Pre-diabetes a Costly Condition for Patients

Study finds they rack up more medical bills than those with normal blood sugar levels

SATURDAY, June 11, 2005 (HealthDay News) -- People with pre-diabetes incur greater health care costs and are in poorer health than people with normal blood glucose levels.

The findings, which are to be presented Saturday at the American Diabetes Association annual meeting in San Diego, indicate that this group of people may need to be followed more closely.

"It certainly suggests that maybe we need to start paying attention to elevated glucose levels sooner, or at least the ramifications of it," said study author Gregory Nichols, a senior research associate at Kaiser Permanente Center for Health Research in Portland, Ore. "It's not clear from our data that doing anything sooner is going to prevent diabetes, although that's what other studies are showing."

"It's an indication of lifestyle issues, and how we really need to be more aware of this condition before it brings out the heart attacks and strokes that it does," added Dr. Stuart Weiss, a clinical assistant professor of medicine at New York University School of Medicine. "We need to be a lot more aggressive in dietary management."

More than 18 million Americans have diabetes, a disease marked by high blood glucose levels and an increasing number of people have pre-diabetes, marked by blood glucose levels that are higher than normal but not high enough to classify as full-blown diabetes.

In 2003, the cut-off point for pre-diabetes was lowered to 100 mg/dL from 110 mg/dL, a move that caused some controversy, Nichols said.

The study by Nichols aimed to compare health care costs between the different classifications of diabetics and pre-diabetics, and to see if people at the new cut-off point have more disease and more costs.

Among a group of 28,000 people, patients with normal blood glucose levels had annual costs of $3,799 versus $4,580 for those at the new cut-off point for pre-diabetes, and $4,960 for those at the old cut-off point. This represented a 31 percent difference between those with normal levels and those with the highest pre-diabetes blood glucose levels.

"People with pre-diabetes cost more than people with normal glycemic levels, but not as much as people with diabetes," Nichols said. "That's kind of what we expected and the reason is they have more cardiovascular disease already and more metabolic syndrome."

Other studies presented at the meeting reported news suggesting that diabetes care in the United States has improved. These papers looked at end-stage renal disease, of which diabetes is the leading cause, and preventable hospitalizations.

"We found that there was a decline in the rate of potentially preventable hospitalizations among people with diabetes, which is good news," said Dr. Michael Engelgau, co-author of both studies and associate director for prevention policy in the division of diabetes translation at the CDC.

And although the number of new cases of end-stage kidney disease has increased since 1990, the incidence rate (annual rate of cases) in people with diabetes declined by 30 percent between 1996 and 2002, added Nilka Rios Burrows, lead author of that report and an epidemiologist in the same CDC division.

"There continues to be a larger number of new cases of renal failure, and there continues to be a larger number of potentially preventable hospitalizations," Engelgau said. "Those numbers are increasing. What we looked at was the rate, which is declining."

Although the studies did not look specifically at why these changes are taking place, the authors have some ideas.

"We do know from other studies that there's a trend towards better diabetes preventive care being delivered in this country," Engelgau said.

For kidney disease, it probably has much to do with controlling blood pressure and blood sugar, and getting the appropriate medications, he added.

It's also possible that the diabetic population is younger and healthier than it has been in the past.

More information

The American Diabetes Association has more on pre-diabetes and diabetes.

SOURCES: Gregory A. Nichols, Ph.D., senior research associate, Kaiser Permanente Center for Health Research, Portland, Ore.; Michael M. Engelgau, M.D., associate director, prevention policy, division of diabetes translation, CDC, Atlanta; Nilka Rios Burrows, MT, MPH, epidemiologist, division of diabetes translation, CDC; Stuart Weiss, M.D., clinical assistant professor, medicine, New York University School of Medicine, New York City; June 12, 2005, presentations, American Diabetes Association annual meeting, San Diego
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