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Jie W, Yao M, Wang M, Wang Y, Jia Y, Liu Y, Zou K, Sun X. Analysis of the Economic Burden of Chronic Kidney Disease With Comorbidities Among Patients in Xuzhou, China. Int J Public Health 2024; 69:1607000. [PMID: 39027012 PMCID: PMC11254622 DOI: 10.3389/ijph.2024.1607000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/13/2024] [Indexed: 07/20/2024] Open
Abstract
Objectives To analyze the costs and medication patterns of patients with chronic kidney disease (CKD) and comorbidities in Xuzhou, China, using a large electronic medical records database. Methods Data were obtained from an electronic medical records database. The annual per-person and per-visit cost of hospitalization, as well as the proportions of those costs, are presented. Results The majority of the participants were middle-aged men, and had medical insurance. Glomerulonephritis was the primary cause of CKD in patients with an identified etiology. The average per-visit cost of hospitalization for the CKD-renal anemia and CKD-mineral and bone disorder groups was 8,674.5 (5,154.3-13,949.6) and 8,182.6 (4,798.2-12,844.7) Yuan, respectively, which was greater than that of the other groups. The major expenses incurred were for diagnostics, drug usage, surgical procedures, laboratory tests and material costs. Conclusion The substantial burden imposed by CKD with comorbidities indicates the importance of implementing public health strategies aimed at detecting and preventing these conditions in the general population. With the aging population, our nation may experience a greater CKD-related economic burden.
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Affiliation(s)
- Wan Jie
- Institute of Integrated Traditional Chinese and Western Medicine and Chinese Evidence-Based Medicine Center and Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, China
| | - Minghong Yao
- Institute of Integrated Traditional Chinese and Western Medicine and Chinese Evidence-Based Medicine Center and Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, China
| | - Mingqi Wang
- Institute of Integrated Traditional Chinese and Western Medicine and Chinese Evidence-Based Medicine Center and Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, China
| | - Yuning Wang
- Institute of Integrated Traditional Chinese and Western Medicine and Chinese Evidence-Based Medicine Center and Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, China
| | - Yulong Jia
- Institute of Integrated Traditional Chinese and Western Medicine and Chinese Evidence-Based Medicine Center and Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, China
| | - Yanmei Liu
- Institute of Integrated Traditional Chinese and Western Medicine and Chinese Evidence-Based Medicine Center and Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, China
| | - Kang Zou
- Institute of Integrated Traditional Chinese and Western Medicine and Chinese Evidence-Based Medicine Center and Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Sun
- Institute of Integrated Traditional Chinese and Western Medicine and Chinese Evidence-Based Medicine Center and Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, West China Hospital, Sichuan University, Chengdu, China
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Butt MD, Ong SC, Rafiq A, Kalam MN, Sajjad A, Abdullah M, Malik T, Yaseen F, Babar ZUD. A systematic review of the economic burden of diabetes mellitus: contrasting perspectives from high and low middle-income countries. J Pharm Policy Pract 2024; 17:2322107. [PMID: 38650677 PMCID: PMC11034455 DOI: 10.1080/20523211.2024.2322107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Introduction Diabetes increases preventative sickness and costs healthcare and productivity. Type 2 diabetes and macrovascular disease consequences cause most diabetes-related costs. Type 2 diabetes greatly costs healthcare institutions, reducing economic productivity and efficiency. This cost of illness (COI) analysis examines the direct and indirect costs of treating and managing type 1 and type 2 diabetes mellitus. Methodology According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Cochrane, PubMed, Embase, CINAHL, Scopus, Medline Plus, and CENTRAL were searched for relevant articles on type 1 and type 2 diabetes illness costs. The inquiry returned 873 2011-2023 academic articles. The study included 42 papers after an abstract evaluation of 547 papers. Results Most articles originated in Asia and Europe, primarily on type 2 diabetes. The annual cost per patient ranged from USD87 to USD9,581. Prevalence-based cost estimates ranged from less than USD470 to more than USD3475, whereas annual pharmaceutical prices ranged from USD40 to more than USD450, with insulin exhibiting the greatest disparity. Care for complications was generally costly, although costs varied significantly by country and problem type. Discussion This study revealed substantial heterogeneity in diabetes treatment costs; some could be reduced by improving data collection, analysis, and reporting procedures. Diabetes is an expensive disease to treat in low- and middle-income countries, and attaining Universal Health Coverage should be a priority for the global health community.
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Affiliation(s)
- Muhammad Daoud Butt
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM, Penang, Malaysia
- Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Siew Chin Ong
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM, Penang, Malaysia
| | - Azra Rafiq
- Department of Biological Sciences, Middle East Technical University, Ankara, Turkey
- Department of Pharmacy, Riphah International University, Lahore, Pakistan
| | - Muhammad Nasir Kalam
- Department of Pharmacy, The Sahara University, Narowal, Pakistan
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Ahsan Sajjad
- Ibn Sina Community Clinic, South Wilcrest Drive, Houston, Texas, USA
| | - Muhammad Abdullah
- Department of Pharmacy, Punjab University College of Pharmacy, Lahore, Pakistan
| | - Tooba Malik
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
| | - Fatima Yaseen
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
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Zeng G, Jin YZ, Huang Y, Hu JS, Li MF, Tian M, Lu J, Huang R. Transcriptomic Analysis of Type 2 Diabetes Mellitus Combined with Lower Extremity Atherosclerotic Occlusive Disease. Diabetes Metab Syndr Obes 2024; 17:997-1011. [PMID: 38435631 PMCID: PMC10909374 DOI: 10.2147/dmso.s432698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
Background The pathological damage mechanism of type 2 diabetes (T2D) and macroangiopathy is extremely complex, and T2D and arteriosclerosis obliterans have different biological behaviors and clinical features. To explore the mechanism of lower extremity arteriosclerosis occlusion (LEAOD) in T2D patients, we utilized RNA-seq to identify unique gene expression signatures of T2D and LEAOD through transcriptomic analysis. Methods We obtained blood samples and performed RNA sequencing from four patients with T2D, five of whom had LEAOD. Another six age- and gender-matched blood samples from healthy volunteers were used for control. By exploring the general and specific differential expression analysis after transcriptome sequencing, specific gene expression patterns of T2D and LEAOD were verified. Results Transcriptome analysis found differentially expressed genes in T2D, and T2D + LEAOD (vs normal) separately, of which 35/486 (T2D/T2D + LEAOD) were up-regulated and 1290/2970 (T2D/T2D + LEAOD) were down-regulated. A strong overlap of 571 genes across T2D, LEAOD, and coexisting conditions was mainly involved in extracellular exosomes and the transcription process. By exploring the sex difference gene expression features between T2D, T2D + LEAOD, and healthy controls, we noticed that sex chromosome-associated genes do not participate in the sexual dimorphism gene expression profiles of T2D and LEAOD. Protein-Protein Interaction Network analysis and drug target prediction provided the drug candidates to treat T2D and LEAOD. Conclusion This study provides some evidence at the transcript level to uncover the association of T2D with LEAOD. The screened hub genes and predicted target drugs may be therapeutic targets.
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Affiliation(s)
- Guang Zeng
- Department of General Surgery, Putuo Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People’s Republic of China
| | - Yong-Zhi Jin
- Department of General Surgery, Putuo Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People’s Republic of China
| | - Yi Huang
- Department of General Surgery, Putuo Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People’s Republic of China
| | - Jun-Sheng Hu
- Department of General Surgery, Putuo Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People’s Republic of China
| | - Meng-Fan Li
- Department of General Surgery, LiQun Hospital, Shanghai, 200333, People’s Republic of China
| | - Ming Tian
- Department of Burn, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Jun Lu
- Department of Endocrinology, Putuo Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People’s Republic of China
| | - Rong Huang
- Department of General Surgery, Putuo Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People’s Republic of China
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Pan Q, Chen H, Fei S, Zhao P, Deng M, Xiao F, Guo L. Medications and medical expenditures for diabetic patients with osteoporosis in Beijing, China: A retrospective study. Diabetes Res Clin Pract 2023; 206:110980. [PMID: 37890699 DOI: 10.1016/j.diabres.2023.110980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
AIMS This study aimed to clarify the changes in treatment regimens and medical expenditures in diabetic patients with osteoporosis. METHODS We recruited 2,853,036 diabetic patients from the Beijing medical insurance database between 2016 and 2018. Among them, 406,221 patients also had osteoporosis. Clinical characteristics, treatment regimens, and medical costs were investigated in diabetic patients with and without osteoporosis. RESULTS Diabetes and osteoporosis were most prevalent in participants aged 45---84 years. Compared with diabetic patients without osteoporosis, those with osteoporosis were prone to developing comorbidities and diabetic complications. They often required multiple glucose-lowering drugs and had a higher rate of insulin use. Similarly, osteoporosis leads to an increased number of medications for non-hypoglycemia as well as higher healthcare costs. These medications and costs increased with the number of complications and comorbidities. Interestingly, from 2016 to 2018, although diabetic patients with osteoporosis took more drugs, medical costs were lower year by year. CONCLUSIONS Osteoporosis might contribute to a worse condition in diabetic patients, and this population often requires more medications with higher medical costs.
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Affiliation(s)
- Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100000, China; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100000, China
| | - Huan Chen
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100000, China; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100000, China
| | - Sijia Fei
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100000, China; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100000, China
| | - Peiyi Zhao
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100000, China; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100000, China
| | - Mingqun Deng
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100000, China
| | - Fei Xiao
- The Key Laboratory of Geriatrics, Beijing Institution of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100000, China.
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100000, China.
