes had poorly controlled HbA1c. Poor glycemic control may increase diabetes-related costs.

Keywords

Acknowledgement

Supported by : Novartis Pharmaceuticals Co.

References

  1. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract 2014;103:137-49. https://doi.org/10.1016/j.diabres.2013.11.002
  2. Malik M, Bakir A, Saab BA, King H. Glucose intolerance and associated factors in the multi-ethnic population of the United Arab Emirates: results of a national survey. Diabetes Res Clin Pract 2005;69:188-95. https://doi.org/10.1016/j.diabres.2004.12.005
  3. UAE National Diabetes Committee. National diabetes guidelines United Arab Emirates 2009. The United Arab Emirates: UAE National Diabetes Committee; 2009.
  4. Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet 2005;366:1059-62. https://doi.org/10.1016/S0140-6736(05)67402-8
  5. Gaster B, Hirsch IB. The effects of improved glycemic control on complications in type 2 diabetes. Arch Intern Med 1998;158:134-40. https://doi.org/10.1001/archinte.158.2.134
  6. Davila EP, Florez H, Trepka MJ, Fleming LE, Niyonsenga T, Lee DJ, et al. Strict glycemic control and mortality risk among US adults with type 2 diabetes. J Diabetes Complications 2011;25:289-91. https://doi.org/10.1016/j.jdiacomp.2011.03.004
  7. Benoit SR, Fleming R, Philis-Tsimikas A, Ji M. Predictors of glycemic control among patients with type 2 diabetes: a longitudinal study. BMC Public Health 2005;5:36. https://doi.org/10.1186/1471-2458-5-36
  8. Nichols GA, Hillier TA, Javor K, Brown JB. Predictors of glycemic control in insulin-using adults with type 2 diabetes. Diabetes Care 2000;23:273-7. https://doi.org/10.2337/diacare.23.3.273
  9. Fox KM, Gerber Pharmd RA, Bolinder B, Chen J, Kumar S. Prevalence of inadequate glycemic control among patients with type 2 diabetes in the United Kingdom general practice research database: a series of retrospective analyses of data from 1998 through 2002. Clin Ther 2006;28:388-95. https://doi.org/10.1016/j.clinthera.2006.03.005
  10. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405-12. https://doi.org/10.1136/bmj.321.7258.405
  11. American Diabetes Association. Standards of medical care in diabetes-2017. Diabetes Care 2017;40(Suppl 1):S1-135. https://doi.org/10.2337/dc17-S001
  12. Stark Casagrande S, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988-2010. Diabetes Care 2013;36:2271-9. https://doi.org/10.2337/dc12-2258
  13. Saadi H, Carruthers SG, Nagelkerke N, Al-Maskari F, Afandi B, Reed R, et al. Prevalence of diabetes mellitus and its complications in a population-based sample in Al Ain, United Arab Emirates. Diabetes Res Clin Pract 2007;78:369-77. https://doi.org/10.1016/j.diabres.2007.04.008
  14. American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care 2013;36:1033-46. https://doi.org/10.2337/dc12-2625
  15. Al-Maskari F, El-Sadig M, Nagelkerke N. Assessment of the direct medical costs of diabetes mellitus and its complications in the United Arab Emirates. BMC Public Health 2010;10:679. https://doi.org/10.1186/1471-2458-10-679
  16. Gilmer TP, O'Connor PJ, Manning WG, Rush WA. The cost to health plans of poor glycemic control. Diabetes Care 1997;20:1847-53. https://doi.org/10.2337/diacare.20.12.1847
  17. Stephens JM, Botteman MF, Hay JW. Economic impact of antidiabetic medications and glycemic control on managed care organizations: a review of the literature. J Manag Care Pharm 2006;12:130-42.
  18. Wagner EH, Sandhu N, Newton KM, McCulloch DK, Ramsey SD, Grothaus LC. Effect of improved glycemic control on health care costs and utilization. JAMA 2001;285:182-9. https://doi.org/10.1001/jama.285.2.182
  19. Ali MK, McKeever Bullard K, Imperatore G, Barker L, Gregg EW; Centers for Disease Control and Prevention (CDC). Characteristics associated with poor glycemic control among adults with self-reported diagnosed diabetes: National Health and Nutrition Examination Survey, United States, 2007-2010. MMWR Suppl 2012;61:32-7.
