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Report Quantifies Diabetes Complications

Report Quantifies Diabetes Complications While physicians know patients with poor control of type 2 diabetes are at increased risk of a variety of complications, quantifying that danger has been lacking—until now. The American Association of Clinical Endocrinologists (AACE) issued a new report on the prevalence and costs of health problems related to this form of diabetes, a disease affecting about 18 million people in the United States (http://www.aace.com/newsroom/press/2007/images/DiabetesComplicationsReport_FINAL.pdf). The report, State of Diabetes Complications in America, notes that 57.9% of patients with diabetes have 1 or more health complications (14.3% have 3 or more). It also estimates that in 2006, such complications lead to $22.9 billion in direct medical costs for physician and health care professional visits, hospital stays, prescribed medicines, and other medical services and equipment. Patients with type 2 diabetes are at higher risk of developing macrovascular and microvascular complications compared with people who have normal blood glucose levels. Quantifying the problem Quantifying the problem For Daniel Einhorn, MD, who worked on the document and is the treasurer of the AACE's Board of Directors, the report was long overdue. Quantifying the problem While it is not news that poor diabetes control leads to complications, quantifying their prevalence is important, explained Einhorn, medical director for Scripps Health's Whittier Institute for Diabetes, in La Jolla, Calif. “We sort of knew this was a big problem, but it surprised me that most of us didn't have these numbers at our fingertips.” Quantifying the problem And some of the numbers are quite revealing. For example, 27.8% of patients with diabetes had chronic kidney disease (defined as having a ratio of albumin to creatinine greater than 30 μg/mg) compared with 6.1% of people with normal blood glucose levels. Myocardial infarction prevalence was 9.8% for patients with diabetes compared with 1.8% for those with normal blood glucose levels, and stroke prevalence was 6.6% for patients with the disease and 1.8% for those with normal blood glucose levels. Quantifying the problem Complications were divided into 2 categories: macrovascular (myocardial infarction, stroke, chest pain, coronary heart disease, and congestive heart failure) and microvascular (chronic kidney disease, eye damage, and foot problems). Quantifying the problem The authors also looked at gender, race, and age to compare complication rates. For gender, the report found that men had high prevalence rates for macrovascular complications while the rates were about the same between the sexes for microvascular problems. Einhorn speculated the difference could be because macrovascular complications are more aggressive in younger men and do not affect women as much until they reach menopause. Quantifying the problem As for costs, the report noted not only national figures tied to diabetes complications, but also broke out individual costs (including out-of-pocket expenses) for specific problems. For a person without diabetes and average health problems, annual health care costs are $2848, including $541 in out-of-pocket expenses. For a person with diabetes and diabetic complications, the annual cost is $9797, with out-of-pocket expenses running at $1566. Quantifying the problem The report synthesized data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 and the Medical Expenditure Panel Survey 2000, 2002, 2004. It was produced by the AACE in partnership with the Amputee Coalition of America, Mended Hearts, the National Federation of the Blind, and the National Kidney Foundation. A call to action? A call to action? The report is the second in a series the AACE is publishing. The first, The State of Diabetes in America, which appeared in 2005, found that about two thirds of all patients with diabetes had poor blood glucose control, defined as a glycated hemoglobin value of no more than 6.5%. Einhorn said his association wants to publish a third report that would further break down the data, with more nuanced information on complications by region, ethnicity, age, and gender. A call to action? The future report should also be able to show if recent improvements in diabetes treatment, including the introduction of new drug classes (incretin mimetics and dipeptidyl peptidase-4 inhibitors), have had an effect on reducing complication prevalence. “I thought [the complication prevalence rates] would have been lower; I thought we’d been doing a better job,” Einhorn said. “Hopefully the next report will show better numbers, recognizing that results from changes in care take years and not months.” A call to action? But for today, Einhorn said the current report should serve as a “call to action” for physicians and patients to improve glucose control before problems arise. A call to action? “Most of us as physicians have gotten away from the fire-and-brimstone speeches in telling patients what to do,” Einhorn said. “But I’ve had patients say they wished their physicians had grabbed them by the lapels and said their blood sugar levels were too high when there was time to do something about them.” http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Report Quantifies Diabetes Complications

JAMA , Volume 297 (21) – Jun 6, 2007

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Publisher
American Medical Association
Copyright
Copyright © 2007 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.297.21.2337
Publisher site
See Article on Publisher Site