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Jiang W, Chen H, Li H, Zhou Y, Xie M, Zhou C, Yang L. The Short-Term Effects and Burden of Ambient Air Pollution on Hospitalization for Type 2 Diabetes: Time-Stratified Case-Crossover Evidence From Sichuan, China. GEOHEALTH 2023; 7:e2023GH000846. [PMID: 38023385 PMCID: PMC10680437 DOI: 10.1029/2023gh000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/22/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023]
Abstract
Type 2 diabetes mellitus (T2DM), a complicated metabolic disease, might be developed or exacerbated by air pollution, resulting in economic and health burden to patients. So far, limited studies have estimated associations between short-term exposure to air pollution and disease burden of T2DM in China. Hence, we aimed to estimate the associations and burden of ambient air pollutants (NO2, PM10, PM2.5, SO2, and CO) on hospital admissions (HAs) for T2DM using a time-stratified case-crossover design. Data on HAs for T2DM during 2017-2019 were collected from hospital electronic health records in nine cities in Sichuan Province using conditional poisson regression. Totally, 92,381 T2DM hospitalizations were recorded. There were significant short-term effects of NO2, PM10, PM2.5, SO2 and CO on HAs for T2DM. A 10 μg/m3 increment of NO2, PM10, PM2.5, SO2 and CO as linked with a 3.39% (95% CI: 2.26%, 4.54%), 0.33% (95% CI: 0.04%, 0.62%), 0.76% (95% CI: 0.35%, 1.16%), 12.68% (95% CI: 8.14%, 17.42%) and 79.00% (95% CI: 39.81%, 129.18%) increase in HAs for T2DM at lag 6. Stratified analyses modified by age, sex, and season showed old (≥65 years) and female patients linked with higher impacts. Using WHO's air quality guidelines of NO2, PM10, PM2.5, and CO as the reference, the attributable number of T2DM HAs exceeding these pollutants exposures were 786, 323, 793, and 2,127 during 2017-2019. Besides, the total medical costs of 25.83, 10.54, 30.74, and 67.78 million China Yuan were attributed to NO2, PM10, PM2.5, and CO. In conclusion, short-term exposures to air pollutants were associated with higher risks of HAs for T2DM.
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Affiliation(s)
- Wanyanhan Jiang
- School of Public HealthChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Han Chen
- Sichuan Wanhao Consulting Co., LtdChengduSichuanChina
| | - Hongwei Li
- School of Public HealthChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Yuelin Zhou
- School of Public HealthChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Mengxue Xie
- School of Public HealthChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Chengchao Zhou
- Centre for Health Management and Policy ResearchSchool of Public HealthCollege of MedicineShandong UniversityJinanChina
| | - Lian Yang
- School of Public HealthChengdu University of Traditional Chinese MedicineChengduSichuanChina
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Pan Q, Fei S, Zhang L, Chen H, Luo J, Wang W, Xiao F, Guo L. How does diabetic peripheral neuropathy impact patients' burden of illness and the economy? A retrospective study in Beijing, China. Front Public Health 2023; 11:1164536. [PMID: 37250086 PMCID: PMC10213523 DOI: 10.3389/fpubh.2023.1164536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Diabetic peripheral neuropathy (DPN) causes significant illness in patients and has a negative impact on the economy. The objective of this study is to evaluate the cost and quantity of anti-diabetic drugs needed by patients with or without DPN, as well as their variation trends in Beijing between 2016 and 2018. Methods This observational cross-sectional study used data on diabetic patients with outpatient medication records obtained from Beijing Medical Insurance from 2016 to 2018. The medications, comorbidities, diabetes-related complications, treatment strategies, and costs of drug treatment were compared between DPN patients and non-DPN patients. Results Of the 28,53,036 diabetic patients included in the study, 3,75,216 (13.15%) had DPN and 1,87,710 (50.03%) of the DPN patients were women. Compared with non-DPN patients, DPN patients used more mediations (4.7 ± 2.47 vs. 3.77 ± 2.32, p < 0.0001, in 2018) to treat related complications and comorbidities (2.03 ± 1.2 vs. 1.71 ± 1.05; 2.68 ± 1.93 vs. 2.06 ± 1.86, p < 0.0001, respectively, in 2018). The total annual costs of drug treatment were higher in DPN patients than in non-DPN patients (¥12583.25 ± 10671.48 vs. ¥9810.91 ± 9234.14, p < 0.0001, in 2018). The usage of DDP4i increased from 2.55 to 6.63% in non-DPN patients and from 4.45 to 10.09% in DPN patients from 2017 to 2018. Conclusions The number of comorbidities, diabetic complications, medications, and annual drug treatment costs were greater in DPN patients than in non-DPN patients.
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Affiliation(s)
- Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Sijia Fei
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Lina Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Huan Chen
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Jingyi Luo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Fei Xiao
- The Key Laboratory of Geriatrics, Beijing Institution of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Kansra P, Oberoi S. Cost of diabetes and its complications: results from a STEPS survey in Punjab, India. Glob Health Res Policy 2023; 8:11. [PMID: 37029445 PMCID: PMC10080818 DOI: 10.1186/s41256-023-00293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 03/13/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Diabetes mellitus is an obtrusive universal health emergency in developed and developing countries, including India. With the exponential rise of epidemiological conditions, the costs of treating and managing diabetes are on an upsurge. This study aimed to estimate the cost of diabetes and determine the determinants of the total cost among diabetic patients. METHODS This cross-sectional study was executed in the northern state of Punjab, India. It involves the multi-stage area sampling technique and data was collected through a self-structured questionnaire adapted following the "WHO STEPS Surveillance" manual. Mann-Whitney U and Kruskal-Wallis tests were performed to compare the cost differences in socio-demographic variables. Lastly, multiple linear regression was conducted to determine and evaluate the association of the dependent variable with numerous influential determinants. RESULTS The urban respondents' average direct and indirect costs are higher than rural respondents. Age manifests very eccentric results; the highest mean direct outpatient care expenditure of ₹52,104 was incurred by the respondents below 20 years of age. Gender, complications, income, history of diabetes and work status were statistically significant determinants of the total cost. Study reports a rapid increase in the median annual direct and indirect cost from ₹15,460 and ₹3572 in 1999 to ₹34,100 and ₹4200 in 2021. CONCLUSIONS The present study highlights that the economic jeopardy of diabetes can be managed by educating people about diabetes and its associated risk factors. The economic burden of diabetes could be restrained by formulating new health policies and promoting the use of generic medicines. The result of the study directs that expenditure on outpatient care is to be reimbursed under the 'Ayushman Bharat-Sarbat Sehat Bima Yojana'.
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Affiliation(s)
- Pooja Kansra
- Department Head of Economics, Mittal School of Business, Lovely Professional University, Punjab, India
| | - Sumit Oberoi
- Symbiosis School of Economics, Symbiosis International University, Pune, India.
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Li Y, Yu D, Guo L, Mu Y, Wan H, Wang J, Xu B, Wang G, Jiang C, Liang L, Zhang J, Liu J, Zhang M, Cui N. Efficacy and safety of basal-first titration order in individuals with type 2 diabetes receiving short-term intensive insulin therapy: An exploratory analysis of BEYOND V. Diabetes Obes Metab 2023; 25:1221-1228. [PMID: 36594649 DOI: 10.1111/dom.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Abstract
AIMS To present the results of an exploratory analysis of the BEYOND V study in which Chinese individuals with uncontrolled type 2 diabetes (T2D) received short-term intensive insulin therapy (SIIT) during study run-in (prior to randomization) using a basal-first insulin titration method. MATERIALS AND METHODS This was exclusively an exploratory analysis of the 7- to 10-day run-in period of BEYOND V. Participants were hospitalized and had oral therapies withdrawn (except metformin). They received SIIT with once-daily insulin glargine and three-times-daily premeal insulin glulisine, titrated daily from a total starting dose of 0.4 to 0.5 units/kg/d, first adjusting insulin glargine to achieve fasting blood glucose (FBG) of 4.4 to 6.1 mmol/L (79 to 119 mg/dL), then insulin glulisine to achieve pre-meal blood glucose of 4.4 to 6.1 mmol/L. Key outcomes were the proportions of participants achieving FBG and 2-hour postprandial blood glucose (PBG) targets. RESULTS Overall, 397 entered the run-in (mean 54.2 years, 235 males [59.2%]). At the end of SIIT, 374/396 participants (94.4%) had both FBG <7.0 mmol/L (<126 mg/dL) and 2-hour PBG <10 mmol/L (<180 mg/dL) and 282/396 (71.2%) had both FBG <6.1 mmol/L (<100 mg/dL) and 2-hour PBG <10 mmol/L. The mean first time taken to achieve FBG <7 mmol/L, 2-hour PBG <10 mmol/L, and both, was 4.35, 3.88, and 5.04 days, respectively. Hypoglycaemia occurred in 99 participants (24.9%). There was no severe hypoglycaemia. CONCLUSIONS Titrating basal insulin first is an effective and safe method of SIIT in individuals with T2D, rapidly achieving target glucose levels with a relatively low rate of hypoglycaemia.
