健康自助

帮您理财BANGNINLICAL怎样治疗最省钱?糖尿病患者为治疗各种并发症所支付的费用,花费高而效益低。上海复旦大学的专家们,对我国11个城市的2型糖尿病及共14种主要并发症的年治疗费用进行了调查,结果表明,有并发症的2型糖尿病患者的年直接医疗费用是无并发症患者的3.71倍。若同时伴有大、小血管并发症,其年直接医疗费用是无并发症的10.35倍。计算得知,我国2型糖尿病的医疗     

糖尿病治疗省钱策略

中国2型糖尿病患者，要想在血糖、血压及血脂方面得到充分的治疗，每月治疗费用需要将近1000元人民币。这种花费有一半是用于大血管并发症的治疗。2002年中国17个省会城市调查显示，全国糖尿病医疗费用188．2亿人民币，约占卫生事业费的4％，平均普通糖尿病患者的费用每人每年3726元（占19％），有并发症患者的平均费用每人每年13，897元（占81％）。     

2型糖尿病患者高同型半胱氨酸血症与慢性血管并发症的关系

目的探讨2型糖尿病血管病变患者血清同型半胱氨酸（Hcy）的变化及可能机制。方法用双抗体夹心酶免（ELISA）法、放免法检测182例2型糖尿病患者血清Hcy、一氧化氮、内皮素水平，同时以45例健康人作为对照组。结果（1）血清Hcy水平：糖尿病各组均高于对照组，大血管并发症组高于微血管并发症组及无并发症组。（2）血清一氧化氮水平：糖尿病组大血管并发症组、微血管并发症组、无并发症组高于对照组，大血管合并微血管并发症组低于对照组;血清内皮素水平：糖尿病各组均高于对照组，各并发症组高于无并发症组，大血管并发症组高于微血管并发症组。（3）高Hcy组血清一氧化氮水平显著升高，血清内皮素增高但无统计学意义。结论糖尿病慢性血管并发症与高Hcy水平有关。     

CORE模型评价地特胰岛素治疗2型糖尿病患者的长期成本效用

一、前言 有效控制糖化血红蛋白(HbA1c)水平是糖尿病患者的主要治疗目标.著名的英国前瞻性糖尿病研究(UKPDS)显示[1]:任何HbA1c水平的降低均有助于降低并发症的风险.而糖尿病患者的治疗费用与并发症数量高度相关[2].有并发症的2型糖尿病患者的年直接医疗费用是无并发症患者的3.71倍.同时伴有大、小血管并发症的2型糖尿病患者的年直接医疗费用则是无并发症的10.35倍[1].由此可知,糖尿病患者的血糖控制水平不仅影响到治疗效果,还影响到患者的经济负担.     

强化降糖治疗对2型糖尿病患者大血管和微血管并发症的影响

目的研究分析强化降糖治疗对2型糖尿病患者大血管和微血管并发症的影响。方法将该院2014年6月—2015年12月收治的存在大血管和微血管病变因素的2型糖尿病患者120例作为研究对象,依照随机原则分为强化组和常规组,每组为60例。强化组患者给予强化降糖治疗,而常规组患者给予常规降糖治疗,对比两组患者治疗前后临床指标变化以及出现大血管和微血管并发症情况。结果治疗前两组患者的空腹血糖(FBG)、糖化血红蛋白(Hb Alc)、晨尿白蛋白/肌酐(A/C)、血压相比差异无统计学意义,治疗后各项指标显著改善,且强化组改善程度优于常规组,差异有统计学意义(P0.05);强化组中无患者出现大血管终点和死亡,而常规组中有7例出现大血管终点事件,4例死亡,两组相比差异有统计学意义(P0.05)。结论对于2型糖尿病患者采用强化降糖治疗有效改善患者临床指标,降低大血管或微血管事件发生,临床疗效显著,值得进行应用。     

