OBJECTIVE -We conducted a retrospective study to evaluate the adequacy of glycemic, lipid, and blood pressure (BP) management for diabetic patients in a managed care organization (MCO).RESEARCH DESIGN AND METHODS -Patients aged Ն18 years with diabetes (n ϭ 7,114) were retrospectively identified over a 2-year period from the MCO's administrative database based on the Health Plan Employer Data and Information Set 2000 selection criteria using pharmacy, laboratory, and encounter data. Analyses examined demographics and percentages of patients tested and meeting American Diabetes Association goals for HbA 1c , lipids, and BP, both overall and for those receiving medication treatment versus no treatment.RESULTS -Testing rates for A1C, LDL cholesterol, and BP were 77, 54, and 95%, respectively. The percentage of patients tested who were at goal were 37% for A1C, 23% for LDL cholesterol, and 41% for systolic BP. Of the patients in our sample, 72% were treated for glycemic control, 64% were treated for BP control, and only 28% were treated for lipid control. Of the patients who received medication treatment, less than one-third were at goal for A1C (29%) and LDL cholesterol (32%), whereas 40% were at goal for systolic BP.CONCLUSIONS -We found that although a large percentage of diabetic patients were tested for A1C, LDL cholesterol, and systolic BP, a much smaller percentage had reached their respective goals. More aggressive glycemic, lipid, and BP management appears to be needed to improve care for these patients.

OBJECTIVE -To examine the direct costs of care before and after onset of end-stage renal disease (ESRD) for patients with and without diabetes based on analyses of retrospective healthcare claims data. RESEARCH DESIGN AND METHODS -Patients with onset of ESRD betweenJanuary 1998 though June 2002 were identified based on use of dialysis, renal transplantation, or other ESRD-related services. Continuous health plan enrollment Ն12 months before and Ն1 month after ESRD onset was required. The costs calculated include both observed and adjusted estimates; the latter were calculated using generalized linear models, controlling for demographic and clinical characteristics, "onset" period, and duration of follow-up. Analyses focus on the diabetic ESRD patient and include a comparison with ESRD patients without diabetes.RESULTS -The study included 2,020 patients with diabetes and 2,170 without diabetes; 63% of patients were Ͼ50 years of age. Average costs were relatively stable before ESRD ($1,535 to $4,357 for diabetes, $1,082 to $2,447 for no diabetes) but more than doubled in the month preceding onset ($9,152 and $8,211, respectively). Postonset, average monthly per-patient costs escalated sharply in the 1st month ($26,507 and $26,789), declined steadily through month 6, and remained flat but elevated thereafter. Adjusted annual costs per patient pre-and postonset of ESRD were significantly higher for diabetes (P Ͻ 0.0001); annual costs were 69% ($38,041 vs. $22,538) and 79% ($96,014 vs. $53,653) higher pre-and postonset, respectively.CONCLUSIONS -The economic burden of ESRD in the year after onset is substantial, particularly among patients with diabetes. Diabetes Care 27:2829 -2835, 2004O ver the past 2 decades, both the incidence and prevalence of end-stage renal disease (ESRD) have continually increased (1-4). Between 1980 and 2001, incidence increased fourfold from 82 to 334 per million of the total population, while prevalence increased fivefold from 271 to 1,400 per million. Much of this increase in ESRD prevalence and incidence may be attributed to diabetes, specifically diabetic nephropathy, which is the leading cause of ESRD in the U.S. (2). The increase in the prevalence and incidence of ESRD caused by other conditions, including hypertension, glomerulonephritis, and cystic kidney disease, were much lower than that caused by diabetes. Between 1982 and 1992, the prevalence of diabetes as the underlying cause of ESRD increased from 27 to 36%; between 1994 and 1999, 40% of all new ESRD cases occurred among individuals with diabetes (2,3).In addition to the clinical burden, preventing or delaying the onset of ESRD also becomes especially crucial in the context of the economic impact on the healthcare system. ESRD patients constitute one-half of 1% of Medicare beneficiaries but account for 5% of Medicare program expenditures. In 1999, ϳ350,000 people in the U.S. suffered from ESRD, resulting in a cost of $12.7 billion to the Medicare ESRD program (2). However, these costs are expected to increase to $28 billion p...

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Vaccination rates in these diabetic patients are unsatisfactory. Secondary care health professionals might increase rates by raising the topic in consultations. Diabet. Med. 18, 599-603 (2001)

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