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Affiliation(s)
- Yijun Li
- The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Dongni Yu
- Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Lixin Guo
- Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yiming Mu
- The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | | | - Junfen Wang
- Second Hospital of Shijiazhuang, Shijiazhuang, China
| | - Binhua Xu
- Harbin the First Hospital, Harbin, China
| | - Guoping Wang
- Second Affiliated Hospital of Baotou Medical College, Baotou, China
| | | | - Li Liang
- People's Hospital of Liaoning Province, Shenyang, China
| | - Jiewen Zhang
- Medical Department, Sanofi Investment Co, Ltd., Shanghai, China
| | - Jingcheng Liu
- Medical Department, Sanofi Investment Co, Ltd., Shanghai, China
| | - Minlu Zhang
- Medical Department, Sanofi Investment Co, Ltd., Shanghai, China
| | - Nan Cui
- Medical Department, Sanofi Investment Co, Ltd., Shanghai, China
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Chen M, Kong F, Su B, Wei X, Yang J. Factors Influencing Hospitalization Cost for Diabetic Patients in Traditional Chinese Medicine Hospitals in Qingyang City, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13859. [PMID: 36360740 PMCID: PMC9657176 DOI: 10.3390/ijerph192113859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: This study aims to understand the factors influencing hospitalization cost related to diabetes mellitus in two traditional Chinese medicine (TCM) hospitals, and to provide a scientific basis for TCM hospitals to control the hospitalization cost of chronic diseases, including diabetes mellitus. (2) Methods: Univariate analysis was used to preliminarily screen the factors related to hospitalization cost, and then multiple linear regression and path models were comprehensively used to analyze the influencing factors of hospitalization cost. (3) Results: The cost of hospitalization for diabetic patients was mainly affected by hospital level, length of stay, type of diabetes, and complications and comorbidities, and hospital level was the most critical influencing factor. (4) Conclusions: The higher the Chinese medicine hospital level, the longer the length of stay, and the more severe the complications and comorbidities, the higher the hospitalization cost for diabetic patients. The Chinese government should continue to promote the tiered medical treatment system and improve the standard of treatment at TCM hospitals to reduce the economic burden of chronic diseases, including diabetes mellitus.
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Affiliation(s)
- Mengen Chen
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Fanxin Kong
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Bin Su
- School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Xuexuan Wei
- School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Jingyu Yang
- School of Public Health, Lanzhou University, Lanzhou 730000, China
- School of Business and Management, Gansu University of Chinese Medicine, Lanzhou 730000, China
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Wang S, Guo Y, Maitland E, Nicholas S, Sun J, Leng A. The Economic Burden of Hospital Costs on Families With Type 1 Diabetes Mellitus Children: The Role of Medical Insurance in Shandong Province, China. Front Public Health 2022; 10:853306. [PMID: 35602147 PMCID: PMC9121097 DOI: 10.3389/fpubh.2022.853306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study estimates the economic burden imposed on families by comparing the hospitalization costs of T1DM children with and without medical insurance in Shandong province. Methods Our data comprised 1,348 T1DM inpatient records of patients aged 18 years or younger from the hospitalization information system of 297 general hospitals in 6 urban districts of Shandong Province. Descriptive statistics are presented and regression analyses were conducted to explore the factors associated with hospitalization costs. Results Children with medical insurance had on average total hospitalization expenditures of RMB5,833.48 (US$824.02) and a hospitalization stay of 7.49 days, compared with the children without medical insurance who had lower hospitalization expenditures of RMB4,021.45 (US$568.06) and an average stay of 6.05 days. Out-of-pocket expenses for insured children were RMB3,036.22 (US$428.89), which is significantly lower than that of the uninsured children (P < 0.01). Out-of-pocket (OOP) expenditures accounted for 6% of the annual household income of insured middle-income families, but rose to a significant 25% of the annual income for low-income families. These OOP expenditures imposed a heavy economic burden on families, with some families experiencing long-term financial distress. Both insured and uninsured families, especially low-income families, could be tipped into poverty by hospitalization costs. Conclusion Hospitalization costs imposed a significant economic burden on families with children with T1DM, especially low-income insured and uninsured families. The significantly higher hospitalization expenses of insured T1DM children, such as longer hospitalization stays, more expensive treatments and more drugs, may reflect both excess treatment demands by parents and over-servicing by hospitals; lower OOP expenses for uninsured children may reflect uninsured children from low-income families forgoing appropriate medical treatment. Hospital insurance reform is recommended.
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Affiliation(s)
- Siyuan Wang
- Faculty of Business and Economics, University of Melbourne, Melbourne, VIC, Australia
| | - Yawei Guo
- Taiyuan Municipal Health Commission, Taiyuan, China
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, United Kingdom
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia
- Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, Jinan, China
| | - Anli Leng
- School of Political Science and Public Administration, Shandong University, Qingdao, China
- Center for Health Preferences Research, Shandong University, Jinan, China
- *Correspondence: Anli Leng
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Liu Y, Ning X, Zhang L, Long J, Liang R, Peng S, Wang H, Li Y, Chen W, Xiao H. Prevalence of long-term complications in inpatients with diabetes mellitus in China: a nationwide tertiary hospital-based study. BMJ Open Diabetes Res Care 2022; 10:10/3/e002720. [PMID: 35545316 PMCID: PMC9096476 DOI: 10.1136/bmjdrc-2021-002720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/12/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is absence of national data to estimate the prevalence of long-term diabetic complications among inpatients with diabetes in tertiary hospitals in China. RESEARCH DESIGN AND METHODS Using the national Hospital Quality Monitoring System database, inpatients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) were identified by the International Classification of Diseases-10 code, and the temporal trends of microvascular and macrovascular complications 2013-2017 were calculated, and then the risk factors were analysed by multivariate regression analysis. RESULTS A total of 92 413 inpatients with T1DM and 6 094 038 inpatients with T2DM were identified in 2013-2017. The proportions of inpatients with microvascular complications in inpatients with T1DM and T2DM increased from 29.9% and 19.0% in 2013 to 31.6% and 21.0% in 2017, respectively. The proportions of inpatients with macrovascular complications in inpatients with T1DM and T2DM increased from 7.3% and 14.5% in 2013 to 13.2% and 18.4% in 2017, respectively. Hypertension and hyperlipidemia were risk factors for both microvascular and macrovascular complications. Among inpatients with T1DM, the adjusted ORs of microvascular complications increased in 40-49 age group and Northeast region, while older age, male and North region were risks factor for macrovascular complications. Among inpatients with T2DM, the ORs of microvascular complications increased in 40-49 age group, female, urban and North region, while older age, male, urban and Southwest region were risks factor for macrovascular complications. CONCLUSIONS The proportions of long-term complications of inpatients with diabetes in China increased in 2013-2017. Efforts are needed to improve the management of patients with diabetes in China.
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Affiliation(s)
- Yihao Liu
- Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin Ning
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Luyao Zhang
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianyan Long
- Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruiming Liang
- Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sui Peng
- Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haibo Wang
- Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Qiao J, Tan Z, Xu X, Zhou Y, Wang W, Luo J, Fan J, Pan Q, Guo L. Medications and medical costs for diabetes patients with or without chronic respiratory disease in Beijing, China: A retrospective study. Front Endocrinol (Lausanne) 2022; 13:980982. [PMID: 36093107 PMCID: PMC9458880 DOI: 10.3389/fendo.2022.980982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS The cost of drug regimens prescribed to Chinese patients has not been evaluated. This study aims to evaluate the medical costs and hypoglycemic agents for diabetes mellitus patients with or without chronic respiratory disease in Beijing, and to investigate the changes in the costs and number of antidiabetic medications used for diabetes patients with chronic respiratory disease from 2016 to 2018. METHODS This observational, retrospective study included diabetes patients with outpatient medication records from Beijing Medical Insurance between 2016 and 2018. The medications, including hypoglycemic and nonhypoglycemic drugs, insulin dosage, comorbidities, diabetes-related complications, treatment strategies, and annual medical costs, were recorded. RESULTS This study included 2,853,036 diabetes patients from 2016 to 2018. About 18.95%-20.53% of patients with chronic respiratory disease were predominantly distributed among those aged 45-84 years (88.7%-89.1%). Diabetes patients with chronic respiratory disease used more medications (4.48 ± 2.41 vs. 3.76 ± 2.33) and had higher total annual drug costs (¥12,286 ± 10,385 vs. ¥9700 ± 9202) to treat more comorbidities (2.52 ± 1.53 vs. 2.05 ± 1.85) than those without chronic respiratory disease (p <.0001, respectively). From 2016 to 2018, diabetes patients with chronic respiratory disease had a 4.2% increase in medication, a 1.9% decrease in comorbidities, and a 5.4% decrease in total annual drug costs. CONCLUSIONS In summary, diabetes patients with chronic respiratory disease had more comorbidities, required more hypoglycemic drugs, and had higher medical costs. During 2016-2018, diabetes patients with chronic respiratory disease used more medications and spent less money on medical care.
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Affiliation(s)
- Jingtao Qiao
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Tan
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaomao Xu
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Zhou
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingyi Luo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingwen Fan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Lixin Guo, ; Qi Pan,
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Lixin Guo, ; Qi Pan,
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Qu R, Ma Y, Tao L, Bao X, Zhou X, Wang B, Li F, Lu S, Tuo L, Zhan S, Zhang Z, Fu W. Features of colorectal cancer in China stratified by anatomic sites: A hospital-based study conducted in university-affiliated hospitals from 2014 to 2018. Chin J Cancer Res 2021; 33:500-511. [PMID: 34584375 PMCID: PMC8435820 DOI: 10.21147/j.issn.1000-9604.2021.04.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/26/2021] [Indexed: 12/22/2022] Open
Abstract
Objective The clinical and biological characteristics of colorectal cancer have been found to differ depending on the anatomic site of the cancer. However, for Chinese patients, there is limited information on the proportion of cases at each site and the related features. In this study, we explored the location, distribution and other features of colorectal cancers at each anatomic site in Chinese patients. Methods We conducted a hospital-based study using hospitalization summary reports from 10 Peking University-affiliated hospitals from 2014 to 2018; the reports covered a total of 2,097,347 hospitalizations. Incident cases were chosen as the study population, and their epidemiological features were further analyzed. Results A total of 20,739 colorectal cancer patients were identified. Rectum was the most common location (48.3%) of the cancer, whereas the proportions of patients with distal and proximal colon cancer were 24.5% and 18.6%, respectively. Patients with rectal cancer were predominantly male and were the youngest for all anatomical sites (each P<0.001). The highest proportion of emergency admissions, the longest hospital stays and the highest hospitalization costs were found in patients with proximal colon cancer (each P<0.001). The proximal colon cancer subgroup included the highest proportions of patients with medical histories of cholecystectomy, cholecystolithiasis and/or gallbladder polyps and appendectomy (P=0.009, P<0.001 and P<0.001, respectively). The distal colon cancer subgroup included the highest proportions of patients with medical histories of diabetes and hypertension (P<0.001, respectively). Conclusions The patterns of colorectal cancer observed in this study differ from those reported for Western patients and show a significantly higher proportion of patients with rectal cancer. Different epidemiological features were also found based on anatomic sites. Further studies based on tumor location should be conducted to facilitate more accurate screening and treatment.
