Time and cost involved in the care of newly registered patients with diabetes mellitus and other lifestyle diseases at diabetes clinics in Japan (JDDM 4)

Factors affecting mobile diabetes monitoring adoption among physicians: questionnaire study and path model

BACKGROUND

Patients with type 1 and type 2 diabetes often find it difficult to control their blood glucose level on a daily basis because of distance or physical incapacity. With the increase in Internet-enabled smartphone use, this problem can be resolved by adopting a mobile diabetes monitoring system. Most existing studies have focused on patients' usability perceptions, whereas little attention has been paid to physicians' intentions to adopt this technology.

OBJECTIVE

The aim of the study was to evaluate the perceptions and user acceptance of mobile diabetes monitoring among Japanese physicians.

METHODS

A questionnaire survey of physicians was conducted in Japan. The structured questionnaire was prepared in a context of a mobile diabetes monitoring system that controls blood glucose, weight, physical activity, diet, insulin and medication, and blood pressure. Following a thorough description of mobile diabetes monitoring with a graphical image, questions were asked relating to system quality, information quality, service quality, health improvement, ubiquitous control, privacy and security concerns, perceived value, subjective norms, and intention to use mobile diabetes monitoring. The data were analyzed by partial least squares (PLS) path modeling.

RESULTS

In total, 471 physicians participated from 47 prefectures across Japan, of whom 134 were specialized in internal and gastrointestinal medicine. Nine hypotheses were tested with both the total sample and the specialist subsample; results were similar for both samples in terms of statistical significance and the strength of path coefficients. We found that system quality, information quality, and service quality significantly affect overall quality. Overall quality determines the extent to which physicians perceive the value of mobile health monitoring. However, in contrast to our initial predictions, overall quality does not have a significant direct effect on the intention to use mobile diabetes monitoring. With regard to net benefits, both ubiquitous control and health improvement are significant predictors. Net benefits in turn significantly motivate physicians to use mobile health monitoring, and has a strong influence on perceived value. Perceived value and subjective norms are predictors of intention to use. In our sample, concerns over privacy and security risk have no significant effects on intention to use mobile diabetes monitoring. Among the 3 control variables, only age significantly affected intention to use mobile diabetes monitoring, whereas experience and gender were not significant predictors of intention.

CONCLUSIONS

Physicians consider perceived value and net benefits as the most important motivators to use mobile diabetes monitoring. Overall quality assessment does affect their intention to use this technology, but only indirectly through perceived value. Net benefits seem to be a strong driver in both a direct and indirect manner, implying that physicians may perceive health improvement with ubiquitous control as a true utility by enhancing cost-effective monitoring, and simultaneously recognize it as a way to create value for their clinical practices.

Fasting insulin levels and metabolic risk factors in type 2 diabetic patients at the first visit in Japan: a 10-year, nationwide, observational study (JDDM 28)

OBJECTIVE

To investigate the relationship between fasting insulin levels and metabolic risk factors (MRFs) in type 2 diabetic patients at the first clinic/hospital visit in Japan over the years 2000 to 2009.

RESEARCH DESIGN AND METHODS

In total, 4,798 drug-naive Japanese patients with type 2 diabetes were registered on their first clinic/hospital visits. Conventional clinical factors and fasting insulin levels were observed at baseline within the Japan Diabetes Clinical Data Management (JDDM) study between consecutive 2-year groups. Multiple linear regression analysis was performed using a model in which the dependent variable was fasting insulin values using various clinical explanatory variables.

RESULTS

Fasting insulin levels were found to be decreasing from 2000 to 2009. Multiple linear regression analysis with the fasting insulin levels as the dependent variable showed that waist circumference (WC), BMI, mean blood pressure, triglycerides, and HDL cholesterol were significant, with WC and BMI as the main factors. ANCOVA after adjustment for age and fasting plasma glucose clearly shows the decreasing trend in fasting insulin levels and the increasing trend in BMI.

CONCLUSIONS

During the 10-year observation period, the decreasing trend in fasting insulin was related to the slight increase in WC/BMI in type 2 diabetes. Low pancreatic β-cell reserve on top of a lifestyle background might be dependent on an increase in MRFs.

The direct economic cost of pharmacologically-treated diabetes in Italy-2006. The ARNO observatory

AIMS/HYPOTHESIS

To estimate the prevalence and the direct cost of pharmacologically-treated diabetes in Italy.