2型糖尿病患者餐后甘油三酯水平与血管并发症关系的研究

目的 研究２型糖尿病患者餐后甘油三酯水平与血管并发症的关系。方法 ４４例２型糖尿病患者以空腹和餐后４小时甘油三酯（ＴＧ和ＴＧ４ｈ）水平分组：空腹及餐后ＴＧ正常组（１９例）、空腹正常餐后增高组（１４例）、空腹增高组（１０例）、分析其血管并发症的发生情况,结果 按上述分组次序,微血管并发症发生率分别为２１．０５％、４２．８５％和７０％,大血管并发症分别为１０．５２％、５７．１４％和８０％。前两组微血管     

高胰岛素血症与动脉粥样硬化研究现状与进展

糖尿病血管病变是糖尿病的一个最常见的慢性并发症,可累及全身的大血管及微血管,其中大血管病变导致的心脑血管疾病是2型糖尿病患者首要的死亡原因,约占2型糖尿病死因的50％.糖尿病合并大血管病变是目前糖尿病并发症研究的热点,但其具体机制至今尚未完全阐述清楚.本文综述了高胰岛素血症与动脉粥样硬化研究现状与进展,并探讨其引发动脉粥样硬化的可能机制.     

胆固醇酯转运蛋白及其基因多态性与2型糖尿病大血管病变的关系

探讨胆固醇酯转运蛋白在2型糖尿病大血管病变发生中所起的作用及胆固醇酯转运蛋白TaqⅠB基因多态性与大血管病变的关系。对96例正常对照者及226例2型糖尿病患者的血清胆固醇酯转运蛋白水平及胆固醇酯转运蛋白TaqⅠB基因型进行研究。结果发现：①2型糖尿病组胆固醇酯转运蛋白水平较正常对照组明显升高，大血管病变组升高更显著；②糖尿病大血管病变组B1B1基因型频率(37．3％)显著高于无大血管病变组(16．4％)，B1B1基因型大血管病变发生率(68．3％)明显高于B1B2(46．6％)和B2B2(29．1％)型；③多元回归分析显示，高胆固醇酯转运蛋白水平和B1等位基因是2型糖尿病大血管病变的危险因素。提示：①2型糖尿病患者血清胆固醇酯转运蛋白水平升高，后者是2型糖尿病大血管病变的危险因素；②胆固醇酯转运蛋白TaqⅠB基因多态性与2型糖尿病大血管病变发生有关，B1等位基因是2型糖尿病大血管病变的易感基因。     

104例2型糖尿病患者规范化治疗临床分析

目的 探讨2型糖尿病患者规范化治疗现状。方法 收集了104例2005年12月～2006年3月的2型糖尿病住院患者，分析了糖尿病大血管并发症的危险因素治疗情况。结果血糖、血脂，糖化血红蛋白、血压的未达标率达25．2％～97．8％。初诊2型糖尿病患者，周围神经病变，下肢血管病变、心血管病变的失检率均超过50．0％。结论 目前2型糖尿病规范化的治疗情况还不尽人意，还有待糖尿病规范化治疗的培训。     

血糖波动与老年人糖尿病血管并发症的研究进展

对于早期2型糖尿病患者,强化降糖治疗可以降低糖尿病微血管和大血管慢性并发症的发生风险。但老年糖尿病患者多伴有重要脏器功能减退、多种疾病共存、用药复杂、血糖波动幅度大及易发低血糖等特点,而过大的血糖波动和严重的低血糖被认为与糖尿病血管并发症密切相关。因此新的治疗理念认为,对于病程较长的老年2型糖尿病患者,在控制血糖的基础上,应减少血糖波动和严重低血糖的发生,从而减少糖尿病慢性并发症的发生发展。     

