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Burden of Diabetes Mellitus Estimated with a Longitudinal Population-Based Study Using Administrative Databases

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Authors:
Luciana Scalone at Università degli Studi di Milano-Bicocca
Luciana Scalone
Giancarlo Cesana at Università degli Studi di Milano-Bicocca
Giancarlo Cesana
Gianluca Furneri
Gianluca Furneri
Gianluca Furneri
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Roberta Ciampichini at Università degli Studi di Milano-Bicocca
Roberta Ciampichini
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Abstract and Figures

To assess the epidemiologic and economic burden of diabetes mellitus (DM) from a longitudinal population-based study. Lombardy Region includes 9.9 million individuals. Its DM population was identified through a data warehouse (DENALI), which matches with a probabilistic linkage demographic, clinical and economic data of different Healthcare Administrative databases. All individuals, who, during the year 2000 had an hospital discharge with a IDC-9 CM code 250.XX, and/or two consecutive prescriptions of drugs for diabetes (ATC code A10XXXX) within one year, and/or an exemption from co-payment healthcare costs specific for DM, were selected and followed up to 9 years. We calculated prevalence, mortality and healthcare costs (hospitalizations, drugs and outpatient examinations/visits) from the National Health Service's perspective. We identified 312,223 eligible subjects. The study population (51% male) had a mean age of 66 (from 0.03 to 105.12) years at the index date. Prevalence ranged from 0.4% among subjects aged ≤45 years to 10.1% among those >85 years old. Overall 43.4 deaths per 1,000 patients per year were estimated, significantly (p<0.001) higher in men than women. Overall, 3,315€/patient-year were spent on average: hospitalizations were the cost driver (54.2% of total cost). Drugs contributed to 31.5%, outpatient claims represented 14.3% of total costs. Thirty-five percent of hospital costs were attributable to cerebro-/cardiovascular reasons, 6% to other complications of DM, and 4% to DM as a main diagnosis. Cardiovascular drugs contributed to 33.5% of total drug costs, 21.8% was attributable to class A (16.7% to class A10) and 4.3% to class B (2.4% to class B01) drugs. Merging different administrative databases can provide with many data from large populations observed for long time periods. DENALI shows to be an efficient instrument to obtain accurate estimates of burden of diseases such as diabetes mellitus.
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Burden of Diabetes Mellitus Estimated with a Longitudinal Population-Based Study Using Administrative Databas
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... Moreover, the lack of therapeutical adherence can cause several complications and costly preventable hospitalisations [18,19]. Notwithstanding some differences that can occur between territorial contexts, the Italian literature reports that around 50% of costs of healthcare services are due to hospitalisation episodes, followed by around 35% of costs for pharmacological treatments and the remainder for specialistic services [17,18,20]. This distribution holds when patients receive appropriate treatments and are followed over time, which is not always the case for undocumented migrants. ...
... The use of aggregated data prevented us from drawing causal claims and specific conclusions on the individual care pathways. Examples of in-depth analysis that did not have these limitations can be found in two previous Italian works that quantified the economic burden of diabetes [20,40] by identifying individuals with diabetes (not considering undocumented migrants) and tracking their health expenditures over time. This approach also enabled the authors to track the healthcare services not strictly related to diabetes, but the comorbidities and complications correlated with it. ...
Healthcare Services for Undocumented Migrants: Organisation and Costs from the Italian NHS Perspective
Article
Full-text available
Based on the principle of health equity, the Italian National Health Service is known worldwide for being a universalistic system that guarantees healthcare services for all its population, among which there are undocumented migrants. A commitment for their health needs is further motivated by their lower utilisation rates of healthcare services, which becomes even more crucial when considering chronic conditions such as diabetes that require adherence and continuity of care. However, the need for more official data has resulted in little research documenting these healthcare usage patterns. For this reason, our objective has been to deepen, from the Italian NHS perspective, the quantity, costs, type, preventability and organisation of healthcare services directed to undocumented migrants. We used official healthcare data from the Lombardy Region, which enable the identification of people receiving the STP code (undocumented migrants) and of people with foreign citizenship (documented migrants). After quantifying the average annual amount and expenditure for healthcare services grouped by Italian citizens, documented migrants and undocumented migrants for all clinical conditions (quantity and costs), we performed three primary investigations where we enlightened differences between the three mentioned groups focusing on the diagnosis of diabetes: (i) mapping the types of healthcare services used and their characteristics (type); (ii) quantifying the impact of preventable hospital admissions (preventability); (iii) examining the healthcare patterns linking pharmaceutical prescriptions with hospital accesses (organisation). Our results reveal significant differences among the three groups, such as more urgent hospital admissions, more preventable complications, and a higher recurrence in terms of access and costs to hospital services rather than pharmaceutical prescriptions for undocumented migrants. These findings can represent the leverage to raise awareness toward the emerging challenges of the migrant health burden.