Abstract

While physicians know patients with poor control of type 2 diabetes are at increased risk of a variety of complications, quantifying that danger has been lacking—until now. The American Association of Clinical Endocrinologists (AACE) issued a new report on the prevalence and costs of health problems related to this form of diabetes, a disease affecting about 18 million people in the United States (http://www.aace.com/newsroom/press/2007/images/DiabetesComplicationsReport_FINAL.pdf). The report, State of Diabetes Complications in America, notes that 57.9% of patients with diabetes have 1 or more health complications (14.3% have 3 or more). It also estimates that in 2006, such complications lead to $22.9 billion in direct medical costs for physician and health care professional visits, hospital stays, prescribed medicines, and other medical services and equipment. Patients with type 2 diabetes are at higher risk of developing macrovascular and microvascular complications compared with people who have normal blood glucose levels. Quantifying the problem Quantifying the problem For Daniel Einhorn, MD, who worked on the document and is the treasurer of the AACE's Board of Directors, the report was long overdue. Quantifying the problem While it is not news that poor diabetes control leads to complications, quantifying their prevalence is important, explained Einhorn, medical director for Scripps Health's Whittier Institute for Diabetes, in La Jolla, Calif. “We sort of knew this was a big problem, but it surprised me that most of us didn't have these numbers at our fingertips.” Quantifying the problem And some of the numbers are quite revealing. For example, 27.8% of patients with diabetes had chronic kidney disease (defined as having a ratio of albumin to creatinine greater than 30 μg/mg) compared with 6.1% of people with normal blood glucose levels. Myocardial infarction prevalence was 9.8% for patients with diabetes compared with 1.8% for those with normal blood glucose levels, and stroke prevalence was 6.6% for patients with the disease and 1.8% for those with normal blood glucose levels. Quantifying the problem Complications were divided into 2 categories: macrovascular (myocardial infarction, stroke, chest pain, coronary heart disease, and congestive heart failure) and microvascular (chronic kidney disease, eye damage, and foot problems). Quantifying the problem The authors also looked at gender, race, and age to compare complication rates. For gender, the report found that men had high prevalence rates for macrovascular complications while the rates were about the same between the sexes for microvascular problems. Einhorn speculated the difference could be because macrovascular complications are more aggressive in younger men and do not affect women as much until they reach menopause. Quantifying the problem As for costs, the report noted not only national figures tied to diabetes complications, but also broke out individual costs (including out-of-pocket expenses) for specific problems. For a person without diabetes and average health problems, annual health care costs are $2848, including $541 in out-of-pocket expenses. For a person with diabetes and diabetic complications, the annual cost is $9797, with out-of-pocket expenses running at $1566. Quantifying the problem The report synthesized data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 and the Medical Expenditure Panel Survey 2000, 2002, 2004. It was produced by the AACE in partnership with the Amputee Coalition of America, Mended Hearts, the National Federation of the Blind, and the National Kidney Foundation. A call to action? A call to action? The report is the second in a series the AACE is publishing. The first, The State of Diabetes in America, which appeared in 2005, found that about two thirds of all patients with diabetes had poor blood glucose control, defined as a glycated hemoglobin value of no more than 6.5%. Einhorn said his association wants to publish a third report that would further break down the data, with more nuanced information on complications by region, ethnicity, age, and gender. A call to action? The future report should also be able to show if recent improvements in diabetes treatment, including the introduction of new drug classes (incretin mimetics and dipeptidyl peptidase-4 inhibitors), have had an effect on reducing complication prevalence. “I thought [the complication prevalence rates] would have been lower; I thought we’d been doing a better job,” Einhorn said. “Hopefully the next report will show better numbers, recognizing that results from changes in care take years and not months.” A call to action? But for today, Einhorn said the current report should serve as a “call to action” for physicians and patients to improve glucose control before problems arise. A call to action? “Most of us as physicians have gotten away from the fire-and-brimstone speeches in telling patients what to do,” Einhorn said. “But I’ve had patients say they wished their physicians had grabbed them by the lapels and said their blood sugar levels were too high when there was time to do something about them.”

Journal

JAMAAmerican Medical Association

Published: Jun 6, 2007

Keywords: diabetes mellitus, type 2

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