Assessing the impact of complications on the costs of Type II diabetes

AIMS/HYPOTHESIS: 'The Cost of Diabetes in Europe - Type II (CODE-2) study' provides the first coordinated attempt to assess the total costs of managing people with Type II (non-insulin-dependent) diabetes mellitus in Europe. Type II diabetes is associated with a number of serious long-term complications, which are a major cause of morbidity, hospitalisation and mortality in diabetic patients. METHODS: Patients were divided into four broad categories defining their complication status in terms of no complications, one or more microvascular complications, one or more macrovascular complications or one or more of each microvascular and macrovascular complication. The prevalence of complications and associated costs were assessed retrospectively for 6 months. RESULTS: In total, 72% of patients in the CODE-2 study had at least one complication, with 19% having microvascular only, 10% having macrovascular only and 24% of the total having both microvascular and macrovascular complications. Of patients with microvascular complications, 28% had neuropathy, 20% renal damage, 20% retinopathy and 6.5% required treatment for eye complications. Among the patients with macrovascular complications, 18% had peripheral vascular disease, 17% angina, 12% heart failure and 9% had myocardial infarction. Percutaneous transluminal coronary angioplasty, coronary artery bypass graft or stroke occurred in 3%, 4% and 5% of the patients, respectively. In patients with both microvascular and macrovascular complications, the total cost of management was increased by up to 250% compared to those without complications. CONCLUSION/INTERPRETATION: Complications have a substantial impact on the costs of managing Type II diabetes. This study has confirmed that the prevention of diabetic complications will not only benefit patients, but potentially reduce overall healthcare expenditure.     

Costs of diabetes mellitus in Korea

Outcome research focusing on the economics of the medical field began in the mid-1990s and has included studies about costs, cost effectiveness, and policies. According to the American Diabetes Association, the total estimated cost of diabetes in 2007 was $174 billion. The economic burden of patients with diabetes in Canada is expected to be about $12.2 billion in 2010. Recent Korean studies have analyzed the expenses associated with type 2 diabetes for patients in selected general hospitals. Type 2 diabetic patients without complications cost approximately 1,184,563 won (the equivalent of US $1,184) per patient for healthcare annually. In contrast, patients with microvascular disease due to diabetic complications cost up to 4.7 times that amount, and patients with macrovascular disease incur up to 10.7 times the annual costs for patients without diabetic complications. Diabetic complications ultimately impact the quality of life for patients and patient mortality, and are associated with higher direct medical expenses for patients. To avoid increased medical costs, appropriate management techniques must be implemented to ensure timely care for patients with diabetes.     

Cost impact of blood glucose self-monitoring on complications of type 2 diabetes: a Swiss perspective (ROSSO study No.11)

QUESTION UNDER STUDY: despite the increasing prevalence of type 2 diabetes, its financial burden on the Swiss healthcare system remains unclear. Our aim was to determine the cost of self-monitoring of blood glucose (SMBG) in reducing diabetic complications by comparing the direct costs to the Swiss statutory health insurance system of diabetic complications in SMBG users vs. nonusers. METHOD: matched pair analysis of the average annual total cost of diabetes monitoring, treatment-related services, complications and followup in the RetrOlective Study Self-Monitoring of Blood Glucose and Outcome in Patients with Type 2 Diabetes (ROSSO) study cohort, updated to 2005 from the year of occurrence or diagnosis of diabetes, applying an annual inflation rate of 5%. RESULTS: in those patients treated with oral antidiabetic drugs only, total annual costs were CHF 5,140 in SMBG users and CHF 5,654 in non - users. In those patients treated with oral antidiabetic drugs plus insulin, total annual costs were CHF 8,254 and CHF 11,776, respectively. SMBG accounted for 1.6% to 1.7% of total costs. CONCLUSION: cost analysis indicates that SMBG provides a rapid return on initial investment.     

Economic burden of diabetic patients in India: A review

The Indian diabetic population is predicted to reach more than 80 million by the year 2030. It indicates that immediate health policy restructuring and investment will be needed if the best use is to be made of scarce health care resources with accompanying economic constraints. The costs of treatment of diabetes exists among the patients of all socioeconomic groups.A recent study showed that, in India, the total annual expenditure by patients on diabetes care was, on average, Rs. 10,000 in urban areas and Rs. 6260 in rural areas. The studies related to diabetes indicate that the direct and indirect cost implications of diabetes are multifold worldwide. The direct costs are related to the medical and non-medical cost of people with diabetes, mostly the burden on individual and at the family level. The indirect costs are related to the society and government, which are associated to loss of productivity. The review also finds that the annual direct and indirect medical costs per patient increase with the number of microvascular and macrovascular complications. A study in India during the years 2008 and 2009 found that total costs for patients without complications were Rs. 4493 compared to Rs. 14,692for patients with complications.The review reveals that it is imperative to work effectively towards implementing a holistic programme for diabetes prevention and reduce diabetic expenditure burden in the community.     

