Эндокринология

[Наталья П.]

Diabetes: cost of illness in Norway

Oddvar Solli 1, Trond Jenssen 2, 3, Ivar S Kristiansen 1, 4

1Department of Health Management and Health Economics, Oslo, Norway

2Rikshospitalet University Hospital, Oslo, Norway

3Institute of Clinical Medicine, Medical Faculty, University of Tromsø, Norway

4Institute of Public Health, University of Southern Denmark, Denmark

BMC Endocrine Disorders - Volume 10

doi:10.1186/1472-6823-10-15 - September 2010

Available online at: [Ссылки доступны только зарегистрированным пользователям ]



“….Diabetes mellitus places a considerable burden on patients in terms of morbidity and mortality and on society in terms of costs. Costs related to diabetes are expected to increase due to increasing prevalence of type 2 diabetes. The aim of this study was to estimate the health care costs attributable to type 1 and type 2 diabetes in Norway in 2005.

Methods

Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, medical equipment, nutrition guidance, physiotherapy, acupuncture, foot therapy and indirect costs were collected from national registers and responses to a survey of 584 patients with diabetes. The study was performed with a prevalence approach. Uncertainty was explored by means of bootstrapping.

Results

When hospital stays with diabetes as a secondary diagnosis were excluded, the total costs were €293 million, which represents about 1.4% of the total health care expenditure.
Pharmaceuticals accounted for €95 million (32%), disability pensions €48 million (16%), medical devices €40 million (14%) and hospital admissions €21 million (7%).



Patient expenditures for acupuncture, physiotherapy and foot therapy were many times higher than expenditure for nutritional guidance. Indirect costs (lost production from job absenteeism) accounted for €70.1 million (24% of the €293 million) and included sick leave (€16.7 million), disability support and disability pensions (€48.2 million) and other indirect costs (€5.3 million). If all diabetes related hospital stays are included (primary- and secondary diagnosis) total costs amounts to €535 million, about 2.6% of the total health care expenditure in Norway.

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Pass on HbA1c for Detecting Diabetes in Adolescents
HbA1c did not perform as well as traditional measures for diagnosing diabetes mellitus in high-risk adolescents.


In 2009, an international committee of diabetes experts recommended that glycosylated hemoglobin (HbA1c) replace fasting plasma glucose (FPG) and 2-hour plasma glucose levels for diagnosing diabetes mellitus in adolescents and adults. The committee and the American Diabetes Association (ADA) also recommend HbA1c testing for screening asymptomatic overweight and obese adolescents. However, the recommended HbA1c cutoffs were derived from data from adults. Therefore, investigators examined the accuracy of the recommended HbA1c cutoff value of 6.5% for diagnosis of diabetes in 1156 asymptomatic overweight and obese adolescents (age range, 12–18 years) who participated in the National Health and Nutritional Examination Surveys (NHANES 1999–2006).

Compared with an FPG cutoff value 126 mg/dL, the HbA1c cutoff of 6.5% had a sensitivity of 75.0% and a specificity of 99.9% for detecting diabetes mellitus in adolescents. However, only four adolescents had undiagnosed diabetes mellitus; this low prevalence resulted in a wide 95% confidence interval. Compared with an FPG cutoff value 100 and <125 mg/dL for detecting prediabetes, the sensitivity of the HbA1c cutoff value of 6.0% (and the ADA cutoff value of 5.7%) was very low (<5%).

Comment: Although use of glycosylated hemoglobin is appealing because the test does not require patients to be fasting, this study argues against using HbA1c for diagnosis of diabetes mellitus or prediabetes in adolescents. The authors acknowledge that their results were limited by the small number of adolescents with undiagnosed diabetes mellitus and the absence of repeat testing. Until we have more-definitive studies to guide us, I would stick with measuring fasting plasma glucose or 2-hour plasma glucose in adolescents.

— Alain Joffe, MD, MPH, FAAP

Published in Journal Watch Pediatrics and Adolescent Medicine July 13, 2011

Citation(s):
Lee JM et al. Diagnosis of diabetes using hemoglobin A1c: Should recommendations in adults be extrapolated to adolescents? J Pediatr 2011 Jun; 158:947.e3.