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Affiliation(s)
- Ruize Qu
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Yanpeng Ma
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Liyuan Tao
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing 100191, China
| | - Xiaoyuan Bao
- Medical Information Center, Peking University Health Science Center, Beijing 100191, China
| | - Xin Zhou
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Bingyan Wang
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Fei Li
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Siyi Lu
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Lin Tuo
- Department of Hospital Management, Peking University Health Science Center, Beijing 100191, China
| | - Siyan Zhan
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing 100191, China
| | - Zhipeng Zhang
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Wei Fu
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
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Kaminska H, Szarpak L, Kosior D, Wieczorek W, Szarpak A, Al-Jeabory M, Gawel W, Gasecka A, Jaguszewski MJ, Jarosz-Chobot P. Impact of diabetes mellitus on in-hospital mortality in adult patients with COVID-19: a systematic review and meta-analysis. Acta Diabetol 2021; 58:1101-1110. [PMID: 33778910 PMCID: PMC8005367 DOI: 10.1007/s00592-021-01701-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/03/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The novel coronavirus disease 2019 (COVID-19) has spread worldwide since the beginning of 2020, placing the heavy burden on the health systems all over the world. The population that particularly has been affected by the pandemic is the group of patients suffering from diabetes mellitus. Having taken the public health in considerations, we have decided to perform a systematic review and meta-analysis of diabetes mellitus on in-hospital mortality in patients with COVID-19. METHODS A systematic literature review (MEDLINE, EMBASE, Web of Science, Scopus, Cochrane) including all published clinical trials or observational studies published till December 10, 2020, was performed using following terms "diabetes mellitus" OR "diabetes" OR "DM" AND "survival" OR "mortality" AND "SARS-CoV-2" OR "COVID-19". RESULTS Nineteen studies were included out of the 7327 initially identified studies. Mortality of DM patients vs non-DM patients was 21.3 versus 6.1%, respectively (OR = 2.39; 95%CI: 1.65, 3.64; P < 0.001), while severe disease in DM and non-DM group varied and amounted to 34.8% versus 22.8% (OR = 1.43; 95%CI: 0.82, 2.50; P = 0.20). In the DM group, the complications were observed far more often when compared with non-DM group, both in acute respiratory distress (31.4 vs. 17.2%; OR = 2.38; 95%CI:1.80, 3.13; P < 0.001), acute cardiac injury (22.0% vs. 12.8%; OR = 2.59; 95%CI: 1.81, 3.73; P < 0.001), and acute kidney injury (19.1 vs. 10.2%; OR = 1.97; 95%CI: 1.36, 2.85; P < 0.001). CONCLUSIONS Based on the findings, we shall conclude that diabetes is an independent risk factor of the severity of COVID-19 in-hospital settings; therefore, patients with diabetes shall aim to reduce the exposure to the potential infection of COVID-19.
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Affiliation(s)
- Halla Kaminska
- Department of Pediatrics and Children's Diabetology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Silesia, Poland
| | - Lukasz Szarpak
- Maria Sklodowska-Curie Bialystok Oncology Center, Ogrodowa 12 str., 15-027, Bialystok, Poland.
- Polish Society of Disaster Medicine, Warsaw, Poland.
| | - Dariusz Kosior
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University, Warsaw, Poland
- Department of Cardiology and Hypertension With Electrophysiological Lab, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Wojciech Wieczorek
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Wladyslaw Gawel
- Department of Surgery, The Silesian Hospital in Opava, Opava, Czech Republic
| | - Aleksandra Gasecka
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Laboratory of Experimental Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, The Netherlands
- 1St Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Przemyslawa Jarosz-Chobot
- Department of Pediatrics and Children's Diabetology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Silesia, Poland
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Guo L, Zheng J, Pan Q, Zhang Q, Zhou Y, Wang W, Zhang L, Tesfaye S, Zhang J. Changes in Direct Medical Cost and Medications for Managing Diabetes in Beijing, China, 2016 to 2018: Electronic Insurance Data Analysis. Ann Fam Med 2021; 19:332-341. [PMID: 34264834 PMCID: PMC8282298 DOI: 10.1370/afm.2686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although the cost and complexity of managing diabetes is increasing around the world, placing greater burden on patients and their families, the cost of drug regimens prescribed to Chinese patients has not been evaluated. This study was conducted to evaluate the temporal changes in the costs and drugs used for people with diabetes. METHODS Patients enrolled in Beijing Medical Insurance with outpatient medical records from 2016 through 2018 were included in this study. The outcomes of interest were: (1) the number of outpatient medications, (2) the number of comorbidities diagnosed, (3) the estimated annual cost of the outpatient drug regimen, (4) the drug therapy strategies used for diabetic patients, and (5) the most commonly prescribed classes of drugs. RESULTS Over the 3-year period, there was a significant decrease (9.0%, P <.001) in the average number of diabetes medications used. Both antiglycemic and non-antiglycemic drug use decreased by 3.6% and 12.9%, respectively. Similarly, for estimated annual costs of medication, an 18.4% (P <.05) decrease was observed, with a gradual decreased from ¥6,868 ($1,059) in 2016 to ¥5,605 ($865) in 2018. CONCLUSION This is the first large-scale cost analysis of the medical management of diabetes since the implementation of medical insurance in China. Despite the increasing availability of newer, more expensive diabetes drugs, there was a significant reduction in the number of diabetes medications used, that may be due to a more rational approach to optimizing metabolic targets.
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Affiliation(s)
- Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Jie Zheng
- Beijing Municipal Medical Insurance Bureau, Beijing, PR China
| | - Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Qun Zhang
- Department of Medical Insurance, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yan Zhou
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Lina Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Jie Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
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Impact of diabetes mellitus on short-term prognosis, length of stay, and costs in patients with acute kidney injury: A nationwide survey in China. PLoS One 2021; 16:e0250934. [PMID: 33939742 PMCID: PMC8092800 DOI: 10.1371/journal.pone.0250934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 04/18/2021] [Indexed: 01/20/2023] Open
Abstract
Background International data suggest that people with diabetes mellitus (DM) are at increased risk for worse acute kidney injury (AKI) outcomes; however, the data in China are limited. Therefore, this study aimed to describe the association of DM with short-term prognosis, length of stay, and expenditure in patients with AKI. Methods This study was based on the 2013 nationwide survey in China. According to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) and expanded criteria of AKI, 7604 patients with AKI were identified, and 1404 and 6200 patients were with and without DM, respectively. Clinical characteristics, outcomes, length of stay, and costs of these patients were compared. Multivariate regression analyses were conducted to evaluate the association of DM with mortality, failed renal recovery, length of stay, and costs. Results Patients with AKI and DM were older, had higher male preponderance (61.9%), presented with more comorbidities, and had higher serum creatinine levels compared with those without DM. An apparent increase in all-cause in-hospital mortality, length of stay, and costs was found in patients with DM. DM was not independently associated with failed renal recovery (adjusted OR (95%CI): 1.08 (0.94–1.25)) and in-hospital mortality (adjusted OR (95%): 1.16 (0.95–1.41)) in multivariate models. However, the diabetic status was positively associated with the length of stay (β = 0.06, p<0.05) and hospital expenditure (β = 0.10, p<0.01) in hospital after adjusting for possible confounders. Conclusion In hospitalized AKI patients, DM (vs. no DM) is independently associated with longer length of stay and greater costs, but is not associated with an increased risk for failed renal recovery and in-hospital mortality.
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Chin YF, Huang TT, Yu HY, Yang HM, Hsu BRS. Factors related to hospital-to-home transitional self-monitoring blood glucose behaviour among patients with diabetes-related foot ulcer. Int J Nurs Pract 2021; 27:e12950. [PMID: 33915598 DOI: 10.1111/ijn.12950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 02/09/2021] [Accepted: 04/06/2021] [Indexed: 12/15/2022]
Abstract
AIMS To explore the factors related to hospital-to-home transitional self-monitoring blood glucose behaviour among patients with diabetes-related foot ulcer. BACKGROUND The 30-day readmission rate of patients with diabetes-related foot ulcer can be reduced when good glycaemic control is achieved. The practice of self-monitoring blood glucose promotes optimal glycaemic control. DESIGN A comparative descriptive study. METHODS In this study, 200 participants, who had been hospitalized due to diabetes-related foot ulcer, were recruited from August 2017 to July 2018. Before participants were discharged from the hospital, psychosocial factors (family support, threat belief, self-efficacy and knowledge) and pre-hospitalization self-monitoring blood glucose behaviour were collected using a structured questionnaire. Then, after discharge, self-monitoring blood glucose behaviour delivery was collected again. RESULTS Five variables explained 47% of the variance in the delivery of self-monitoring of blood glucose at home. The delivery of hospital-to-home transitional self-monitoring blood glucose behaviour was more likely for individuals with higher pre-discharge self-efficacy, higher post-discharge self-efficacy, more attention to pre-hospitalization glycaemic status and post-discharge insulin usage and those without an insensitive foot. CONCLUSION Self-monitoring blood-glucose behaviour should be promoted among post-discharge patients with diabetes-related foot ulcer. The modifiable factors identified in this study can be integrated into the discharge plan.
