Costs and consequences of tight glycemic control in diabetic patients

糖尿病患者严格血糖控制的成本和后果

• 批准号: 8088629
• 负责人: Leonard Marshall Pogach
• 金额: --
• 依托单位: VA NEW JERSEY HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-01 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8088629
• 关键词: Accounting; Adverse effects; Ambulatory Care; American; American College of Physicians; Applications Grants; Cardiovascular Diseases; Cardiovascular system; Caring; Centers for Disease Control and Prevention (U.S.); Chronic; Clinical; Clinical Trials; Cohort Studies; Comorbidity; Complex; Complications of Diabetes Mellitus; Cost Effectiveness Analysis; Current Procedural Terminology Codes; Data; Databases; Decision Analysis; Department of Defense; Development; Diabetes Mellitus; Diabetic Angiopathies; Diagnosis; Disease; Economic Models; Elderly; Epidemiology; Event; Future; Generic Drugs; Goals; Health; Health Care Costs; Health Resources; Healthcare; Hypoglycemia; ICD-9; Individual; Inpatients; Intensive Care; Life Expectancy; Managed Care; Mental disorders; Metabolic; Methodology; Methods; Modeling; Musculoskeletal; Newly Diagnosed; Non-Insulin-Dependent Diabetes Mellitus; Onset of illness; Outcome; Outpatients; Patients; Pharmaceutical Preparations; Pilot Projects; Population; Preventive; Protocols documentation; Recommendation; Relative Risks; Research; Resources; Risk; Services; Societies; Substance abuse problem; System; United Kingdom; Veterans; Weight; Work; aged; base; burden of illness; clinical practice; cohort; cost; cost effectiveness; diabetes management; diabetic; diabetic patient; disorder prevention; economic value; follow-up; glycemic control; health administration; health care service utilization; health economics; improved; macrovascular disease; prospective

DESCRIPTION (provided by applicant): Project Background: The benefit of "tight glycemic control" in decreasing microvascular events over a 10 year period is based upon the UKPDS trial. An epidemiological follow-up demonstrates an association with improved microvascular and macrovascular complications over a 20 year period. However, a recent prospective cohort study suggests that the cardiovascular benefit of tighter glycemic control in more recent onset disease may be limited to individuals with a lower illness burden. The VADT and ACCORD studies demonstrate an increasing rate and risk of hypoglycemia in patients with a longer duration of diabetes. Such patients are still healthier than many veterans who have significant comorbid disease burdens alongside diabetes. Overall, the relative risks and benefits of tight glycemic control, especially with newer medications, have been understudied in patients with additional chronic complex diseases. Project Objectives In order to understand the value of these newer medications on the VHA diabetes population, we intend to develop a VHA specific model of tight glycemic control for new onset diabetes by adapting the Centers for Disease Control Diabetes Outcomes model. The goal of this pilot study is to develop new methodology for developing such a cost-effectiveness model incorporating inputs from specific aims 1 to 3 below. Among veterans aged 25-64 years with newly diagnosed diabetes, we will: Aim 1: Evaluate healthcare resource utilization and costs associated with the provision of diabetes-related outpatient care to veterans, with and without chronic complex illnesses. We will evaluate differences in utilization and costs among patient groups according to the presence of concordant and discordant co-morbid chronic complex illnesses. Aim 2: Evaluate healthcare utilization and costs associated with inpatient care for diabetes-related complications in veterans, with and without chronic complex illnesses. Complications include macrovascular, microvascular and metabolic complications. Aim 3: Among veterans with discordant illnesses, we will specifically explore inpatient and outpatient utilization and costs for veterans with mental illness and/or substance abuse as these patients may require more intensive care to achieve tight glycemic control. Project Methods We will use the Diabetes Epidemiology Cohort (DEpiC), developed using VHA data for FY 2003 and FY 2004, to evaluate resource utilization in the inpatient and outpatient settings for veterans with recently diagnosed diabetes, using existing definitions of recent diagnosis and type II diabetes. Chronic complex illness will be categorized as 1) no CCI; 2) concordant conditions only; 3) discordant conditions only; 4) both concordant and discordant chronic complex illnesses. Categorization will be based on ICD-9 and CPT codes, using a validated and established protocol developed within this research group. Costs will be developed from Health Economics Resource Center average cost data, in order to develop estimates of costs of delivering diabetes care, managing diabetes complications in the outpatient setting and managing diabetes complications in the inpatient setting.

描述（由申请人提供）：