DOC News March 1, 2005
Volume 2 Number 3 p. 14
© 2005 American Diabetes Association
Looking Beyond A1C Levels
Blood levels of glycated hemoglobin (A1C) are an important measure of
diabetes care, indicating the quality of glucose control and the risk of
microvascular complications. Despite its clinical value, however, A1C is not
the best predictor of health care costs for people with type 2 diabetes,
according to a group of University of California, San Diego, researchers and
the HealthPartners Research Foundation in Bloomington, Minn.
Todd P. Gilmer, PhD, and colleagues thought variables such as A1C and the
duration of diabetes would be strong predictors of health care costs. They
aren't, according to the group's analysis reported in the January 2005 issue
of Diabetes Care.
Investigators studied 1,694 adults with diabetes covered by Health
Partners, a health plan with 600,000 members. Data were accumulated from a
patient survey and medical-record review, merged with 3 years of medical
claims. The analysis revealed that patients with coronary heart disease (CHD)
and hypertension had 3-year costs 300% greater than those with diabetes alone.
Patients with depression had a 50% increase in costs.
Hypertension, CHD, and depression are all stronger predictors of health
care costs than A1C, according to the group. Higher A1C levels predicted
higher costs only when the baseline level was >7.5%. Patients with A1C of
10% had costs 11% higher than those with A1C of 6%.
Along with keeping an eye on the clinically important A1C, greater efforts
to manage or prevent CHD, hypertension, and depression are needed to control
diabetes health care costs, the authors conclude.
Gilmer TP, O'Connor PJ, Rush WA, et al.: Predictors of
health care costs in adults with diabetes. Diabetes
Care 28:59–64, 2005.[Abstract/Free Full Text]
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