Small reduction in blood sugar can lower health costs

NEW YORK, Jan 10 (Reuters Health) - For patients with type 2 diabetes, lowering blood sugar can be a difficult and expensive endeavor. But a recent study suggests that a 1% reduction in blood sugar sustained over several years leads to substantial cost savings.

The report in the January 10th issue of The Journal of the American Medical Association found that adults who kept their blood glucose stable had fewer doctor visits, were hospitalized less often, and were less likely to visit hospital emergency departments. This translated into a savings of $685 to $950 within 2 years.

"Improvements in glycemic control provide positive reinforcement for the patient's efforts in managing their illness, which may increase self-efficacy and reduce dependency on medical care for diabetes management," according to Dr. Edward H. Wagner, from the University of Washington in Seattle, and colleagues.

Patients with type 2 diabetes do not respond to insulin, the hormone that regulates blood sugar. High blood glucose can lead to a number of serious medical complications including heart disease, kidney failure, blindness and amputations.

The study of more than 4,700 diabetics aged 18 years and older found that those who sustained a 1% or more decrease in blood glucose for more than a year, lowered their average annual healthcare costs. Costs rose for those whose blood glucose did not improve, the report indicates.

Those who lowered their blood glucose had higher rates of complications such as stroke, heart disease and foot ulcers at the outset, suggesting that their disease was more advanced. This might explain why those who managed to lower their blood glucose had slightly higher rates of death after 3 years, the authors note.

The findings "provide stronger support for more aggressive management of type 2 diabetes and for investment in system improvements," Wagner and colleagues write. The cost savings "would more than pay for system enhancements required to achieve better glycemic control," they add.

SOURCE: The Journal of the American Medical Association 2001;285:182-189.