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Affiliation(s)
- Yen-Fan Chin
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Endocrinology and Metabolism, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzu-Ting Huang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsing-Yi Yu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Child Ophthalmology, Department of Ophthalmology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hui-Mei Yang
- Department of Endocrinology and Metabolism, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Brend Ray-Sea Hsu
- Department of Endocrinology and Metabolism, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Healthcare Costs Associated with Complications in Patients with Type 2 Diabetes among 1.85 Million Adults in Beijing, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073693. [PMID: 33916217 PMCID: PMC8036594 DOI: 10.3390/ijerph18073693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 12/29/2022]
Abstract
We aimed to provide reliable regression estimates of expenditures associated with various complications in type 2 diabetics in China. In total, 1,859,039 type 2 diabetes patients with complications were obtained from the Beijing Medical Claim Data for Employees database from 2008 to 2016. We estimated costs for complications using a generalized estimating equation model adjusted for age, sex, and the incidence of various complications. The average total cost for diabetic patients with complications was 17.12 thousand RMB. Prescribed drugs accounted for 63.4% of costs. We observed a significant increase in costs in the first year after the onset of complications. Compared with costs before the incidence of complications, the additional costs per person in the first year and >1 year after the event would be 10,631.16 RMB and 1150.71 RMB for cardiovascular disease, 1017.62 RMB and 653.82 RMB for cerebrovascular disease, and 301.14 RMB and 624.00 RMB for kidney disease, respectively. The estimated coefficients for outpatient visits were relatively lower than those of inpatient visits. Complications in diabetics exert a significant impact on total healthcare costs in the first year of their onset and in subsequent years. Our estimates may assist policymakers in quantifying the economic burden of diabetes complications.
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Rosa LDS, Mistro S, Oliveira MG, Kochergin CN, Cortes ML, de Medeiros DS, Soares DA, Louzado JA, Silva KO, Bezerra VM, Amorim WW, Barone M, Passos LC. Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting. Front Pharmacol 2021; 11:588309. [PMID: 33542687 PMCID: PMC7851089 DOI: 10.3389/fphar.2020.588309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
Objective: We evaluated the cost-effectiveness of the point-of-care A1c (POC-A1c) test device vs. the traditional laboratory dosage in a primary care setting for people living with type 2 diabetes. Materials and Methods: The Markov model with a 10-year time horizon was based on data from the HealthRise project, in which a group of interventions was implemented to improve diabetes and hypertension control in the primary care network of the urban area of a Brazilian municipality. A POC-A1c device was provided to be used directly in a primary care unit, and for a period of 18 months, 288 patients were included in the point-of-care group, and 1,102 were included in the comparison group. Sensitivity analysis was performed via Monte Carlo simulation and tornado diagram. Results: The results indicated that the POC-A1c device used in the primary care unit was a cost-effective alternative, which improved access to A1c tests and resulted in an increased rate of early control of blood glucose. In the 10-year period, POC-A1c group presented a mean cost of US$10,503.48 per patient and an effectiveness of 0.35 vs. US$9,992.35 and 0.09 for the traditional laboratory test, respectively. The incremental cost was US$511.13 and the incremental effectiveness was 0.26, resulting in an incremental cost-effectiveness ratio of 1,947.10. In Monte Carlo simulation, costs and effectiveness ranged between $9,663.20-$10,683.53 and 0.33-0.37 for POC-A1c test group, and $9,288.28-$10,413.99 and 0.08-0.10 for traditional laboratory test group, at 2.5 and 97.5 percentiles. The costs for nephropathy, retinopathy, and cardiovascular disease and the probability of being hospitalized due to diabetes presented the greatest impact on the model's result. Conclusion: This study showed that using POC-A1c devices in primary care settings is a cost-effective alternative for monitoring glycated hemoglobin A1c as a marker of blood glucose control in people living with type 2 diabetes. According to our model, the use of POC-A1c device in a healthcare unit increased the early control of type 2 diabetes and, consequently, reduced the costs of diabetes-related outcomes, in comparison with a centralized laboratory test.
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Affiliation(s)
- Lorena de Sousa Rosa
- Program of Post-Graduation in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | - Sóstenes Mistro
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Marcio Galvão Oliveira
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | | | - Mateus Lopes Cortes
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Danielle Souto de Medeiros
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Daniela Arruda Soares
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - José Andrade Louzado
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Kelle Oliveira Silva
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Vanessa Moraes Bezerra
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Welma Wildes Amorim
- Departament of Natural Sciences, State University of Southwest Bahia, Vitória da Conquista, Brazil
| | - Mark Barone
- Intersectoral Forum to Fight NCDs in Brazil, São Paulo, Brazil
| | - Luiz Carlos Passos
- Program of Post-Graduation in Medicine and Health, Federal University of Bahia, Salvador, Brazil
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Alzaid A, Ladrón de Guevara P, Beillat M, Lehner Martin V, Atanasov P. Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses. Expert Rev Pharmacoecon Outcomes Res 2020; 21:785-798. [PMID: 32686530 DOI: 10.1080/14737167.2020.1782748] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: To estimate the clinical and economic burden of type 2 diabetes (T2D) in established (EST) and emerging markets (EMG).Methods: Three systematic literature reviews were conducted in MEDLINE and Embase to capture all relevant publications reporting 1) the epidemiology of T2D and complications in T2D and 2) the economic burden of T2D and associated complications.Results: In total, 294 studies were included in this analysis. Evidence indicates a high and increasing overall prevalence of T2D globally, ranging up to 23% in EMG markets and 14% in EST markets. Undiagnosed cases were higher in EMG versus EST markets (up to 67% vs 38%), potentially due to a lack of education and disease awareness in certain regions, that could lead to important clinical and economic consequences. Poor glycemic control was associated with the development of several complications (e.g. retinopathy, cardiovascular diseases and nephropathy) that increase the risk of morbidity and mortality. Direct costs were up to 9-fold higher in patients with vs without T2D-related complications.Conclusions: The burden of T2D, related complications and inherent costs are higher in emerging versus established market countries. This review explores potential strategies to reduce costs and enhance outcomes of T2D treatment in developing countries.
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Affiliation(s)
- Aus Alzaid
- Consultant Diabetologist, Riyadh, Saudi Arabia
| | - Patricia Ladrón de Guevara
- Health Economics & Market Access, Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | - Maud Beillat
- Global Market Access, Health Economics & Outcomes Research, Servier Global Market Access & HEOR, France
| | | | - Petar Atanasov
- Health Economics & Market Access, Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
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21
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Kim EJ, Han K. Factors related to self‐care behaviours among patients with diabetic foot ulcers. J Clin Nurs 2020; 29:1712-1722. [DOI: 10.1111/jocn.15215] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/19/2019] [Accepted: 02/03/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Eun Jo Kim
- College of Nursing Korea University Seoul Korea
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22
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Dong Y, Liu C, Zhou P, Zhu Y, Tang Q, Wang S, Wang X. How Serious is the Economic Burden of Diabetes Mellitus in Hainan Province? A Study Based on "System of Health Account 2011". Diabetes Ther 2019; 10:2251-2263. [PMID: 31628594 PMCID: PMC6848319 DOI: 10.1007/s13300-019-00712-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The treatment of diabetes requires extensive use of healthcare resources, resulting in high medical costs, which in turn places a heavy economic burden on society, patients and their families. METHODS A multi-stage stratified random sampling method was used to investigate 283 medical and health institutions in Hainan Province. The total medical expenses relating to diabetes in Hainan Province in 2016, institutional flow directions, the composition of service functions and the distribution of the healthcare costs to beneficiaries were analyzed based on the System of Health Account 2011. The STATA version 12.0 statistical software package was used to collate operation data, and SPSS software was used to carry out regression analysis on the factors affecting hospitalization costs. RESULTS In 2016, the total medical expenses for the treatment of diabetes in Hainan Province was 242.17 billion renminbi (RMB), of which 81.95% was spent in high-level hospitals and 14.71% was spent in medical institutions providing primary care. There was little difference between outpatient and hospitalization expenses (53.01 and 46.99%, respectively). Hospitalization accounted for 77.62% of the expenses of medical institutions providing primary care. Older patients were found to spend more on medical and drug expenditure. CONCLUSION The economic burden of healthcare expenses for the treatment of diabetes in Hainan Province is massive, and patient treatment is concentrated in large hospitals. It is necessary to inform patients to focus more on medical institutions that provide primary care, adjust the proportion of medical insurance reimbursement, control the cost of hospitalization and strengthen the healthcare management of middle-aged and elderly diabetic patients. Only in this way can costs be reduced and the economic burden be eased.
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Affiliation(s)
- Yuanyuan Dong
- College of the Humanities and Social Sciences, China Medical University, Shenyang, People's Republic of China
| | - Chunping Liu
- Administration School, Hainan Medical University, Haikou, People's Republic of China
| | - Peng Zhou
- Administration School, Hainan Medical University, Haikou, People's Republic of China
| | - Yalan Zhu
- College of the Humanities and Social Sciences, China Medical University, Shenyang, People's Republic of China
| | - Qingcheng Tang
- Medical Information School, Hainan Medical University, Haikou, People's Republic of China
| | - Siyu Wang
- Clinical Medical Science, China Medical University, Shenyang, People's Republic of China
| | - Xin Wang
- College of the Humanities and Social Sciences, China Medical University, Shenyang, People's Republic of China.
- School of Public Health, Xinjiang Medical University, Urumqi, People's Republic of China.