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... Due diversi studi condotti in Italia [25,26] hanno calcolato che le ospedalizzazioni (attribuibili per più di 1/3 a cause cardio-o cerebro-vascolari [25]) sono il principale driver di costo per la gestione del diabete, rappresentando circa il 50% dei costi diretti, mentre la spesa per farmaci ammonta a circa il 30% del totale. ...
... Due diversi studi condotti in Italia [25,26] hanno calcolato che le ospedalizzazioni (attribuibili per più di 1/3 a cause cardio-o cerebro-vascolari [25]) sono il principale driver di costo per la gestione del diabete, rappresentando circa il 50% dei costi diretti, mentre la spesa per farmaci ammonta a circa il 30% del totale. ...
[The Multidisciplinary Management of Type 2 Diabetes: an Integrated Care Model]
Article
Full-text available
  • Sep 2021
Over the past 20 years, the prevalence of diabetes in Italy has been growing, up to the current estimated proportion of about 8.5%, which accounts also for undiagnosed patients. As most of these subjects are >65 years of age, the probability of having comorbidities is high. In addition, diabetes itself exposes patients to a wide spectrum of complications, that cover several therapeutic areas. This is why the optimal management of diabetes necessarily involves a multidisciplinary team. Several models of integrated care of chronic diseases may be set: for instance, the role assigned to GPs and specialists may differ among models. Indeed, a disequilibrium between GPs and specialists is deemed to be the main cause of the low patients’ participation in Progetto Cronicità (chronic diseases project), which started in Lombardia (a Northern region in Italy) in 2018. A help to understand how to build a proper integrated care model in diabetes comes from the experience of the Authors, that describe in detail their experience in IRCCS MultiMedica (Sesto San Giovanni, MI, Italy). This Supplement ends with a review of the evidence found in literature about the advantages of a multidisciplinary management of diabetes in terms of outcomes, costs, and patients’ satisfaction.
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... Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia, which is a serious threat to human health [1]. The incidence of diabetes has been on the rise, with the global incidence of 6.4% in 2010 and projected to rise to 7.7% by 2030 [2]. And in China, the incidence of DM had increased to 11.6% by 2010 [3]. ...
... Studies have confirmed that persistent hyperglycemia leads to abnormal biochemical indexes such as increased oxidative load in patients with DM, which eventually evolves into liver damage [5]. According to Scalone et al., DM costs an average of 3,315 euros per case per year, with 31.5% of the total drug cost [2]. Sulfonylurea drugs cause hypoglycemia, and a few patients will develop rashes and edema [6]. ...
Bilobalide Enhances AMPK Activity to Improve Liver Injury and Metabolic Disorders in STZ-Induced Diabetes in Immature Rats via Regulating HMGB1/TLR4/NF-κB Signaling Pathway
Article
Full-text available
This study was aimed at examining the effect and underlying mechanisms of bilobalide (BB) on hepatic injury in streptozotocin- (STZ-) induced diabetes mellitus (DM) in immature rats. Immature rats (one day old) were randomly divided into five groups: group I, control nondiabetic rats; group II, STZ-induced, untreated diabetic rats; groups III/IV/V, STZ-induced and BB-treated diabetic rats, which were intraperitoneally injected with BB (2.5 mg/kg, 5 mg/kg, or 10 mg/kg) after 3 days followed by STZ treatment. We observed that BB improved the histopathological changes and maintained normal glucose metabolism, blood lipid, and liver function indicators, such as fasting blood glucose, obesity index, HbA1c, HOMA-IR, fast serum insulin, adiponectin, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), aspartate transaminase (AST), and alanine transaminase (ALT) in STZ-induced DM in immature rats by a biochemical analyzer or ELISA. Meanwhile, Western blot analysis showed that in STZ-induced DM immature rats, BB decreased the expression of apoptosis-related proteins Bax, cleaved caspase-3, and cleaved caspase-9 while enhancing the Bcl-2 expression; BB downregulated the expression of ACC related to fat anabolism, while upregulating the expression of CPT-1 related to fat catabolism. Strikingly, treatment with BB significantly increased the expression of AMPKα1 as well as inhibited HMGB1, TLR4, and p-P65 expression in hepatic tissues of immature DM rats. AMPK inhibitor (compound C, CC) cotreated with BB undermined the protective effect of BB on the liver injury. The results of the present study suggested BB may have a significant role in alleviating liver damage in the STZ-induced immature DM rats.
