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      Comorbidity Type and Health Care Costs in Type 2 Diabetes: A Retrospective Claims Database Analysis

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          Abstract

          Introduction

          Previous studies suggest that the type and combination of comorbidities may impact diabetes care, but their cost implications are less clear. This study characterized how diabetes patients’ health care utilization and costs may vary according to comorbidity type classified on the basis of the Piette and Kerr framework.

          Methods

          We conducted a retrospective observational study of privately insured US adults newly diagnosed with type 2 diabetes ( n = 138,466) using the 2014–2016 Optum Clinformatics ® Data Mart. Diabetes patients were classified into five mutually exclusive comorbidity groups: concordant only, discordant only, both concordant and discordant, any dominant, and none. We estimated average health care costs of each comorbidity group by using generalized linear models, adjusting for patient demographics, region, insurance type, and prior-year costs.

          Results

          Most type 2 diabetes patients had discordant conditions only (27%), dominant conditions (25%), or both concordant and discordant conditions (24%); 7% had concordant conditions only. In adjusted analyses, comorbidities were significantly associated with higher health care costs ( p < 0.0001) and the magnitude of the association varied with comorbidity type. Diabetes patients with dominant comorbidities incurred substantially higher costs ($38,168) compared with individuals with both concordant and discordant conditions ($20,401), discordant conditions only ($9173), concordant conditions only ($9000), and no comorbidities ($3365). More than half of the total costs in our sample (53%) were attributable to 25% of diabetes patients who had dominant comorbidities.

          Conclusions

          Diabetes patients with both concordant and discordant conditions and with clinically dominant conditions incurred substantially higher health costs than other diabetes patients. Our findings suggest that diabetes management programs must explicitly address concordant, discordant, and dominant conditions because patients may have distinctly different health care needs and utilization patterns depending on their comorbidity profiles. The Piette and Kerr framework may serve as a screening tool to identify high-need, high-cost diabetes patients and suggest targets for tailored interventions.

          Funding

          Sanofi.

          Electronic supplementary material

          The online version of this article (10.1007/s13300-018-0477-2) contains supplementary material, which is available to authorized users.

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          Most cited references 57

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          Evidence on the Chronic Care Model in the new millennium.

          Developed more than a decade ago, the Chronic Care Model (CCM) is a widely adopted approach to improving ambulatory care that has guided clinical quality initiatives in the United States and around the world. We examine the evidence of the CCM's effectiveness by reviewing articles published since 2000 that used one of five key CCM papers as a reference. Accumulated evidence appears to support the CCM as an integrated framework to guide practice redesign. Although work remains to be done in areas such as cost-effectiveness, these studies suggest that redesigning care using the CCM leads to improved patient care and better health outcomes.
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              Dementia and cognitive decline in type 2 diabetes and prediabetic stages: towards targeted interventions.

              Type 2 diabetes is associated with dementia, and also with more slight cognitive decrements. In this Review we discuss trajectories from normal cognition to dementia in people with type 2 diabetes, and explore opportunities for treatment. Slight diabetes-associated cognitive decrements and dementia affect different age groups and show a different evolution. These cognitive entities should therefore not be regarded as a continuum, although their effects might be additive. Vascular damage is a key underlying process in both entities. Glucose-mediated processes and other metabolic disturbances might also have a role. No treatment has been established, but management of vascular risk factors and optimisation of glycaemic control could have therapeutic benefit. We identify possible opportunities for intervention to improve cognitive outcomes in people with type 2 diabetes, and suggest how treatment can be tailored to individual risk profiles and comorbidities. Copyright © 2014 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                plin@tuftsmedicalcenter.org
                Journal
                Diabetes Ther
                Diabetes Ther
                Diabetes Therapy
                Springer Healthcare (Cheshire )
                1869-6953
                1869-6961
                10 August 2018
                10 August 2018
                October 2018
                : 9
                : 5
                : 1907-1918
                Affiliations
                [1 ]ISNI 0000 0000 8934 4045, GRID grid.67033.31, Center for the Evaluation of Value and Risk in Health, , Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, ; Boston, MA USA
                [2 ]ISNI 0000 0000 8814 392X, GRID grid.417555.7, Real World Evidence and Clinical Outcomes, , Sanofi, ; Bridgewater, NJ USA
                Article
                477
                10.1007/s13300-018-0477-2
                6167298
                30097994
                ebbc643a-ab4b-4fa4-82bf-b4a8cac3ca3a
                © The Author(s) 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004339, Sanofi;
                Categories
                Original Research
                Custom metadata
                © Springer Healthcare Ltd., part of Springer Nature 2018

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