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Shi X, Liu H, Zhan S, Wang Z, Wang L, Dong C, Wang Y, Yao C, Ding J, Li Y. Rare diseases in China: analysis of 2014-2015 hospitalization summary reports for 281 rare diseases from 96 tertiary hospitals. Orphanet J Rare Dis 2019; 14:160. [PMID: 31262329 PMCID: PMC6604331 DOI: 10.1186/s13023-019-1137-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 06/12/2019] [Indexed: 05/13/2023] Open
Abstract
Background There are many public health issues to resolve regarding rare diseases, including a lack of data from large-scale studies. The objective of this study was to explore fundamental data for a list of rare diseases in China, based on a hospitalization summary reports (HSRs) database. The Target Rare Diseases List (TRDL) 2017 was generated using an expert consensus method in which experts listed diseases according to research priorities. Using codes of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and key search terms of rare diseases in English and Chinese, data were obtained from HSRs of 96 hospitals, covering a population of over 15 million in China from 2014 to 2015. We extracted and analyzed information on demographics, hospitalizations, and readmissions. Results A total 281 rare diseases were included in the TRDL 2017. Altogether, 106,746 hospitalizations for a rare disease were captured from 1 January 2014 to 31 December 2015, accounting for 0.69% of inpatients during the same period. The top 10 rare diseases with most cases on the TRDL 2017 were thalassemia, idiopathic pulmonary arterial hypertension, pulmonary Langerhans cell histiocytosis, moyamoya disease, motor neuron disease, idiopathic pulmonary fibrosis, systemic sclerosis, hepatolenticular degeneration, coarctation of the aorta, and transposition of the great arteries. Among the 24 cities in the database, the five cities with the most types of the rare disease were Beijing, Changsha, Guangzhou, Shanghai, and Chengdu, with 191, 162, 143, 141, and 133 types, respectively. The five cities with most cases of the 281 rare diseases were Beijing, Guangzhou, Shanghai, Nanning, and Chengdu. The age distribution of rare diseases was 52% for the age group 25–64 years, and 27% of cases in the age group of 0–14 years were among children. The 10 highest readmission rates ranged from 35 to 65%. Conclusions This study provided the TRDL 2017 and descriptive analysis of 281 rare diseases in a hospitalized population. Our study reveals important fundamental information that will be useful in national policy making and legislation; registry implementation; and diagnosis, treatment, and prevention of rare diseases in China. Electronic supplementary material The online version of this article (10.1186/s13023-019-1137-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xinmiao Shi
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Hui Liu
- Medical Informatics Center, Peking University, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Bio-statistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Lin Wang
- Beijing Society of Rare Diseases, Beijing, China
| | - Chongya Dong
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Yanfang Wang
- Peking University Clinical Research Institute, Beijing, China
| | - Chen Yao
- Department of Biostatistics, Peking University First Hospital, Beijing, China.,Peking University Clinical Research Institute, Beijing, China
| | - Jie Ding
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
| | - Yan Li
- Department of Hospital Administration of Peking University Health Science Centre, Peking University, Beijing, China.
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Chin YF, Huang TT, Hsu BRS, Weng LC, Wang CC. Factors associated with foot ulcer self-management behaviours among hospitalised patients with diabetes. J Clin Nurs 2019; 28:2253-2264. [PMID: 30791155 DOI: 10.1111/jocn.14822] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/22/2019] [Accepted: 02/09/2019] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To determine prehospitalised diabetes-related foot ulcer (DFU) self-management behaviours and explore the factors associated with these behaviours. BACKGROUND Although there are many studies that explore DFU prevention and treatment, to our knowledge, there are no quantitative studies of DFU self-management behaviours. DESIGN Cross-sectional design. METHODS From June 2015-June 2016, 199 hospitalised patients with DFU were given a survey questionnaire at a medical centre in northern Taiwan. DFU self-management behaviours, diabetes foot self-care behaviours, beliefs in regard to barriers to DFU self-management behaviours, and knowledge regarding warning signs of DFU deterioration were assessed by well-designed measurement tools. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to ensure quality reporting during this observational study (see Supporting Information Appendix S1). RESULTS The results revealed that 62.8% of participants never monitored their blood glucose level when they had foot ulcers, and 63.8% never sought treatment for their wounds when their wounds were not painful. After controlling for demographic and medical variables, stepwise multiple regression analysis revealed that the following eight significant variables were associated with DFU self-management behaviours: two DFU self-management barrier beliefs, foot self-care behaviour, no treatment for diabetes, poor financial status, employment, knowledge regarding the warning signs of DFU deterioration, and number of DFU hospitalisations. CONCLUSIONS Diabetes-related foot ulcer self-management behaviours were insufficient. Some modifiable factors and high-risk groups for insufficient DFU self-management behaviour were identified. RELEVANCE TO CLINICAL PRACTICE Diabetes-related foot ulcer self-management behaviours should be promoted. Interventions that modify the risk factors that were identified in this study can be designed to promote the performance of DFU self-management behaviours.
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Affiliation(s)
- Yen-Fan Chin
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Tzu-Ting Huang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Healthy Aging Research Center, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Brend Ray-Sea Hsu
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chih-Ching Wang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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25
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Li X, Xu Z, Ji L, Guo L, Liu J, Feng K, Xu Y, Zhu D, Jia W, Ran X, Chen L, Zhao S, Shi B, Zhu J, Shan Z, Zhou Z, Zeng L, Weng J. Direct medical costs for patients with type 2 diabetes in 16 tertiary hospitals in urban China: A multicenter prospective cohort study. J Diabetes Investig 2019; 10:539-551. [PMID: 30079578 PMCID: PMC6400170 DOI: 10.1111/jdi.12905] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/25/2018] [Accepted: 08/01/2018] [Indexed: 02/05/2023] Open
Abstract
AIMS/INTRODUCTION To investigate the direct medical costs for patients with type 2 diabetes in China and to examine the influencing factors. MATERIALS AND METHODS In the present multicenter study, 1,070 patients with type 2 diabetes from 16 tertiary hospitals in 14 major cities of China were enrolled. Patient data and direct medical costs were collected during a follow-up period of 6 months at intervals of 1 month. The log-transformed direct medical costs were fitted by a generalized estimation equation to indicator variables for demographics, metabolic control, treatments, complications and comorbidities. RESULTS Data of 871 participants were included in the analysis. The mean annual total direct medical costs and outpatient medical costs were $1,990.20 and $1,687.20 respectively. The average costs per inpatient per admission were $2,127.10. The share of out-of-pocket for total medical costs, outpatient costs and cost per inpatient per admission were 45.4, 46.3 and 26.0% respectively. Independent determinants of total medical costs were diabetes duration, dyslipidemia and diabetic complications, such as neuropathy and nephropathy, as well as diabetes treatment, such as the use of glucagon-like peptide-1 receptor agonists. Costs showed prominent variation across centers. CONCLUSIONS Diabetes is imposing a growing economic burden in patients with type 2 diabetes in China. Diabetes-related complications and comorbidities have a great impact on the medical costs. As different health policies, economic development and regional health inequalities also have an important influence on the direct medical cost, healthcare reform needs to optimize resource allocation in health service delivery systems, and provide more equitable and affordable healthcare.
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Affiliation(s)
- Xiang Li
- Diabetes CenterDepartment of EndocrinologyThe 306th Hospital of PLABeijingChina
| | - Zhangrong Xu
- Diabetes CenterDepartment of EndocrinologyThe 306th Hospital of PLABeijingChina
| | - Linong Ji
- Department of Endocrine and MetabolismPeking University People's HospitalBeijingChina
| | - Lixin Guo
- Department of EndocrinologyBeijing HospitalBeijingChina
| | - Jing Liu
- Department of EndocrinologyGansu Provincial HospitalLanzhouChina
| | - Kun Feng
- Department of EndocrinologyHeilongjiang Provincial HospitalHarbinChina
| | - Yushan Xu
- Department of EndocrinologyFirst Affiliated Hospital of Kumming Medical UniversityKunmingChina
| | - Dalong Zhu
- Department of EndocrinologyNanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Weiping Jia
- Department of EndocrinologyShanghai Jiao Tong UniversityAffiliated Sixth People's HospitalShanghaiChina
| | - XinWu Ran
- Department of Endocrinology and MetabolismWest China HospitalSichuan UniversityChengduChina
| | - Limin Chen
- Key Laboratory of Hormones and Development (Ministry of Health)Tianjin Key Laboratory of Metabolic Diseases HospitalTianjin Medical UniversityTianjinChina
| | - Shi Zhao
- Department of EndocrinologyThe Central Hospital of Wuhan Tongji Medical CollegeHuazhong University of Science & TechnologyWuhanChina
| | - Bingying Shi
- Department of EndocrinologyThe First Affiliated Hospital of Xi'anJiao Tong UniversityXi'anChina
| | - Jun Zhu
- Department of EndocrinologyFirst Affiliated Hospital of Xinjiang Medical UniversityUrumqiChina
| | - Zhongyan Shan
- The First Affiliated Hospital of China Medical UniversityShenyangChina
| | - Zhiguang Zhou
- Department of Endocrinology and MetabolismThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Longyi Zeng
- Department of Endocrinology and MetabolismThe Third Affiliated Hospital Sun Yat‐Sen UniversityGuangzhouChina
| | - Jianping Weng
- Department of Endocrinology and MetabolismThe Third Affiliated Hospital Sun Yat‐Sen UniversityGuangzhouChina
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26
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Moucheraud C, Lenz C, Latkovic M, Wirtz VJ. The costs of diabetes treatment in low- and middle-income countries: a systematic review. BMJ Glob Health 2019; 4:e001258. [PMID: 30899566 PMCID: PMC6407562 DOI: 10.1136/bmjgh-2018-001258] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/04/2019] [Accepted: 01/12/2019] [Indexed: 01/24/2023] Open
Abstract
Introduction The rising burden of diabetes in low- and middle-income countries may cause financial strain on individuals and health systems. This paper presents a systematic review of direct medical costs for diabetes (types 1 and 2) in low- and middle-income countries. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases (PubMed, International Bibliography of Social Science, EconLit) were searched for publications reporting direct medical costs of type 1 and 2 diabetes. Data were extracted from all peer-reviewed papers meeting inclusion criteria, and were standardised into per-patient-visit, per-patient-year and/or per-complication-case costs (2016 US$). Results The search yielded 584 abstracts, and 52 publications were included in the analysis. Most articles were from Asia and Latin America, and most focused on type 2 diabetes. Per-visit outpatient costs ranged from under $5 to over $40 (median: $7); annual inpatient costs ranged from approximately $10 to over $1000 (median: $290); annual laboratory costs ranged from under $5 to over $100 (median: $25); and annual medication costs ranged from $15 to over $500 (median: $177), with particularly wide variation found for insulin. Care for complications was generally high-cost, but varied widely across countries and complication types. Conclusion This review identified substantial variation in diabetes treatment costs; some heterogeneity could be mitigated through improved methods for collecting, analysing and reporting data. Diabetes is a costly disease to manage in low- and middle-income countriesand should be a priority for the global health community seeking to achieve Universal Health Coverage.
