Personalized blood sugar goals can save diabetes patients thousands

December 11, 2017, University of Chicago Medical Center
Blood glucose monitoring. Credit: Wikipedia

A cost analysis by researchers at the University of Chicago Medicine shows treatment plans that set individualized blood sugar goals for diabetes patients, tailored to their age and health history, can save $13,546 in health care costs over their average lifetime when compared with treatment strategies that stick to a uniform national standard.

The study, published December 12 in the Annals of Internal Medicine, showed the majority of those savings come from lower medication costs. Individualized care also slightly increased quality-adjusted life years, or the amount of time spent living in relative good health without severe complications.

"People don't want to be treated by a standard value or an algorithm, they want to be treated like individuals," said Neda Laiteerapong, MD, assistant professor of medicine at UChicago Medicine and lead author of the study.

"I think this model will give evidence to physicians that individualized glycemic control is something to consider. It can help save our health system money, and it's in line with what many want," she said.

Hemoglobin A1C is a common measure of for diabetics, measured as a percentage of blood cells that carry extra glucose molecules. The lower the A1C percentage, the better, and for years the American Diabetes Association (ADA) recommended a standard goal of less than seven percent for most diabetics.

In 2012, the ADA and the European Association for the Study of Diabetes published a statement recommending that physicians individualize blood sugar goals based on several factors, including age, life expectancy, complications and how long a patient has had diabetes. In many cases, say for an elderly patient who has been living with diabetes for decades and has several complications, aggressive control may not be appropriate, so they can set a higher A1C target of less than eight percent.

In the new study, Laiteerapong and her colleagues used a statistical model that calculated over the average expected lifetime of the patients, using data from 569 patients in the National Health and Nutrition Examination Survey (NHANES) who are representative of the population of U.S. adults over the age of 30 with type 2 diabetes. The model factored in variables such as age, duration of diabetes and history of complications such as heart disease, hypertension, stroke, retinopathy and kidney disease. It assigned costs for typical type 2 diabetes treatment regimens with drugs like metformin, insulin and sulfonylureas, and included standard values from the research literature for the cost of treating major events like a heart attack or stroke.

Using this input data, they ran 2,500 simulations for the expected remaining lifetime of each patient with both : a personalized A1C value which changed over their lifetime, versus a standard, uniform value less than seven. The model showed that the individualized control strategy saved on average $13,564 per person compared to the uniform strategy ($105,307 vs. $118,853 lifetime). The difference was almost entirely due to lower medication costs ($34,521 vs. $48,763). Given that roughly 17.3 million adults in the U.S. over 30 have type 2 , this could amount to a whopping $234 billion lifetime savings nationwide.

The model did predict a slight decrease in life expectancy (36 days) due to an increase in complications on the personalized strategy. Laiteerapong attributes that to statistical limitations in the model that don't account for long-term, cumulative benefits of treatment.

"The differences in and complication rates were very small, but choosing a personalized A1C goal can reduce medications by half per year," Laiteerapong said. "If I told my patients they could take half as many medications but maybe there's a small chance they might live a month less, I'm pretty sure many of them would sign up for it."

Explore further: High lifetime costs for type 2 diabetes

More information: "Cost-effectiveness Analysis of Individualized Glycemic Control for U.S. Adults with Type 2 Diabetes," Annals of Internal Medicine (2017). DOI: 10.7326/M17-0537

Related Stories

High lifetime costs for type 2 diabetes

August 9, 2013
A person with type 2 diabetes may spend an average of nearly $85,500 to treat the disease and its complications over his or her lifetime, reports a new study in the American Journal of Preventive Medicine. The earlier diabetes ...

Team urges use of evidence-based medicine to avoid overtreatment of type 2 diabetes

January 31, 2017
UT Southwestern Medical Center research supports an evidence-based medicine (EBM) approach that embraces individualized care to prevent overtreatment, specifically for patients with type 2 diabetes.

Study of UK diabetic patients suggests obesity surgery could save National Health Service almost 100,000 per patient

June 2, 2016
A small study presented at this year's European Obesity Summit in Gothenburg (1-4 June) shows that obese patients with type 2 diabetes who have obesity surgery could save the UK National Health Service around £95,000 per ...

Home monitoring of blood sugar did not improve glycemic control after one year

June 10, 2017
Self-monitoring of blood glucose levels in patients with type 2 diabetes who are not treated with insulin did not improve glycemic control or health-related quality of life after one year in a randomized trial, results that ...

One-size-fits-all approach can lead to over-treatment in older diabetes patients

January 12, 2015
Diabetes treatments have saved many lives, but in older patients with multiple medical conditions, aggressively controlling blood sugar with insulin and sulfonylurea drugs, could lead to over-treatment and hypoglycemia (low ...

Is the finger-stick blood test necessary for type 2 diabetes treatment?

June 10, 2017
In a landmark study, UNC School of Medicine researchers have shown that blood glucose testing does not offer a significant advantage in blood sugar control or quality of life for type 2 diabetes patients who are not treated ...

Recommended for you

Team provides insight into glucagon's role in diabetic heart disease

February 21, 2018
A UT Southwestern study reveals the hormone glucagon's importance to the development of insulin resistance and cardiac dysfunction during Type 2 diabetes, presenting opportunities to develop new therapies for diabetic diseases ...

Physical exercise reduces risk of developing diabetes: study

February 20, 2018
Exercising more reduces the risk of diabetes and could see seven million fewer diabetic patients across mainland China, Hong Kong and Taiwan, according to new research.

Some viruses produce insulin-like hormones that can stimulate human cells—and have potential to cause disease

February 19, 2018
Every cell in your body responds to the hormone insulin, and if that process starts to fail, you get diabetes. In an unexpected finding, scientists at Joslin Diabetes Center have identified four viruses that can produce insulin-like ...

Researchers discover link between gut and type 1 diabetes

February 19, 2018
Scientists have found that targeting micro-organisms in the gut, known as microbiota, could have the potential to help prevent type 1 diabetes.

Researchers find existing drug effective at preventing onset of type 1 diabetes

February 15, 2018
A drug commonly used to control high blood pressure may also help prevent the onset of type 1 diabetes in up to 60 percent of those at risk for the disease, according to researchers at the University of Colorado Anschutz ...

Chemist designs diabetic treatment minus harmful side effects

February 9, 2018
A chemist in the College of Arts and Sciences (A&S) has figured out how to control glucose levels in the bloodstream without the usual side effects of nausea, vomiting or malaise.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.