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... Inoltre, l'analisi delle singole voci di spesa ha evidenziato che il principale driver dei costi per questa categoria di pazienti è rappresentato dalle ospedalizzazioni che costituiscono oltre l'86% della spesa complessiva. Questo dato è in linea con tutti gli studi che hanno affrontato il tema dei costi del diabete in diversi setting e impiegando differenti metodologie e fonti di dati (13)(14)(15)(16)(17)(18)(19)(20)(21). ...
Burden of disease, healthcare pathways and costs of cardiovascular high-risk patients with type 2 diabetes: a real world analysis: L’onere della malattia, risorse sanitarie e costi dei pazienti con diabete di tipo 2 ad elevato rischio cardiovascolare: un’analisi “real world”
Article
Full-text available
  • Mar 2018
Objective: To estimate the burden of disease and to describe healthcare pathways and costs of type-2diabetes (DMT2) patients at high cardiovascular risk (HRCV). Methods: A real-world analysis was performed by using a subset of the AR-CO database, containing administrative health data of >4.3 million of inhabitants. A cohort of adult patients with DMT2 and HRCV was selected in 2013, and followed for 1 year. Through this period, information on antidiabetic and cardiovascular therapies, other co-treatments, hospitalisations, and outpatient services, was collected and analysed. The costs associated with each variable were assessed to estimate the integrated health care expenditure. Results: Overall, 7,167 patients with DMT2 and HRCV were identified, corresponding to 3.1% of all diabetic patients and 0.2% of adult population. During the 1-year follow-up, 90.1% of the cohort received at least a prescription of an antidiabetic drug, 98.0% of a cardiovascular medication and 95.9% used at least an outpatient service. 44.5% had an admission during the follow-up period, especially for cardiovascular events. The integrated cost analysis showed that the overall average cost for each subject was € 13,567. Hospitalisations generated 86.8% of this expenditure, followed by drugs (7.7%) and by outpatient services (5.5%). Conclusions: Although patients with DMT2 and HRCV represent a small percentage of the overall population with diabetes, they generate very high costs for National Healthcare System. These costs are mainly due to the hospitalisations, especially for cardiovascular events. New therapeutic strategies involving these patients should allow reduction of hospital admission, resulting in savings for National Healthcare System.
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... The economic impact of diabetes is primarily due to the cost and duration of treatment and to secondary complications of diabetes, such as renal disease and cardiovascular disease, with their associated costs. Two different studies conducted in Italy [10,11] have calculated that hospitalizations (more than a third attributable to cardio-or cerebrovascular causes) are the main cost driver for the management of diabetes, representing approximately 50% of direct costs, while expenditure on drugs amounts to approximately 30%. ...