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Affiliation(s)
- Corrina Moucheraud
- Health Policy and Management, University of California Fielding School of Public Health, Los Angeles, California, USA
| | - Cosima Lenz
- Health Policy and Management, University of California Fielding School of Public Health, Los Angeles, California, USA
| | - Michaella Latkovic
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Wang YM, Liu HX, Fang NY. High Glucose Concentration Impairs 5-PAHSA Activity by Inhibiting AMP-Activated Protein Kinase Activation and Promoting Nuclear Factor-Kappa-B-Mediated Inflammation. Front Pharmacol 2019; 9:1491. [PMID: 30666198 PMCID: PMC6330329 DOI: 10.3389/fphar.2018.01491] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 12/05/2018] [Indexed: 01/22/2023] Open
Abstract
Recently, the endogenous fatty acid palmitic acid-5-hydroxystearic acid (5-PAHSA) was found to increase insulin sensitivity and have anti-inflammatory effects in mice with high-fat diet (HFD)-induced diabetes. However, it is unknown if 5-PAHSA affects glucose and lipid metabolism in db/db mice, which are characterized by extreme hyperglycemia. Here, we aim to determine the effect of continued 5-PAHSA administration on glucose and lipid metabolism in db/db mice. We also used 3T3-L1 cells and HepG2 cells to investigate the mechanism behind this effect. HepG2 cells and 3T3-L1 cells were induced to become models of insulin resistance. The models were used to test the effect of 5-PAHSA on insulin signaling. 5-PAHSA was administered orally to db/db mice for 1 month to assess its effects on glucose and lipid metabolism. We also exposed HepG2 cells to high glucose concentrations to investigate the influence on 5-PAHSA’s effects on hepatic lipid metabolism and inflammation. 5-PAHSA improved glucose uptake and insulin signaling in HepG2 cells and 3T3-L1 cells. However, after 1 month of treatment, 5-PAHSA did not reduce blood glucose levels, but increased inflammation and promoted fatty liver in db/db mice. In HepG2 cells under normal glucose conditions, 5-PAHSA treatment reduced lipogenesis and increased lipid oxidation. Notably, a high glucose concentration in cell media abolished the positive effects of 5-PAHSA treatment. These changes were associated with: decreased phosphorylation of AMP-activated protein kinase (AMPK) and acetyl-CoA carboxylase (ACC); upregulation of sterol-regulatory element-binding protein 1c (SREBP1c), and fatty acid synthase (FAS); and downregulation of carnitine palmitoyltransferase 1 (CPT1). Besides, the anti-inflammatory effect of 5-PAHSA was also impaired by high glucose conditions. Thus, high glucose concentrations impaired 5-PAHSA action by inhibiting the AMPK signaling pathway and promoting nuclear factor-kappa-B (NF-κB) mediated inflammation.
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Affiliation(s)
- Yan-Mei Wang
- Department of Geriatrics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong-Xia Liu
- Department of Geriatrics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ning-Yuan Fang
- Department of Geriatrics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Cheng SW, Wang CY, Ko Y. Costs and Length of Stay of Hospitalizations due to Diabetes-Related Complications. J Diabetes Res 2019; 2019:2363292. [PMID: 31583247 PMCID: PMC6754874 DOI: 10.1155/2019/2363292] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 08/11/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) has become a significant worldwide public health problem and economic burden because a great proportion of healthcare costs has been spent on the treatment of DM and its related complications. The aim of this study was to examine the costs and length of stay (LoS) of hospitalizations due to diabetes-related complications in Taiwan. METHODS This study is a retrospective claim database analysis using the Longitudinal Cohort of Diabetes Patients, with 2012 used as the base year. The hospitalization costs and LoS per admission were estimated for each complication of interest using data from the LHDB 2004 to 2012 cohorts. The presence of eight DM-related complications were identified using the ICD-9-CM codes and procedure codes. ANOVA was used to examine the relationships of diabetes duration with the LoS and costs of the complications. RESULTS A total of 27,473 DM patients who were hospitalized in 2012 due to one of the examined DM-related complications were identified. The most common complications that caused the hospitalizations were nonfatal stroke (34.7%) and nonfatal ischemic heart disease (IHD) (28.7%). Amputation was the complication with the longest hospital stay, with a mean ± SD of 21.6 ± 14.1 days, followed by nonfatal stroke (13.6 ± 11.3), ulcer (12.7 ± 11.8), and fatal IHD (12.2 ± 13.6). The complications with the greatest hospitalization cost were fatal IHD (mean = TWD 306,209.8; median = TWD 221,417.0; 1TWD = 0.034USD) and fatal myocardial infarction (mean = TWD 272,840.1; median = TWD 174,008). CONCLUSIONS This study indicates that DM-related complications are associated with significant hospital LoS and costs. The study results could be useful for economic evaluations of diabetes treatments and the estimation of the overall economic impact of diabetes.
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Affiliation(s)
- Ssu-Wei Cheng
- Department of Pharmacy, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Department of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yuan Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu Ko
- Department of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Research Center of Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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Hu X, Lian W, Zhang X, Yang X, Jiang J, Li M. Efficacy of negative pressure wound therapy using vacuum-assisted closure combined with photon therapy for management of diabetic foot ulcers. Ther Clin Risk Manag 2018; 14:2113-2118. [PMID: 30498354 PMCID: PMC6207409 DOI: 10.2147/tcrm.s164161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetes mellitus, one of the most prevalent chronic metabolic diseases, causes many complications. Among the complications, one of the most common chronic complications is diabetic foot ulcers (DFUs). OBJECTIVE This study was conducted to investigate the efficacy of negative pressure wound therapy using vacuum-assisted closure (VAC) combined with photon therapy for the management of DFUs. PATIENTS AND METHODS The study included a total of 69 patients with DFUs during the period from January 2014 to December 2015. All patients were diagnosed with DFUs with Wagner's stage 2 or 3 and were divided into two groups - the VAC group in which patients received only VAC and the combined group in which patients received both VAC and photon therapy. Data on duration of the treatment, pre- and postoperative wound surface areas, dressing changing times, pain conditions assessed using visual analog scale scores, recurrence rate and amputation rate were collected. RESULTS Among all patients, 35 patients were divided into the VAC group and 34 patients into the combined group. Areas of foot ulcers for all patients ranged from 5 to 100 cm2. The treatment duration, dressing changing times and the peak value of visual analog scale scores were all significantly lower in the combined group compared with the VAC group (P < 0.05). However, the reduced area for wound surface showed no significant difference between the two groups. Both recurrence and amputation rates showed no significant difference between the two groups of patients. CONCLUSION Both VAC and VAC combined with photon therapy were effective and safe in the treatment of DFUs, while the combined therapy might have accelerated wound healing, but did not influence the long-term efficacy.
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Affiliation(s)
- Xiaoxiao Hu
- Department of interventional Vascular Surgery, The Tenth People's Hospital affiliated to Tongji University, Tongji University School of Medicine, shanghai, 200072, China,
| | - Weishuai Lian
- Department of interventional Vascular Surgery, The Tenth People's Hospital affiliated to Tongji University, Tongji University School of Medicine, shanghai, 200072, China,
| | - Xiaojun Zhang
- Department of interventional Catheter, The Tenth People's Hospital affiliated to Tongji University, Shanghai, 200072, China
| | - Xue Yang
- Department of Anesthesiology, eastern hospital affiliated to Tongji University, Shanghai, 200120, China
| | - Jinxia Jiang
- Department of Emergency, The Tenth People's Hospital affiliated to Tongji University, Shanghai, 200072, China,
| | - Maoquan Li
- Department of interventional Vascular Surgery, The Tenth People's Hospital affiliated to Tongji University, Tongji University School of Medicine, shanghai, 200072, China,
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De Giglio R, Stefani I, Mondello T, De Filippis G, Mazzone A. BIOACTIVE GLASS S53P4: a new opportunity for the treatment in the diabetic foot osteomyelitis. Eur J Intern Med 2018; 54:e15-e16. [PMID: 29709419 DOI: 10.1016/j.ejim.2018.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 11/25/2022]
Affiliation(s)
- R De Giglio
- Internal Medicine Department, ASST Ovest Milanese, Milano, Italy
| | - I Stefani
- Internal Medicine Department, ASST Ovest Milanese, Milano, Italy
| | - T Mondello
- Internal Medicine Department, ASST Ovest Milanese, Milano, Italy
| | - G De Filippis
- HealthCare Management, ASST Ovest Milanese, Milano, Italy
| | - A Mazzone
- Internal Medicine Department, ASST Ovest Milanese, Milano, Italy.
