Background:
Newer classes of oral anti-diabetic medications affect not only HbA1c but also weight and blood pressure (BP); however, the use and effects may be limited in patients with chronic kidney disease (CKD). To better understand the potential value of newer anti-diabetic medications, we assessed the individual and collective contribution of these co-existing conditions on healthcare resource utilization (HRU) and costs within a large US T2DM patient population.
Methods:
This study analyzed electronic health records from integrated delivery networks across the US between 2008 and 2012. Beginning at first evidence of T2DM diagnosis, adults with T2DM and medical and laboratory data observed were categorized by CKD, BP, HbA1c, and obesity status as observed in the 12-month post-index period.CKD stage 5 patients were excluded. HRU was assessed during the 12-month post-index period (i.e., physician office, outpatient, and emergency room [ER) visits and hospitalizations). Unit costs were assigned to HRU to estimate total medical costs. Regression models were performed to assess the association between clinical variables and HRU/costs.
Results:
The final study sample included 23,492 T2DM patients (mean age: 60.7 years; female: 52.2%). More advanced CKD and a higher systolic BP were associated with a higher risk of hospitalization/ER visits and more outpatient/physician visits. Higher HbA1c levels were associated with a higher risk of hospitalization/ER visits. The relationship between body mass index (BMI) and HRU varied. Compared to overweight patients, normal/underweight patients had significantly greater risk of being hospitalized and ER visits, while patients with obesity classes 1-3 had similar risk. CKD stage 1, 2, 3A, 3B, and 4 had total costs of 1.18, 1.17, 1.44, 1.54, and 1.80 times those of patients without CKD (all p<0.01). Compared to patients with HbA1c <7%, those with an HbA1c 7.5%-<8%, 8%-<9%, and ≥9% had 1.07, 1.17, and 1.24 times of total costs, respectively (all p<0.05). Patients with systolic BP 130-<140 and ≥140 mmHg had total costs 1.12 and 2.30 times those of patients with systolic BP<130mmHg (both p<0.01). Normal/underweight and obesity stage 1, 2, 3 patients showed a non-linear trend of having total costs of 1.13, 0.91, 0.92 and 1.07 times those of overweight patients, respectively (all p<0.01).
Conclusions:
Among T2DM patients,
t
here is a positive relationship between CKD, BP, and HbA1c on HRU/costs. These findings highlight the importance of managing comorbid conditions in T2DM patients. Future studies should investigate reasons for the relationships we observed between BMI and HRU/costs.
Healthcare Resource Utilization Costs Related to Anaemia Management In Chronic Kidney Disease Non-Dialysed Patients: A Retrospective Clinical and Administrative Database Analysis