Cost-effectiveness of Empagliflozin, in Addition to Metformin, in Patients with Type 2 Diabetes in Italy
Article
Full-text available
  • Dec 2022
BACKGROUND: Cardiovascular diseases represent the main cause of mortality and morbidity in type 2 diabetes mellitus (T2DM) patients. Empagliflozin is used as a treatment for T2DM because of its association with reduced risk of hospitalization for heart failure (hHF). Recently oral semaglutide, in association with metformin, has shown better results. This study analyzes the cost-effectiveness of empagliflozin versus oral semaglutide, in addition to metformin, in patients with T2DM who are inadequately controlled on metformin alone in Italy. METHODS: This analysis was conducted from the Italian National Health Service (SSN) perspective using the IQVIA Core Diabetes Model. For the base case analysis, a 50-year time horizon was chosen to capture the complications, their associated costs, and the final impact on life-years (LYs) and quality-adjusted life-years (QALYs) gained. Cohort baseline characteristics and efficacy data, were mainly sourced from the PIONEER 2 study. Health-state utilities and event disutilities were based on published sources. Drug acquisition and administration costs and patient management inputs were sourced from Italian-specific data. A sensitivity analysis and a range of scenario analyses were carried out. RESULTS: In the base case analysis treatment cost of empagliflozin plus metformin were significantly lower compared to oral semaglutide plus metformin both including and excluding the effect of empagliflozin on hHF (€-13.371/€-13.580; LYs -0.004/0.109 and QALYs -0.037/0.038). The sensitivity analysis confirmed the robustness of the model with empagliflozin plus metformin that was dominant in 63% and in 42% of simulations considering and non-considering the treatment effect on hHF, respectively. CONCLUSIONS: Empagliflozin 25 mg plus metformin is a cost-effective option versus oral semaglutide 14 mg plus metformin for patients with T2DM uncontrolled on metformin alone in Italy
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... Nel 2021 su scala mondiale la patologia diabetica ha determinato 6,7 milioni di decessi, mentre la spesa sanitaria globale per il diabete si attesta intorno ai 966 miliardi di dollari USA (3) . In Italia si stima che ogni paziente generi un impatto di spesa per il SSN di 3500 euro/anno per costi diretti per un totale di circa 14 miliardi/anno (4) . A questa spesa vanno aggiunti i costi indiretti (generati da assenze dal lavoro per visite e malattia sia dei pazienti che di eventuali caregiver) stimati essere di entità almeno pari ai costi diretti (5) . ...
The pandemic and the PNPV 2017-19. Are vaccinations in the hearts of diabetologists? The AMD 2022 surveyLa pandemia e il PNPV 2017-19. Le vaccinazioni sono nelle corde dei diabetologi? La survey di AMD 2022
Article
Full-text available
  • Nov 2022
The 2017-2019 National Vaccine Prevention Plan has updated the vaccination offer of the S.S.N./S.S.R. for those affected by certain diseases as well as defining the vaccination schedule for the general population. As we know, vaccines are among the interventions with the lowest cost and the best results that can be implemented to improve personal and community health. Chronic diseases, such as diabetes, are associated with an increased incidence of many infections and a greater severity and/or frequency of complications related to these diseases. The recent pandemic has highlighted how vaccination coverage can prevent serious complications in people with chronic diseases and comorbidities. This important preventive shield was partly undermined by the reduction in vaccination coverage due to a rampant phenomenon called “vaccine hesitancy”, i.e. a delay in joining or a r efusal of vaccination. This phenomenon is largely caused by low health literacy, disinformation and / or conspiracy campaigns that suggest that vaccination is a medical practice of unproven scientific safety and with obscure purposes. AMD launched, 3 years after the previous survey, a second survey to understand if Italian diabetologists had changed their attitudes towards vaccinations. The results clarify how, even if vaccinations are not the “core business” of our work, we are on the whole very favourable to vaccinations but with a strong demand for training, improvement of work organization, and support in order to better help our patients to join the PNPV. KEY WORDS vaccines; diabetes mellitus; prevention.
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... countries account for 30-50% of the total direct medical expenditures in the USA, Italy and Spain. [12][13][14] Chan et al. 15,16 and the International Diabetes Foundation (IDF) 4 recommend the use of routinely collected individual hospitalization and mortality data to study the relationships between risk factors, caring for patients and clinical outcomes. ...
Trends in hospitalization of patients with diabetes mellitus in Ghana from 2012 to 2017 with predictions to 2032
Article
Full-text available
  • Nov 2021
Background This study explores sociodemographic and health factors associated with hospitalizing diabetes mellitus (DM) patients and estimates the number of future hospitalizations for DM in Ghana. Methods We conducted a secondary analysis using nationally representative patient hospitalization data provided by the Ghana Health Service and projected population counts from the Ghana Statistical Service. Data were stratified by year, age, sex and region. We employed Poisson regression to determine associations between sociodemographic and health factors and hospitalization rates of DM patients. Using projected population counts, the number of DM-related hospitalizations for 2018 through 2032 were predicted. We analysed 39 846 DM records from nearly three million hospitalizations over a 6-y period (2012–2017). Results Most hospitalized DM patients were elderly, female and from the Eastern Region. The hospitalization rate for DM was higher among patients ages 75–79 y (rate ratio [RR] 23.7 [95% confidence interval {CI} 18.6 to 30.3]) compared with those ages 25–29 y, females compared with males (RR 1.9 [95% CI 1.4 to 2.5]) and the Eastern Region compared with the Greater Accra Region (RR 1.9 [95% CI 1.7 to 2.2]). The predicted number of DM hospitalizations in 2022 was 11 202, in 2027 it was 12 414 and in 2032 it was 13 651. Conclusions Females and older patients are more at risk to be hospitalized, therefore these groups need special surveillance with targeted public health education aimed at behavioural changes.