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31
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Yang C, Huang Z, Sun K, Hu Y, Bao X. Comparing the Economic Burden of Type 2 Diabetes Mellitus Patients with and without Medical Insurance: A Cross-Sectional Study in China. Med Sci Monit 2018; 24:3098-3102. [PMID: 29752429 PMCID: PMC5973488 DOI: 10.12659/msm.907909] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The burden of diabetes has become a worldwide public health issue. Previous studies focused on the composition and influencing factors of hospitalization costs for insured patients. The aim of this study was to compare the economic burden of diabetic patients with and without medical insurance (MI) in China, from the aspects of types of medical costs and diabetic comorbidities. Material/Methods We identified 124 701 patients with type 2 diabetes mellitus in 2015 from electronic Hospitalization Summary Reports. The information on demographics, comorbidities, and hospitalization costs were extracted and evaluated. Differences between groups were analyzed by Mann-Whitney U test. Results The mean age of patients was 58.0±13.4 years. Hypertensive diseases (63.5%), ischemic heart diseases (21.3%), and chronic kidney disease (17.5%) were the most common comorbidities. The median hospitalization costs for diabetic patients with and without MI were 9485.0 RMB and 9104.0 RMB, respectively. The insured patients’ median out-of-pocket (OOP) cost was 1601.3 RMB, and they incurred more costs for laboratory tests, imaging examinations, and medical services, and less costs for prescribed drugs (p<0.05). Insured patients had higher costs when associated with hypertensive diseases, cerebrovascular diseases, and ischemic heart diseases (p<0.05). Conclusions Diabetic patients with MI have higher hospitalization costs than those without MI, but uninsured patients carry a heavier OOP burden. The MI system in China needs further improvement to reduce the economic burden of diabetes.
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Affiliation(s)
- Chao Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China (mainland)
| | - Zhe Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China (mainland)
| | - Kexin Sun
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (mainland)
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China (mainland).,Medical Informatics Center, Peking University, Beijing, China (mainland)
| | - Xiaoyuan Bao
- Medical Informatics Center, Peking University, Beijing, China (mainland)
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McGrath RT, Dryden JC, Newlyn N, Pamplona E, O'Dea J, Hocking SL, Glastras SJ, Fulcher GR. Utility of the Hospital Admission Risk Programme diabetes risk calculator in identifying patients with type 2 diabetes at risk of unplanned hospital presentations. Intern Med J 2018; 48:1198-1205. [PMID: 29604162 DOI: 10.1111/imj.13824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/23/2018] [Accepted: 03/25/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Prevention of hospitalisation is an important aspect of type 2 diabetes (T2D) management. AIMS We retrospectively determined the utility of the Hospital Admission Risk Programme (HARP) diabetes risk calculator (HARP tool) in identifying patients with T2D more likely to have unplanned hospital presentations. METHODS The HARP tool includes a clinical assessment score (Part A) and a psychosocial and self-management impact score (Part B), and categorises patients into low, medium, high or urgent risk of acute hospitalisation. It was completed for T2D patients attending Royal North Shore Hospital, Sydney, in 2013. RESULTS Within the cohort of 278 patients (age 65.3 ± 10.5 years; 62.9% male; diabetes duration 10.7 ± 6.6 years), 67.3% were classified as low risk, 32.7% as medium risk and none as high or urgent risk. Following adjustment for confounders, a medium HARP score was associated with a 3.1-fold increased risk of unplanned hospital presentations in the subsequent 12 months (95% confidence interval: 1.35-7.31; P = 0.008). Part A scores were significantly higher for patients that presented to hospital compared to those that did not (14.2 ± 6.8 vs 11.4 ± 5.5; P = 0.034), whereas there was no difference in Part B scores (P = 0.860). CONCLUSIONS In patients with low and medium HARP scores, clinical features were more predictive of hospital presentations than certain psychosocial or self-management factors in the present cohort. Further studies are required to characterise unplanned hospitalisation in patients with higher HARP scores, or whether additional psychosocial assessments could improve the tool's predictability.
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Affiliation(s)
- Rachel T McGrath
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Kolling Institute of Medical Research, Sydney, New South Wales, Australia
| | - Justin C Dryden
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Neroli Newlyn
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Elline Pamplona
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Judy O'Dea
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Samantha L Hocking
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Kolling Institute of Medical Research, Sydney, New South Wales, Australia
| | - Gregory R Fulcher
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Zeng C, Zhou Z, Han Y, Wen Z, Guo C, Huang S, Xiao D, Ye X, Ou M, Huang C, Ye X, Yang G, Jing C, Nie L. Interactions of TRAF6 and NLRX1 gene polymorphisms with environmental factors on the susceptibility of type 2 diabetes mellitus vascular complications in a southern Han Chinese population. J Diabetes Complications 2017; 31:1652-1657. [PMID: 29046236 DOI: 10.1016/j.jdiacomp.2017.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 08/03/2017] [Accepted: 08/28/2017] [Indexed: 12/18/2022]
Abstract
AIMS To evaluate the effects of TRAF6 and NLRX1 polymorphisms and their interactions with environmental factors on the susceptibility of type 2 diabetes mellitus (T2DM) vascular complications in a southern Han Chinese population. METHODS Five single nucleotide polymorphisms (SNPs) were genotyped in a case-control study to estimate risk factors of T2DM vascular complications. Gene-gene and gene-environment interactions and haplotype associations were also estimated. RESULTS The CA genotype of the NLRX1 rs4245191 was identified as a risk factor for T2DM macrovascular complications and diabetic cerebral infarction (OR=2.88, 95% CI=1.15-7.22, P=0.024; OR=4.00, 95% CI=1.04-15.38, P=0.043, respectively). A significantly lower T allele frequency in the TRAF6 rs16928973 was observed in T2DM patients with both microvascular and macrovascular complications compared with patients without any complication under the allelic model (T vs. C: OR=0.36, 95% CI=0.14-0.98, P=0.038). No significant differences in haplotypes, gene-gene interactions and gene-environment interactions were observed among T2DM vascular subgroup patients. CONCLUSIONS Our study provides evidence that the NLRX1 rs4245191 polymorphisms influence the risk of T2DM macrovascular complications and diabetic cerebral infarction.
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Affiliation(s)
- Chengli Zeng
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Zixing Zhou
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Yajing Han
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Zihao Wen
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Congcong Guo
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Shiqi Huang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Di Xiao
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Xiaohong Ye
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Meiling Ou
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Chuican Huang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Xingguang Ye
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Guang Yang
- Department of Pathogen biology, School of Medicine, Jinan University, Guangzhou 510632, China; Guangzhou Key Laboratory of Environmental Exposure and Health, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China.
| | - Chunxia Jing
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou 510632, China; Guangzhou Key Laboratory of Environmental Exposure and Health, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China.
| | - Lihong Nie
- Department of Endocrine, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China.
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Chen D, Liu S, Tan X, Zhao Q. Assessment of hospital length of stay and direct costs of type 2 diabetes in Hubei Province, China. BMC Health Serv Res 2017; 17:199. [PMID: 28288623 PMCID: PMC5348848 DOI: 10.1186/s12913-017-2140-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of type 2 diabetes is increasing, creating a huge burden for China's social healthcare system. This study aimed to evaluate hospital length of stay (LOS) based on admission characteristics and direct costs correlated with various types of complications for type 2 diabetic inpatients in Hubei Province, China. METHODS A total of 1528 inpatients diagnosed with type 2 diabetes discharged between April 1, 2013, and March 31, 2014, were included in this study. Information regarding patients' admission and hospitalization were obtained from the hospital information system. The relationship between admission characteristics and LOS, distribution of total costs, and types of complications were described and analysed. RESULTS (1) The mean LOS was 11.65 days (median: 10 days). Multiple linear regression analysis demonstrated that inpatients with New Cooperative Medical Scheme (NCMS), aged 80 and above, had longer LOS than the reference group, and inpatients with chronic or acute + chronic complications had shorter LOS than those without. (2) Mean total costs per patient were US$159.72 ± 130.83 (median: US$135.33), US$240.60 ± 166.58 (median: US$192.09), and US$247.98 ± 166.22 (median: US$200.99) for inpatients with no complications, chronic complications, and acute + chronic complications, respectively. Total and individual costs were significantly less for patients without complications than for those with the two types of complications (p < 0.001). (3) Mean total costs per patient were US$225.40 ± 115.32 (median: US$200.34), US$221.25 ± 177.64 (median: US$170.05), and US$275.18 ± 193.14 (median: US$217.91) for inpatients with microvascular complications, macrovascular complications, and microvascular + macrovascular complications, respectively. Total costs were significantly higher for patients with microvascular + macrovascular complications than for those with other types of chronic complications (p < 0.001). (4) Drugs were the greatest expense for patients, and the least expensive treatment was nursing care. CONCLUSIONS Medical insurance status, age, and type of complication may help to predict LOS for patients with type 2 diabetes in Hubei Province, China. The total and individual costs for patients with complications were higher than for those without, and hospitalization expenses posed a heavy burden. Efforts should be made to reduce the financial impact on patients by integrating the medical insurance system of urban and rural areas, and by reducing the risk of complications, especially microvascular complications.
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Affiliation(s)
- Dajie Chen
- Wuhan University, 115# Donghu Road, Wuhan, 430071, China
| | - Shuai Liu
- Wuhan University, 115# Donghu Road, Wuhan, 430071, China
| | - Xiaodong Tan
- Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Qihan Zhao
- Wuhan University, 115# Donghu Road, Wuhan, 430071, China
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35
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The analysis of the cost and amputation rates of hospitalized diabetic foot infection patients. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0524-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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