Small reduction in blood sugar can lower health costs

NEW YORK, Jan 10 (Reuters Health) - For patients with type 2 diabetes, lowering blood sugar can be a difficult and expensive endeavor. But a recent study suggests that a 1% reduction in blood sugar sustained over several years leads to substantial cost savings.

The report in the January 10th issue of The Journal of the American Medical Association found that adults who kept their blood glucose stable had fewer doctor visits, were hospitalized less often, and were less likely to visit hospital emergency departments. This translated into a savings of $685 to $950 within 2 years.

"Improvements in glycemic control provide positive reinforcement for the patient's efforts in managing their illness, which may increase self-efficacy and reduce dependency on medical care for diabetes management," according to Dr. Edward H. Wagner, from the University of Washington in Seattle, and colleagues.

Patients with type 2 diabetes do not respond to insulin, the hormone that regulates blood sugar. High blood glucose can lead to a number of serious medical complications including heart disease, kidney failure, blindness and amputations.

The study of more than 4,700 diabetics aged 18 years and older found that those who sustained a 1% or more decrease in blood glucose for more than a year, lowered their average annual healthcare costs. Costs rose for those whose blood glucose did not improve, the report indicates.

Those who lowered their blood glucose had higher rates of complications such as stroke, heart disease and foot ulcers at the outset, suggesting that their disease was more advanced. This might explain why those who managed to lower their blood glucose had slightly higher rates of death after 3 years, the authors note.

The findings "provide stronger support for more aggressive management of type 2 diabetes and for investment in system improvements," Wagner and colleagues write. The cost savings "would more than pay for system enhancements required to achieve better glycemic control," they add.

SOURCE: The Journal of the American Medical Association 2001;285:182-189.

A rather odd way of arguing the point, I should think; die first, save money later! Hey, if we all committed suicide now, just think of all the medical costs we'd save in the long run!

After reading the article twice, I got it - I think. It sounds to me like what they're saying is that people with more advanced diabetes are at higher risk for medical complications and death, even if they lower their blood sugar (if they do, presumably, their risks decrease in the long term, if not right away). Sheesh, why didn't they just say so?

Rachel

Nah, there'd be all the police and coroner expenses, and no-one would be able to collect the insurance money. Of course, you are a linguistics expert, and master of efficient English. But this is doctorspeak. Even their handwriting is indecipherable.

I'm reminded of my first nursing job many, many years ago. The doctor came by as I was wheeling a cart laden with the supplies I needed to do my "morning care". She pointed to an "Attends" size XXXL.

"What's that?" she asked.

I held it up, and before I could utter a word, she exclaimed, "Oh, I see, it's an incontinence device for adults who are obese."

Good job I bit my tongue. I was going to say, "It's a fat diaper." So much for plain english.

Doreen

It's worth noting that this is a US study, where patients pay out-of-pocket (or private insurance) for health care, doctor visits, etc. Thus, the financial incentive becomes more personal, and immediate.

The details given in this report are rather sketchy. I was curious if there was a difference among age groups. The study included 4,700 Type 2 diabetics, 18 yrs and older. It's highly unlikely that 18 yr olds would have such advanced disease that they'd be experiencing severe complications like stroke, heart disease and vascular (foot) ulcers. So, does this mean only the older, more advanced patients kept their blood sugar lower?

I think the gist of this report is more about patient motivation. Keep your blood sugar lower and stable, have more money in your pocket. It's kinda like smoking and drunk driving, for those who disregard the health warnings (they mean everyone else, not me) - money talks.

Another detail not indicated in the study is HOW they reduced blood sugar - medication, diet, exercise, etc..... I'm curious to know how maintaining a lowered, stable blood sugar following a low-carbohydrate diet would influence results. We know of other studies showing that a lowcarb diet reduces blood cholesterol and risk of heart disease - it's possible that the higher death rates were associated with the standard calorie-reduced, HIGH carb diabetic diet, and oral medication. Although these lower blood sugar, they may have ultimately contributed to the complications which were the cause of death.



[Edited by doreen T on 11-01-01 at 15:07]