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... T1DM and T2DM are polygenic diseases, meaning that they are caused by a combination of genes. Single gene disorders leading to beta cell or other defects are rare types of DM (about 1% of cases) (18).T1DM has a well-established genetic basis, with more than 60 known genes accounting for 80% of its heritability, the DQB1 gene, which encodes the beta chain In T2DM,Having a diabetic parent raises the risk of developing diabetes by 30-40 %, More than 200 genomic regions have been implicated in the predisposition to T2DM in GWAS studies (22,23). The interplay between insulin sensitivity, appetite control, adipose storage, and beta cell failure is controlled by genetic and environmental factors in T2DM.28 Genes work byregulating a variety of aspects,such as: the insulinmediatedglucose uptake in skeletal muscle which is regulated by TBC1D4 gene, the ability to generate new adipocytesand the regulation of gene expression in these cells such asPPARG, IRS1, KLF14 genes, lipoprotein lipas-mediated lipolysis (24). ...
RELATIONSHIP BETWEEN RISKS OF MICROBIAL INFECTION, GENETIC PREDISPOSITION, IMMUNODEFICIENCY AND COMPLICATIONS OF DIABETES MELLITUS PANDEMIC
Article
Full-text available
  • Jun 2021
In general, infectious diseases are more prevalent and/or severe in diabetic mellitus patients, Increased morbidity is possible. Immune dysfunction is preferred in a hyperglycemic environment (such as: damage to neutrophil function, depression of the antioxidant system, and humoral immunity), micro-and macroangiopathies, neuropathy, decline in urine antibacterial activity, urinary dysmotility and gastrointestinal, and a higher number of medical interruptions, all of which lead to a higher incidence of infections in diabetic patients.Both systems and organs are affected by the infections. Some of these concerns, such as: foot infections, rhinocerebralmucormycosis, malignant external otitis and gangrenous cholecystitis, are more common with diabetics, In addition to the elevated morbidity, infectious mechanisms can be the primary sign of diabetes mellitus (DM)/or the triggers for diseaserelated complications including: diabetic ketoacidosis and hypoglycemia, to avoid hospitalizations, deaths, and treatment costs, influenza vaccines and anti pneumococcal are recommended.
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... We included adult patients aged ≥20 years and who had claim records containing the diagnostic code for diabetes in at least two outpatient visits or one hospitalization between January 1, 2017, and December 31, 2017. Based on the literature review [13,14], the diagnostic codes for diabetes were identified as E10 (type1 diabetes mellitus), E11 (type2 diabetes mellitus), E12 (malnutrition-related diabetes mellitus), E13 (other specified diabetes mellitus), and E14 (unspecified diabetes mellitus) as listed in the International Classification of Diseases-10th Revision (ICD-10 codes). ...
