How Diabetes Cost Is Directly Related To A1c 

Have you ever paid attention to the cost of a box of diabetic test strips? Poor management of type 2 diabetes can cost a person with diabetes thousands of dollars; it costs less to pay attention to your health. 

It’s no secret that type 2 diabetes affects millions of people worldwide. More specifically, there has been a steady incline in the diagnosis of the disease in the past three decades. As you can imagine, this comes with a cost, owing to the fact that uncontrolled diabetes leads to chronic complications, disabilities, and premature death.  

In efforts to gain insight on this issue, previous studies found that medical costs in persons with type 2 diabetes were higher than those of a person without it. This cost was associated with the increased use of hospital resources due to the complications of diabetes. Additionally, this study concluded that despite people with diabetes having a lower life expectancy, type 2 diabetes has a sizeable increased lifetime medical expense.    

Since the previous studies only scratched the surface of this pressing matter, this study, conducted in Spain, aimed to discover whether the degree of glycemic control makes a difference in annual health care costs in people with type 2 diabetes. Additionally, this study analyzed hospital admissions and medication costs.  

100,391 people were included in the study. The cross-sectional study design was used to estimate and compare the costs of people with type 2 diabetes, based on glycemic control, and quantified by the hemoglobin A1C. Four categories of the hemoglobin A1C were used: good glycemic control <7%, fair control for >7% to <8%, poor glycemic control for >8% to <10%,  and very poor control for >10%. Additional variables included micro or macrovascular complications (or both), hypertension, and hypercholesterolemia.  

To calculate annual direct costs, researchers added: primary care visits, referrals of patients from primary care physicians to specialist care, hospitalizations, diagnostic tests, all medications billed to the national health system, dialysis treatment, and the utilization of self-monitoring test strips. Annual health care costs were calculated using pricing set by the Official Bulletin of the Catalan Government (DOGC). Hospital admissions were retrieved from a classification system published by the DOGC and were categorized by level of hospital complexity (high, medium, and low). Pharmacy billing information was used for medications and the mean annual cost per patient for the type and amount of self-monitoring test strips. Dialysis was calculated by the mean of sessions per week. As for the total health care costs, every resource used by an individual was identified, quantified, and multiplied by the unit cost of each resource. The outcome measures used were the total health care, medication, and hospitalization costs.  

Researchers found that as the hemoglobin A1C worsened, patients were more likely to suffer from microvascular complications, reporting that 18% suffered from microvascular complications in the very poor glycemic control group and 8% in the good glycemic control group. Contrarily, it was observed that macrovascular complications decreased as glycemic control got worse.  

The general annual cost per person with type 2 diabetes was found to have a mean of 3,300 dollars (3,039 euros). This number increased as the hemoglobin did, in the respective categories listed previously. Hospitalization weighed heavily on the overall cost, followed by medication costs and primary care visits. Those three categories were observed to be lower in patients with optimal glycemic control. In the very poor glycemic control group, health care costs were 470 dollars (428.3 euros)  higher than that in the good control cohort. This was the largest area of increase in costs. An increase in hospitalization costs had a direct correlation with more inadequate glycemic control. Patients in the poor glycemic control group had a higher probability of 7.93% of hospitalization and higher costs at 1010 dollars (927.5 euros). As far as medication costs, patients in the fair glycemic control group had a 13.2% increase in costs compared to the patients in the good glycemic control group. The percentage increased as the glycemic control worsened at 33.6% in patients with very poor glycemic control.  

In conclusion, the quantifying data of this study undoubtedly proves the association of how poor glycemic control in type 2 diabetes increases health care costs annually and long-term. Also, researchers even went to the extent to control the presence of micro and macrovascular complications, which still resulted in higher health care costs in higher hemoglobin levels than those with lower levels. The limitations of this study were minimal, recalling that the use of a population–based database can yield incomplete clinical variables and that it only included individuals in Spain.  

Practice Pearls: 

• Type 2 diabetes, in conjunction with poor glycemic control, leads to increased annual healthcare costs 
• There is a direct relationship between the total health care, medication, and hospitalization costs and elevated hemoglobin A1C levels 
• Limitations exist, lacking diversity among the study population. 

Manel Mata-Cases, Beatriz Rodríguez-Sánchez, Dídac Mauricio, Jordi Real, Bogdan Vlacho, Josep Franch-Nadal and Juan Oliva, “The Association Between Poor Glycemic Control and Health Care Costs in People With Diabetes: A Population-Based Study.” Diabetes Care 2020 Apr; 43 (4): 751-758. https://doi.org/10.2337/dc19-0573 

Deonna Andrews, PharmD Candidate 2020 of Florida Agricultural & Mechanical University College of Pharmacy and Pharmaceutical Sciences