Inpatient costs for people with type 1 and type 2 diabetes in scotland_ a study from the scottish diabetes research network epidemiology group

The rising prevalence of diabetes worldwide has increased interest the costs of diabetes in total and relative to the rest of the population. Type 1 diabetes insulin dosing Estimates of the proportion of total healthcare expenditure spent on people with diabetes have varied widely ranging between 3-4% (for type 2 diabetes in eight European countries ( 1) or Ireland ( 2)) to 20% (for all people with diabetes) in the United States ( 3). Type 1 diabetes symptoms child Estimates will vary depending on the accuracy of the methods used, success in identifying people with diabetes and costs, population prevalence of diabetes (which range between 3 and 5.8% in these studies) and underlying healthcare costs. Type 1 diabetes prognosis Most recently it was estimated that people with diabetes in Wales accounted for 12.3% of the total acute hospital expenditure with diabetes prevalence 3.5% ( 4).

In studies of total costs, hospitalizations accounted for approximately half of the costs ( 1- 3). Gestational diabetes numbers chart Drug therapies, ambulatory, outpatient and primary care accounted for the remainder.

In Scotland almost all people with diabetes are included in a national clinical information system (described at www.diabetesinscotland.org.uk). Type 1 diabetes mellitus definition The register is populated by data from all hospital clinics for adults, the nationwide retinopathy screening service and all except five of the approximately 1000 primary care practices in Scotland. Type 1 diabetes mellitus symptoms Data on all hospital admissions are collated centrally. Definition of type 1 diabetes Data linkage allows assessment of the national inpatient costs for people with diabetes at the population level along with assessment of factors associated with these costs.

Very few studies have examined the total costs of diabetes ( 5) and there is a need for accurate and up-to-date estimates.


Late onset type 1 diabetes symptoms The total inpatient costs of people with diabetes in Scotland were examined. Reversing type 1 diabetes naturally The effects of characteristics such as age, sex, diabetes duration and HbA 1c on admission to hospital and cost of admission were investigated to suggest which factors could be focused on to reduce admission and to assist in health services planning.

A two-part model clustered by person was used to examine which variables were associated with at least one admission within one year, and which variables were associated with the total cost of all admissions for people admitted within each year. Signs of type 1 diabetes in child The first part of the model estimated the probability of one or more hospital admission in a given year using logistic regression. Type 1 diabetes in babies The second part of the model estimated total cost of all admissions per year conditional on admission using generalised linear models (GLM) assuming a gamma distribution to handle right skew in the data. Type 1 diabetes statistics The expected (unconditional) cost of admission is calculated from the two-part model by combining the estimated cost of hospital admission in one year, conditional on an admission occurring, and the probability of admission. Juvenile onset diabetes Following convention, costing estimates are given as mean and standard deviation ( 11). Difference between type1 and type 2 diabetes symptoms Parametric relationships between continuous variables and outcomes were examined using the grouped smoothing and fractional polynomial methods ( 12). Difference between type1 and type 2 diabetes Analyses were conducted in Stata version 11. Type 1 diabetes autoimmune disease Only linear relationships were included in final models as higher order relationships did not improve model fit.

To aid interpretation, the model using untransformed data was taken as the final model, because transformed variables provided minimally better model fit. Type 1 diabetes ppt Due to missing data in the explanatory variables, the numbers of people included in the models were 19,753 for type 1 and 154,044 for type 2 diabetes (see Table 1). Type 1 diabetes in toddlers For type 1 diabetes, those with diabetes for less than 180 days were excluded.

Increasing age and creatinine, female sex and previous vascular history in people with both type 1 and type 2 diabetes as well as insulin prescription in type 2 were associated with increased probability of admission to hospital in multivariate models ( Table 3). Type 1 diabetes life expectancy 2015 Interestingly, greater BMI was associated with a reduced probability of hospital admission in both type 1 and type 2 ( Table 3, Figure 1a,b). Cure type 1 diabetes naturally Higher HbA 1c was associated with a marked increase in probability of admission in type 1 but had a significant, if small, decreasing effect in type 2 diabetes. Diabetes type 1 life expectancy People with a shorter history of diabetes had slightly higher likelihood of admission to hospital.

In both type 1 and type 2 diabetes, the cost of admission per person per year in the group with at least one admission increased with age, creatinine and previous vascular history, and decreased with greater BMI. Type 1 diabetes autoimmune Higher HbA 1c was also associated with lower costs in type 2 diabetes ( Table 3, Figure 1c,d).

Expected costs ( Figure 1e,f) describe the combination of the cost of an admission per person per year in the group with at least one admission and the probability of an admission, as demonstrated in the following example. Juvenile diabetes mellitus A man with type 1 diabetes, who has no previous admission for vascular reasons, and with characteristics set to reflect the average values provided in Table 1, has a probability of admission of 0.22. How to reverse type 1 diabetes The total cost of all admissions in a given year, conditional on at least one admission, was £3854 and the expected cost of admission to hospital would be £855 (0.22 × £3854).

