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Health care costs and glycaemic control in type 2 diabetesin Swedish primary care
Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims: The aim of this study was to explore the annual health care cost for patients with type 2diabetes and its association with glycaemic control in primary care.

Methods: All patients with diabetes at 18 primary health care centres (PHCC) in Swedenwere surveyed in this cross sectional observational study. From a total population of 208 490,we identified 6495 patients with type 2 diabetes and information were retrieved from medicalrecords on resource utilisation, clinical data, treatment category and use of self monitoring ofblood glucose (SMBG). Data on costs for pharmaceuticals and test strips for SMBG wereimported from the general ledger.

Results: The mean annual health care cost per patient with type 2 diabetes, was 586 Euro (SD435). Factors associated with high costs at individual level were; type of treatment (r=0.67),number of GP visits (r=0.61), use of SMBG (r=0.46), number of visits to nurse (r=0.34), andlevel of HbA1c (r=0.33). No association was found between costs per health care centre andmean HbA1c per PHCC (r=0.17). Use of SMBG was associated with high total cost evenwhen adjusted for duration of diabetes and treatment type (p<0.01).

Conclusions: Health care costs for type 2 diabetes varied substantially in primary care,primarily explained by differences in costs for SMBG and insulin.

National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-20578OAI: oai:DiVA.org:liu-20578DiVA: diva2:235277
Available from: 2009-09-15 Created: 2009-09-15 Last updated: 2010-01-14Bibliographically approved
In thesis
1. Monitoring blood glucose and obesity in type 2 diabetes in primary care
Open this publication in new window or tab >>Monitoring blood glucose and obesity in type 2 diabetes in primary care
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Type 2 diabetes is a common chronic disease worldwide. An important part of the treatment is monitoring and treating the elevated levels of blood glucose. But there is also a need for monitoringother risk factors that confer an increased risk for vascular complications. This thesis is based on four studies that explore different aspectsof monitoring blood glucose and obesity in patients with type 2 diabetes in primary care.

Methods: To examine the cost and effect on glycaemic control of patients performing self-monitoring of blood glucose (SMBG) an observationalstudy was performed in the county of Östergötland and Jönköping 2003-2004. The study included all known patients with type 2 diabetes at 18 primary health care centres (PHCC), excluding patients in nursery homes.

A structured observational intervention study of 98 patients with type 2 diabetes living at 17 nursery homes were done with monitoringof hypoglycaemic episodes followed by a controlled withdrawal of diabetes medication in patients with HbA1c ≤ 6.0 %.

Baseline data from the cohort study; Cardiovascularrisk in type 2 diabetes – a prospectivestudy in primary care (CARDIPP), was analysed for correlation analyses between anthropometric status and early cardiovascular organ damage, measured by pulse wave velocity (PWV) and left ventricular mass index (LVMI).

Results: When comparing users of SMBG to non-users, there was no association between improvedglycaemic control and use of SMBG. A plasma glucose profile for three consecutive days of the patients at nursery homes, indentified 31 episodes of plasma glucose levels≤ 4.4 mmol/l. A withdrawal of insulin and oral antiglycaemic medicine was performed, which after 3 months follow up was successful in 24 (75 %) of the patients.

The mean annual cost per PHCC for visits to general practitioner and nurse, insulin, SMBG and oral antiglycaemic agents was586 € (SD 435) per patient. There was no correlationbetween costs and glycaemic control at PHCC level.

In the CARDIPP study, both increased sagittalabdominal diameter and increased waist circumference were, independently of sex, age, blood pressure and HbA1c, associated to increasedPWV and LVMI.

Conclusions: Use of SMBG in primary care confers a substantialpart of the treatment costs, but is not associated with improved glycaemic control. Systematic use of SMBG for patients not treated with insulin should not be recommended. At nursery homes, patients with type 2 diabetes are at risk for harmful hypoglycaemia and may benefit from a more frequent control of plasma glucose and a less strict glycaemic control.

Increased abdominal obesity measured with either sagittal abdominal diameter or waist circumference is associated with early cardiovascularorgan damage. In addition to analyses of blood glucose, blood pressure and lipids, the monitoring of abdominal obesity is a feasible risk factor assessment tool, that provides further information about cardiovascular risk that goes beyond that of traditional risk factors.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 55 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1140
Keyword
Diabetes, primary care
National Category
Family Medicine
Identifiers
urn:nbn:se:liu:diva-20049 (URN)978-91-7393-573-9 (ISBN)
Public defence
2009-09-18, Originalet, Qulturumhuset, Länssjukhuset Ryhov, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-09-15 Created: 2009-08-26 Last updated: 2010-03-02Bibliographically approved

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Tengblad, AndersBorgquist, LarsMölstad, SigvardÖstgren, Carl Johan

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Tengblad, AndersBorgquist, LarsMölstad, SigvardÖstgren, Carl Johan
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General PracticeFaculty of Health SciencesUnit of Research and Development in Local Health Care, County of ÖstergötlandWest County Primary Health Care
Medical and Health Sciences

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