  20. Degli Esposti L, Saragoni S, Buda S, Sturani A, Degli Esposti E. Glycemic control and diabetes-related health care costs in type 2 diabetes: retrospective analysis based on clinical and administrative databases. Clinicoecon Outcomes Res 2013;5:193-201.
  21. Oglesby AK, Secnik K, Barron J, Al-Zakwani I, Lage MJ. The association between diabetes related medical costs and glycemic control: a retrospective analysis. Cost Eff Resour Alloc 2006;4:1. https://doi.org/10.1186/1478-7547-4-1
  22. Sirgi C. Abu Dhabi healthcare system: a rational thinking based on data analysis. Hum Health 2012;21:10-4.
  23. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika 1983;70:41-55. https://doi.org/10.1093/biomet/70.1.41
  24. Gu XS, Rosenbaum PR. Comparison of multivariate matching methods: structures, distances, and algorithms. J Comput Graph Stat 1993;2:405-20.
  25. Desgagne A, Castilloux AM, Angers JF, LeLorier J. The use of the bootstrap statistical method for the pharmacoeconomic cost analysis of skewed data. Pharmacoeconomics 1998;13(5 Pt 1):487-97. https://doi.org/10.2165/00019053-199813050-00002
  26. Manning WG, Mullahy J. Estimating log models: to transform or not to transform? J Health Econ 2001;20:461-94. https://doi.org/10.1016/S0167-6296(01)00086-8
  27. Basu A, Rathouz PJ. Estimating marginal and incremental effects on health outcomes using flexible link and variance function models. Biostatistics 2005;6:93-109. https://doi.org/10.1093/biostatistics/kxh020
  28. Basu A, Arondekar BV, Rathouz PJ. Scale of interest versus scale of estimation: comparing alternative estimators for the incremental costs of a comorbidity. Health Econ 2006;15:1091-107. https://doi.org/10.1002/hec.1099
  29. Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. J Diabetes Complications 2010;24:84-9. https://doi.org/10.1016/j.jdiacomp.2008.12.008
  30. Beaton SJ, Nag SS, Gunter MJ, Gleeson JM, Sajjan SS, Alexander CM. Adequacy of glycemic, lipid, and blood pressure management for patients with diabetes in a managed care setting. Diabetes Care 2004;27:694-8. https://doi.org/10.2337/diacare.27.3.694
  31. Juarez DT, Sentell T, Tokumaru S, Goo R, Davis JW, Mau MM. Factors associated with poor glycemic control or wide glycemic variability among diabetes patients in Hawaii, 2006-2009. Prev Chronic Dis 2012;9:120065. https://doi.org/10.5888/pcd9.120065
  32. Chuang LM, Soegondo S, Soewondo P, Young-Seol K, Mohamed M, Dalisay E, et al. Comparisons of the outcomes on control, type of management and complications status in early onset and late onset type 2 diabetes in Asia. Diabetes Res Clin Pract 2006;71:146-55. https://doi.org/10.1016/j.diabres.2005.05.007
  33. Rozenfeld Y, Hunt JS, Plauschinat C, Wong KS. Oral antidiabetic medication adherence and glycemic control in managed care. Am J Manag Care 2008;14:71-5.
  34. Valle T, Koivisto VA, Reunanen A, Kangas T, Rissanen A. Glycemic control in patients with diabetes in Finland. Diabetes Care 1999;22:575-9. https://doi.org/10.2337/diacare.22.4.575
  35. Akbar DH. Low rates of diabetic patients reaching good control targets. East Mediterr Health J 2001;7:671-8.
  36. Otiniano ME, Al Snih S, Goodwin JS, Ray L, AlGhatrif M, Markides KS. Factors associated with poor glycemic control in older Mexican American diabetics aged 75 years and older. J Diabetes Complications 2012;26:181-6. https://doi.org/10.1016/j.jdiacomp.2012.03.010
  37. Shetty S, Secnik K, Oglesby AK. Relationship of glycemic control to total diabetes-related costs for managed care health plan members with type 2 diabetes. J Manag Care Pharm 2005;11:559-64.
  38. Morris AD, Boyle DI, McMahon AD, Greene SA, MacDonald TM, Newton RW. Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO collaboration: diabetes audit and research in Tayside Scotland. Medicines Monitoring Unit. Lancet 1997;350:1505-10. https://doi.org/10.1016/S0140-6736(97)06234-X
  39. Brandle M, Zhou H, Smith BR, Marriott D, Burke R, Tabaei BP, et al. The direct medical cost of type 2 diabetes. Diabetes Care 2003;26:2300-4. https://doi.org/10.2337/diacare.26.8.2300