Prevalence and socioeconomic burden of diabetes mellitus in South Korean adults: a population-based study using administrative data
Article
Full-text available
  • Mar 2021
  • BMC PUBLIC HEALTH
Background: Diabetes leads to severe complications and imposes health and financial burdens on the society. However, currently existing domestic public health studies of diabetes in South Korea mainly focus on prevalence, and data on the nationwide burden of diabetes in South Korea are lacking. The study aimed to estimate the prevalence and economic burden of diabetes imposed on the South Korean society. Methods: A prevalence-based cost-of-illness study was conducted using the Korean national claims database. Adult diabetic patients were defined as those aged ≥20 years with claim records containing diagnostic codes for diabetes (E10-E14) during at least two outpatient visits or one hospitalization. Direct costs included medical costs for the diagnosis and treatment of diabetes and transportation costs. Indirect costs included productivity loss costs due to morbidity and premature death and caregivers' costs. Subgroup analyses were conducted according to the type of diabetes, age (< 65 vs. ≥65), diabetes medication, experience of hospitalization, and presence of diabetic complications or related comorbidities. Results: A total of 4,472,133 patients were diagnosed with diabetes in Korea in 2017. The average annual prevalence of diabetes was estimated at 10.7%. The diabetes-related economic burden was USD 18,293 million, with an average per capita cost of USD 4090 in 2019. Medical costs accounted for the biggest portion of the total cost (69.5%), followed by productivity loss costs (17.9%), caregivers' costs (10.2%), and transportation costs (2.4%). According to subgroup analyses, type 2 diabetes, presence of diabetic complications or related comorbidities, diabetes medication, and hospitalization represented the biggest portion of the economic burden for diabetes. As the number of complications increased from one to three or more, the per capita cost increased from USD 3991 to USD 11,965. In inpatient settings, the per capita cost was ~ 10.8 times higher than that of outpatient settings. Conclusions: South Korea has a slightly high prevalence and economic burden of diabetes. These findings highlight the need for effective strategies to manage diabetic patients and suggest that policy makers allocate more health care resources to diabetes. This is the first study on this topic, conducted using a nationally representative claims database in South Korea.
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Identification of Health Expenditures Determinants: A Model to Manage the Economic Burden of Cardiovascular Disease
Article
Full-text available
The purpose of this paper is to investigate the determinants influencing the costs of cardiovascular disease in the regional health service in Italy's Apulia region from 2014 to 2016. Data for patients with acute myocardial infarction (AMI), heart failure (HF), and atrial fibrillation (AF) were collected from the hospital discharge registry. Generalized linear models (GLM), and generalized linear mixed models (GLMM) were used to identify the role of random effects in improving the model performance. The study was based on socio-demographic variables and disease-specific variables (diagnosis-related group, hospitalization type, hospital stay, surgery, and economic burden of the hospital discharge form). Firstly, both models indicated an increase in health costs in 2016, and lower spending values for women (p < 0.001) were shown. GLMM indicates a significant increase in health expenditure with increasing age (p < 0.001). Day-hospital has the lowest cost, surgery increases the cost, and AMI is the most expensive pathology, contrary to AF (p < 0.001). Secondly, AIC and BIC assume the lowest values for the GLMM model, indicating the random effects' relevance in improving the model performance. This study is the first that considers real data to estimate the economic burden of CVD from the regional health service's perspective. It appears significant for its ability to provide a large set of estimates of the economic burden of CVD, providing information to managers for health management and planning.
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Globalization of Diabetes: The role of diet, lifestyle, and genes
Article
Full-text available
  • Jun 2011
Type 2 diabetes is a global public health crisis that threatens the economies of all nations, particularly developing countries. Fueled by rapid urbanization, nutrition transition, and increasingly sedentary lifestyles, the epidemic has grown in parallel with the worldwide rise in obesity. Asia's large population and rapid economic development have made it an epicenter of the epidemic. Asian populations tend to develop diabetes at younger ages and lower BMI levels than Caucasians. Several factors contribute to accelerated diabetes epidemic in Asians, including the "normal-weight metabolically obese" phenotype; high prevalence of smoking and heavy alcohol use; high intake of refined carbohydrates (e.g., white rice); and dramatically decreased physical activity levels. Poor nutrition in utero and in early life combined with overnutrition in later life may also play a role in Asia's diabetes epidemic. Recent advances in genome-wide association studies have contributed substantially to our understanding of diabetes pathophysiology, but currently identified genetic loci are insufficient to explain ethnic differences in diabetes risk. Nonetheless, interactions between Westernized diet and lifestyle and genetic background may accelerate the growth of diabetes in the context of rapid nutrition transition. Epidemiologic studies and randomized clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications. Translating these findings into practice, however, requires fundamental changes in public policies, the food and built environments, and health systems. To curb the escalating diabetes epidemic, primary prevention through promotion of a healthy diet and lifestyle should be a global public policy priority.
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Prevalence of overweight and obesity in young adults aged 20–40 years in North India (Kashmir Valley)
Article
Full-text available
  • Dec 2009
We conducted a survey to know the prevalence of diabetes and obesity in young-adult (20-40 years) men and non-pregnant-women in Kashmir Valley (India); prevalence of latter is presented here. The age-adjusted prevalence of overweight-obesity was 16.3% and that of obesity 5.1%; the relationship of overweight-obesity with glucose intolerance is discussed.