In both type 1 and type 2 diabetes, younger age, no previous vascular admissions, shorter diabetes duration and lower creatinine were associated with lower costs per person per year for all those with diabetes ( Figure 1e,f). Type 1 diabetes symptoms in adults For type 2, insulin prescription was associated with increased expected costs compared to those not prescribed insulin.

The results of analyses using the secondary outcomes of hypoglycaemia, hyperglycaemia, vascular, diabetic-related, and cancer are presented in Table 4. Type 1 diabetes insulin dependent In type 1 diabetes, diabetes duration has a reduced effect on hyperglycaemia and diabetes-related admissions. Type 1 diabetes symptoms adults In both types of diabetes HbA1c has an increased effect and age has a reduced effect on admission for hyperglycaemia. Type 1 diabetes life expectancy For both type 1 and type 2 diabetes, males are more likely to be admitted for vascular reasons, and HbA1c has a reduced effect on likelihood of admission for cancer. Type 1 diabetes nhs Those with type 2 diabetes receiving insulin have an increased risk of any admission, particularly for hyperglycaemia.

Of the total Scottish inpatient expenditure (£2.4billion), 12% of the cost of hospitalisations was attributable to the 4.3% of people in Scotland with diagnosed diabetes, a similar estimate to that achieved by the Welsh study ( 4). Type 1 diabetes insulin resistance In part this increased expenditure reflects the older age of people with diabetes. Type 1 diabetes pregnancy symptoms However we also show that a doubling of hospital admission rates compared to the background population after adjustment for age and sex. Difference between type1 and type 2 diabetes mellitus Younger age groups had the most marked increase in admissions rate and total costs, while those in older age groups had the largest relative increase in cost per admission.

A number of risk factors and complications – including higher age, creatinine and previous vascular admission – have predictable influence on the probability of admission and costs of admission. Type 1 diabetes complications timeline Longer duration of diabetes exerted only a small effect among people with type 2 diabetes and indeed reduced the probability of admission in type 1. Type 1 diabetes insulin dosing The effect of duration in type 1 diabetes appears to reflect admission early after diagnosis as duration of diabetes has no effect when those who had diabetes for less than 180 days are included, but is a positive predictor of admission after excluding these people.

Less predictably, higher BMI appeared to be associated with lower likelihood of admission and costs in both type 1 and type 2 diabetes. Type 1 diabetes symptoms child One explanation is the possible concomitant effects of acute or chronic disease on BMI, with lower BMI acting as a marker of co-morbidity. Type 1 diabetes prognosis Notably, a J-shaped relationship has been shown to exist between BMI and mortality( 13), and a similar relationship between BMI and mortality appears to be present in the Scottish population ( 14). Gestational diabetes numbers chart Low BMI may also reflect undertreatment of hyperglycaemia but we think that this is unlikely to be the explanation as found that the effect of BMI was independent of recent HbA 1c.

The relationship of HbA 1c and admission was divergent in type 1 and type 2 diabetes. Type 1 diabetes mellitus definition Higher HbA 1c was associated with an increased risk of total admission in type 1 but slightly reduced overall risk of admission in type 2 diabetes. Type 1 diabetes mellitus symptoms One obvious explanation of this is that while HbA1c acts as a predictor of “hyperglycaemia” admissions in both type 1 and type 2 diabetes ( Table 4), such admissions form a much larger proportion of total admissions in type 1 than type 2 diabetes ( Table 2: 14.5% vs 0.3%). Definition of type 1 diabetes The population with type 2 diabetes is almost 30 years older on average and would be expected to have a much higher rate of admissions for conditions either unrelated or less directly related to HbA1c. Late onset type 1 diabetes symptoms There are also important clinical differences between the two diseases. Reversing type 1 diabetes naturally It is notable that the rates of “hyperglycaemia” admissions are much higher in type 1 than type 2 diabetes with almost 0.06 admissions per year per person with type 1 diabetes compared to 0.002 admissions per year per person with type 2 diabetes. Signs of type 1 diabetes in child Some of this may reflect hospital coding but much will reflect underlying differences in the two conditions.

For type 1, the effect of HbA 1c was large. Type 1 diabetes in babies With all other variables held constant, the estimated probability of admission doubles if HbA 1c was 12% compared to 6.5%. Type 1 diabetes statistics This is a clinically important effect given that 9% of people with type 1 diabetes had HbA 1c >12% compared with 4% of people with HbA 1c <6.5%. Juvenile onset diabetes The result suggests that HbA 1c is an important indicator of likelihood of both clinical complications and costs in people with type 1 diabetes. Difference between type1 and type 2 diabetes symptoms Along with attempts to avoid microvascular complications, the data suggest that those individuals with the highest HbA 1c might usefully be supported in attempts to reduce hospital admissions and costs in type 1 diabetes but not type 2 diabetes. Difference between type1 and type 2 diabetes This is not to suggest that HbA1c is always necessarily causal in these admissions but would appear to be acting as a marker of risk of admission.