METHODS

The ARNO observatory database, containing the 20-year medical prescriptions of over 10 million Italian people, was used. Ten-year longitudinal data were available in 22 Local Health Districts (LHD). Subjects were classified as having diabetes when prescribed glucose-lowering drugs (oral agents or insulin) (311,979 individuals in 2006). The direct cost was calculated as the sum of drug use, financial compensation by LHD for the inpatient (hospital DRG) and outpatient activities (consultations, laboratory tests, radiology, etc.), all regulated by government contracts. Individuals with diabetes were compared with pharmacologically-treated subjects without diabetes, pair-matched for age, sex and general practitioner.

RESULTS

In the 10-year period, the prevalence of pharmacologically-treated diabetes increased from 3.08% to 4.45% (P for trend, <0.001). The average pro capita cost totaled €2,589 in 2006 (95% confidence interval (CI), 2,584-2,594), corresponding to a rate ratio vs. no-diabetes of 1.54 (95% CI, 1.50-1.56). The cost of drugs was € 827 (rate ratio, 1.80 vs. no-diabetes; 95% CI, 1.79-1.82), that of service use, € 488 (rate ratio, 1.07 (0.93-1.25). Only 20% of the pharmaceutical cost was due to glucose-lowering drugs, a percentage stable through the years. The cost of any hospital admission, as defined by DRGs, was independent of diabetes, but the overall cost was much higher in diabetes due to much higher admission rates. Cardiovascular complications and renal failure accounted for the large majority of excess hospital cost.

CONCLUSION

The direct economic burden of pharmacologically-treated diabetes on the National Health System is very high, due to the growing prevalence of disease and the cost of complications.

Time and Costs of Insulin Treatment in the Care of Newly Registered Type 2 Diabetes Patients in Diabetes Clinics Across Japan (JDDM 22)

AIMS

To study the time and costs of insulin treatment of newly registered outpatients with Type 2 diabetes mellitus (T2DM).

METHODS

In total, 355 patients with T2DM were registered on their first visit to one of 11 diabetes clinics across Japan. Of these, 313 were not being treated with insulin (the non-insulin group), whereas 42 were (the insulin group). In the insulin group, 26 were already on insulin at the first visit, whereas 16 were started on insulin after their first visit. The time and costs involved in the care were recorded over the following 5 months.

RESULTS

In the first 3 months, considerable time was expended in both groups, with the time spent by physicians a little (but significantly) longer for the insulin group. The total time expended by all care providers was approximately 1.3-fold greater for the insulin compared with the non-insulin group. The total cost and total cost/min for the insulin group was almost twice that for the non-insulin group. Over the 5-month period, mean HbA1c in the non-insulin group improved from 8.0% to 6.5%, with 72% achieving a glycemic target of HbA1c ≤ 6.5%. In contrast, in the insulin group, mean HbA1c improved from 9.4% to 7.6%, with only 39% achieving the target. There were no reports of major hypoglycemic events in either group and body mass index remained stable.

CONCLUSIONS

The insulin therapy for T2DM can be achieved safely and effectively at outpatient clinics, even though it requires considerably more time and resources than non-insulin therapy.

Diabetes in Japan: a review of disease burden and approaches to treatment

In recent years there has been rapid growth in diabetes in Japan which now is one of the nations most affected by the worldwide diabetes epidemic. Diabetes has been identified as a healthcare priority by the Ministry of Health, Labour and Welfare (MHLW). Type 1 diabetes is rare in Japan, and type 2 diabetes predominates in both adults and children. The growth in diabetes is due to increases in the number of people with type 2 diabetes associated with increased longevity and lifestyle changes. Approximately 13.5% of the Japanese population now has either type 2 diabetes or impaired glucose tolerance. This high prevalence of type 2 diabetes is associated with a significant economic burden, with diabetes accounting for up to 6% of the total healthcare budget. The costs of diabetes are increased in patients with co-morbidities such as hypertension and hyperlipidaemia and in patients who develop complications, of which retinopathy has the highest cost. Costs increase with increasing number of complications. Current guidelines from the Japan Diabetes Society (JDS) recommend a target HbA(1c) of 6.5% for glycaemic control. This is achieved in approximately one third of patients with type 2 diabetes, and Japanese patients typically have lower HbA(1c) than patients in Western countries (e.g. US, UK). Japanese patients with type 2 diabetes have better adherence with diet and exercise recommendations than their peers in Western countries. Sulfonylureas have been the most widely prescribed first-line treatment for type 2 diabetes, although there is increasing use of combination therapy and of insulin.