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A Theory for Record Linkage
Article
A mathematical model is developed to provide a theoretical framework for a computer-oriented solution to the problem of recognizing those records in two files which represent identical persons, objects or events (said to be matched). A comparison is to be made between the recorded characteristics and values in two records (one from each file) and a decision made as to whether or not the members of the comparison-pair represent the same person or event, or whether there is insufficient evidence to justify either of these decisions at stipulated levels of error. These three decisions are referred to as link (A1), a non-link (A3), and a possible link (A2). The first two decisions are called positive dispositions. The two types of error are defined as the error of the decision A1 when the members of the comparison pair are in fact unmatched, and the error of the decision A3 when the members of the comparison pair are, in fact matched. The probabilities of these errors are defined as and respectively where u(γ), m(γ) are the probabilities of realizing γ (a comparison vector whose components are the coded agreements and disagreements on each characteristic) for unmatched and matched record pairs respectively. The summation is over the whole comparison space r of possible realizations. A linkage rule assigns probabilities P(A1|γ), and P(A2|γ), and P(A3|γ) to each possible realization of γ ε Γ. An optimal linkage rule L (μ, λ, Γ) is defined for each value of (μ, λ) as the rule that minimizes P(A2) at those error levels. In other words, for fixed levels of error, the rule minimizes the probability of failing to make positive dispositions. A theorem describing the construction and properties of the optimal linkage rule and two corollaries to the theorem which make it a practical working tool are given.
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Prevalence, incidence and mortality of diagnosed diabetes: Evidence from an Italian population-based study
Article
  • Sep 2011
  • DIABETIC MED
To describe trends in diagnosed diabetes prevalence, incidence and mortality from 2000 to 2007 in the most heavily populated Italian region. We examined the prevalence and incidence rates of Type 1 and Type 2 diabetes and yearly mortality rates among individuals with diabetes from 2000 to 2007 using an administrative health database of prescription, disease-specific exemption and hospitalization records of more than 9 million inhabitants of Lombardy. Age- and sex-specific rates were calculated and temporal trends for subjects aged ≥ 30 years were analysed. The crude point diabetes prevalence rose from 3.0% in 2000 to 4.2% in 2007, a 40% increase. The incidence remained stable during the study period with a rate of 4/1000 per year. Overall mortality declined from 43.2/1000 in 2001 to 40.3/1000 in 2007 (6.7% decrease) at a rate slightly higher than that of the general population (4.8% decrease). Our projection in subjects aged ≥ 30 years indicates that the prevalence will rise continuously over the next years, reaching 11.1% in 2030. The prevalence of diabetes increased substantially between 2000 and 2007, mainly because there are more patients with a new diagnosis each year than those who die. The increase observed by 2007 almost reached the World Health Organization prediction for 2030. Our analyses suggest that the increase will continue over the next few decades. These data are important for defining the burden of diabetes in the near future, to help in planning health services and ensure proper allocation of resources.
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The global burden of diabetes and its complications: An emerging pandemic
Article
  • May 2010
  • EUR J CARDIOV PREV R
The number of patients with type 2 diabetes is increasing rapidly in both developed and developing countries around the world. The emerging pandemic is driven by the combined effects of population ageing, rising levels of obesity and inactivity, and greater longevity among patients with diabetes that is attributable to improved management. The vascular complications of type 2 diabetes account for the majority of the social and economic burden among patients and society more broadly. This review summarizes the burden of type 2 diabetes, impaired glucose tolerance, and their vascular complications. It is projected that by 2025 there will be 380 million people with type 2 diabetes and 418 million people with impaired glucose tolerance. Diabetes is a major global cause of premature mortality that is widely underestimated, because only a minority of persons with diabetes dies from a cause uniquely related to the condition. Approximately one half of patients with type 2 diabetes die prematurely of a cardiovascular cause and approximately 10% die of renal failure. Global excess mortality attributable to diabetes in adults was estimated to be 3.8 million deaths.
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The Direct Economic Cost of Pharmacologically-Treated Diabetes in Italy-2006. The ARNO Observatory
Article
  • Feb 2010
To estimate the prevalence and the direct cost of pharmacologically-treated diabetes in Italy. 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. 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. 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.
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