The relationship between admission and HbA 1c in type 2 diabetes shows that those at the lowest levels of HbA 1c have a slightly higher likelihood of admission and higher unconditional costs. Type 1 diabetes autoimmune disease This may reflect the influence of other co-morbidities and illness leading to reduction in HbA 1c and increased probability of hospital admission. Type 1 diabetes ppt Notably a recent study has also shown J-shaped relationships between HbA 1c and survival ( 15) so while the relationship of HbA1c and admission may predominantly reflect reverse causality a direct effect of lower HbA1c on risk of admission cannot be excluded.

This study took advantage of linked data for both hospital admissions (SMR-01) and clinical information (SCI-DC), providing almost 100% coverage of all data for people with diagnosed diabetes in Scotland during 2005-2007. Type 1 diabetes in toddlers This allowed accurate estimation of associations between patient characteristics and admission, avoiding underestimation as a result of underreporting of diabetes (3;16) in hospital admission data. Type 1 diabetes life expectancy 2015 Few studies have estimated the cost of diabetes ( 5), and fewer have been able to examine type 1 and type 2 diabetes separately. Cure type 1 diabetes naturally These are distinct conditions and although it has been recognised that the cost information should be estimated separately ( 17) this has only recently been possible.

People with diabetes accounted for 4.3% of the population but 12% of inpatient costs. Diabetes type 1 life expectancy This cost estimate is similar to that reported by investigators in Wales ( 4). Type 1 diabetes autoimmune The estimates in both studies were also considerably higher than the previous studies conducted in Europe (1;2), but lower than the United States ( 3). Juvenile diabetes mellitus There are several reasons why this may be the case. How to reverse type 1 diabetes First, in contrast with our methods (individual patient records for hospitalisation), these studies use national data averages and small samples in order to extrapolate costs to the wider population. Type 1 diabetes symptoms in adults These methods may under- or over-estimate costs depending on the accuracy of the national estimates and the methods used. Type 1 diabetes insulin dependent Second, the European study ( 1) uses data from eight countries, each with different national healthcare systems and data collection tools and methods. Type 1 diabetes symptoms adults The US study ( 3) makes use of several medical claims databases, which the authors identify as being less accurate than clinical reports due to the under- or over-diagnosis of conditions. Type 1 diabetes life expectancy Our study has the advantage of using data from a single data source for hospitalisations, which is linked to the clinical registry for people with diabetes in Scotland. Type 1 diabetes nhs Finally, our study includes all people with diabetes in Scotland, while two of the studies only included those with type 2 diabetes who were over 30 years of age (1;2), giving a lower prevalence and, therefore, lower cost estimates.

A number of factors suggest that costs may still be underestimated. Type 1 diabetes insulin resistance First, costs were attributed for different types of admission using HRG codes using the Scottish national tariff. Type 1 diabetes pregnancy symptoms This system does not account for differences in individual length of stay ( 8). Difference between type1 and type 2 diabetes mellitus As has been suggested by others ( 18), these may be systematically higher in people with diabetes leading to underestimation of costs. Type 1 diabetes complications timeline This is also the case in our data where while people with diabetes account for 12% of admissions, they account for 18% of hospital days. Type 1 diabetes insulin dosing Second, for admissions with multiple episodes of care, the most expensive episode was chosen as the cost of admission. Type 1 diabetes symptoms child The estimates of costs for such admissions are therefore conservative since additional episodes are not taken into account, but this approach has the advantage of avoiding double counting of shared costs.

Third, this analysis was restricted to inpatient costs of diabetes and does not include ambulatory care or prescription costs. Type 1 diabetes prognosis Previous studies suggest that inpatient costs will account for around 50% of total healthcare costs for people with diabetes ( 1- 3). Gestational diabetes numbers chart Prescription costs were not available on an individual basis. Type 1 diabetes mellitus definition Data from the Scottish Prescription Costs Analysis ( 19) shows that prescription costs for drugs used in the direct treatment of diabetes (£163million) was 5.6% of the total Scottish expenditure for all drugs (£2.9billion) for years 2005-2007. Type 1 diabetes mellitus symptoms The cost of all drugs used in the care of people with diabetes will be higher.

Fourth, costs in this analysis relate to diagnosed diabetes while those as yet undiagnosed may comprise a further 1% of the population ( 20). Definition of type 1 diabetes Finally indirect costs such as lost productivity were not included. Late onset type 1 diabetes symptoms It is likely then that the costs presented are a lower limit of the total cost burden of diabetes.

In summary this study shows that people with diabetes account for a high proportion of inpatient costs. Reversing type 1 diabetes naturally The findings reinforce the importance of addressing modifiable risk factors for cardiovascular and renal disease in both type 1 and type 2 diabetes, and optimal glycaemic control in type 1 diabetes. Signs of type 1 diabetes in child This suggests that HbA1c might be useful as a marker for programmes supporting people with diabetes to remain well and out of hospital.