Association between glycemic control and short-term healthcare costs among commercially insured diabetes patients in the United States

Figures & data

Table 1.  Patient characteristics.

Characteristics	Type 1 diabetes (n = 1,837)	Type 2 diabetes (n = 34,469)
Mean age (years ± SD)	41 ± 16	56 ± 9
Female/male (%)	49/51	45/55
Healthcare plan type, n (%)
EPO	330 (18)	6,453 (19)
HMO	132 (7)	3,928 (11)
POS	1,185 (65)	20,527 (60)
PPO	184 (10)	3,441 (10)
Other	6 (0)	120 (0)
Diabetes treatment, n (%):
DPP-4	NA	3,308 (10)
Metformin	NA	17,449 (51)
OAD combination	NA	6,354 (18)
Sulfonylurea	NA	10,086 (29)
Thiazolidinedione	NA	6,985 (20)
Exenatide	NA	2,601 (8)
Other OAD	NA	1,084 (3)
Basal insulin	879 (48)	5,273 (15)
Bolus insulin	1,567 (85)	3,010 (9)
Premix insulin	88 (5)	1,516 (4)
Co-morbidities, n (%):
Hypertension	702 (38)	25,551 (74)
High blood cholesterol	969 (53)	27,646 (80)
Obesity	63 (3)	4,550 (13)
Non-alcoholic fatty liver disease	11 (1)	915 (3)
Kidney disease	91 (5)	1,491 (4)
Cardiovascular disease	13 (1)	371 (1)
HbA1c, (%)
>6–≤7	583 (31.7)	19,249 (55.8)
>7–≤7.5	316 (17.2)	4,389 (12.7)
>7.5–≤8	285 (15.5)	2,802 (8.1)
>−≤8.5	207 (11.3)	1,835 (5.3)
>8.5–≤9	133 (7.2)	1,444 (4.2)
>9	313 (17.0)	4,750 (13.8)

EPO. exclusive provider organization; HMO, health maintenance organization; POS, point-of-service plan; PPO, preferred provider organization; NA, not applicable; DPP-4, dipeptidyl peptidase–4 inhibitor; OAD, oral antidiabetic drug; OAD combination, combination products of more than one OAD.

Co-morbidities are identified by ICD–9 diagnosis codes.

Table 2.  Annual overall and diabetes-related healthcare resource utilization for type 1 and type 2 diabetes.

Healthcare resource	Type 1 diabetes		Type 2 diabetes
	Number*	Costs ($)	Number*	Costs ($)
Overall healthcare resources
Medical visits	21.6 (22.4)	14,912 (30,807)	21.4 (25.3)	17,492 (48,567)
Office visits	11.2 (11.1)	3,195 (7,084)	11.2 (11.3)	3,716 (12,495)
Outpatient visits	2.5 (5.0)	3,631 (12,961)	2.8 (5.7)	4,816 (17,260)
ER visits	0.4 (2.2)	107 (900)	0.5 (2.6)	95 (795)
Inpatient visits	1.3 (6.9)	3,838 (19,361)	2.0 (11.3)	6,486 (35,476)
Other†	6.2 (9.5)	4,139 (6,735)	4.8 (6.8)	2,380 (6,257)
Prescription refills	33.5 (25.7)	5,010 (4,512)	40.6 (30.4)	4,352 (4,690)
Diabetes-related healthcare resources
Medical visits	9.8 (9.5)	7,421 (16,227)	6.9 (7.0)	5,680 (18,627)
Office visits	4.3 (3.3)	877 (1,423)	3.8 (3.3)	658 (1,143)
Outpatient visits	0.7 (1.8)	1,399 (5,386)	0.5 (1.9)	1,536 (7,509)
ER visits	0.1 (0.5)	24 (377)	0.1 (0.5)	17 (452)
Inpatient visits	0.5 (2.5)	2,305 (13,296)	0.5 (3.1)	2,723 (15,385)
Other†	4.2 (6.7)	2,816 (3,912)	2.1 (2.3)	746 (1,692)
Prescription refills	7.7 (5.6)	1,811 (1,240)	9.8 (8.9)	1,342 (1,583)

Data are mean (SD).

*Number of visits or refills.

†Laboratory test, rehabilitation facilities, and nursing homes.

Table 3.  Multivariate analysis of diabetes-related medical costs.

Characteristics	Type 1 diabetes		Type 2 diabetes
	Estimate	p-value	Estimate	p-value
Intercept	7.4559 (0.2485)	<0.0001	6.2698 (0.0758)	<0.0001
Age	−0.0016 (0.0024)	NS	0.0084 (0.0009)	<0.0001
HbA1c	0.0583 (0.0213)	0.0061	0.0431 (0.0056	<0.0001
Gender, female	0.1168 (0.0608)	NS	0.1469 (0.0169)	<0.0001
Healthcare plan type*
EPO	0.1968 (0.1194)	NS	0.1297 (0.0322)	<0.0001
HMO	0.0421 (0.1475)	NS	0.1667 (0.0355)	<0.0001
POS	−0.0340 (0.1026)	NS	0.0673 (0.0281)	0.0168
Other	1.3261 (0.5387)	0.0138	−0.6120 (0.1418)	<0.0001
Diabetes treatment
DPP-4	NA	NA	0.0153 (0.0282)	NS
Metformin	NA	NA	0.2236 (0.0175)	<0.0001
OAD combination	NA	NA	0.1443 (0.0223)	<0.0001
Sulfonylurea	NA	NA	0.2227 (0.0188)	<0.0001
Thiazolidinedione	NA	NA	0.0516 (0.0207)	0.0127
Exenatide	NA	NA	0.0451 (0.0314)	NS
Other OAD	NA	NA	−0.0153 (0.0473)	NS
Basal insulin	−0.3588 (0.0611)	<0.0001	0.2218 (0.0266)	<0.0001
Premix insulin	0.9742 (0.1581)	<0.0001	0.5834 (0.0410)	<0.0001
Bolus insulin	0.8031 (0.0958)	<0.0001	0.9404 (0.0339)	<0.0001
Co-morbidities
Hypertension	0.4136 (0.0756)	<0.0001	0.7054 (0.0200)	<0.0001
High blood cholesterol	0.1416 (0.1416)	NS	0.1861 (0.0218)	<0.0001
Obesity	0.0462 (0.1679)	NS	0.6748 (0.0245)	<0.0001
Non-alcoholic fatty liver disease	1.3699 (0.3926)	0.0005	0.5934 (0.0511)	<0.0001
Kidney disease	0.9288 (0.1442)	<0.0001	0.8995 (0.0414)	<0.0001
Cardiovascular disease	0.8544 (0.3581)	0.017	0.9052 (0.0795)	<0.0001

Dummy variables are shown in italic.

Data are estimate (SD).

Variables were coded as follows: age – continuous; gender – male and female; healthcare plan type – EPO, HMO, POS, PPO and Other; diabetes treatment use – 1 (yes) and 0 (no); co-morbidities – 1 (yes) and 0 (no).

*PPO healthcare plan was used as benchmark. EPO, exclusive provider organization; HMO, health maintenance organization; POS, point-of-service plan; PPO, preferred provider organization; NS, non-significant; NA, not applicable; OAD, oral antidiabetic drug.