Imbalance in inpatient costs between urban and rural diabetes patients in Jinan,China

This study was to describe and compare the expenditures per hospital admission between urban and rural patients with a primary diagnosis of type 2 diabetes with and without complications in an urban tertiary hospital in Jinan, China. This study comprised 880 inpatients hospitalized from 1 January 2006 to 31 August 2008. Inpatient costs were directly collected from hospital accounting system, which comprised the costs of all prescribed drugs, medical procedures, laboratory tests, hotel service, and nursing care during the hospital stay. Generalized linear model (GLM) with log-link and gamma variance functions was used to identify the differences in the total inpatient costs between urban and rural patients after controlling for the potential cost predictors. The adjusted individual inpatient costs per hospitalization were $1680 for urban patients and $1437 for rural patients who had no complications; $1973 and $1687 for those with microvascular diseases; $2045 and $1750 for those with macrovascular diseases; $2208 and $1889 for those with both microvascular and macrovascular diseases (p < 0.05 between urban and rural patients for all the categories). The costs of prescribed drugs accounted for more than two thirds of the total costs in both groups. Urban residence was positively associated with inpatient costs in addition to diabetic complications, insurance, days in the hospital, male gender, and insulin treatment. In conclusion, within the same disease category, rural patients always spent less than the urban patients’ per hospital admission. Large out-of-pocket financing burden, low medical insurance coverage and reimbursement rate, and low income of rural patients can partly attribute to the urban–rural gap in healthcare expenditures.

     

Direct medical costs for patients with type 2 diabetes in Sweden

OBJECTIVES: To estimate the total direct medical costs to society for patients with type 2 diabetes in Sweden and to investigate how different factors, for example diabetic late complications, affect costs. DESIGN: Cross-sectional data regarding health care utilization, clinical characteristics and quality of life, were collected at a single time-point. Data on resource use cover the 6-month period prior to this time point. SETTING: Patient recruitment and data collection were performed in nine primary care centres in three main regions in Sweden. SUBJECTS: Only patients with an age at diabetes diagnosis >/= 30 years (type 2 diabetes) were included (n = 777). RESULTS: The total annual direct medical costs for the Swedish diabetes type 2 population were estimated at about 7 billion SEK (Swedish Kronor) in 1998 prices, which is about 6% of the total health care expenditures and more than four times higher than the former Swedish estimate obtained when using diabetes as main diagnosis for calculating costs. The annual per patient cost was about 25 000 SEK. The largest share of this cost was hospital inpatient care. Costs increased with diabetes duration and were higher for patients treated with insulin compared to those treated with oral hypoglycaemic drugs or with life style modification only. Patients with both macro- and microvascular complications had more than three times higher costs compared with patients without such complications. CONCLUSIONS: Type 2 diabetes is a serious and expensive disease and the key to reducing costs seems to be intensive management and control in order to prevent and delay the associated late complications.     

Healthcare cost of type 2 diabetes mellitus in Bangladesh: a hospital-based study

Healthcare-related expenditure for diabetes is increasing at an alarming rate all over the world, resulting in a huge burden on patients. The purpose of this cross-sectional study was to estimate the healthcare cost incurred by patients with type 2 diabetes mellitus (T2DM). The study included 531 registered patients with diabetes of more than 1 year. All the treatment-related records of the last 12 months were collected from the patients’ guide books. Data were analyzed to determine the average cost (exchange rate: US$1?=?Bangladeshi Taka 80) incurred by the diabetic patients in treating the disease and were calculated based on the total amount spent by them to that of total number of patients. The mean?±?SD age of the patients (male 46.5 % and female 53.5 %) was 53.0?±?10 years with duration of diabetes 9?±?6.7 years. The average annual cost of care was US$314 (direct cost US$283 and indirect cost US$31). Drugs accounted for the largest share (68 %) of the direct cost, followed by laboratory investigations (12.5 %) and consultation fees (11.7 %). Results of bivariate analysis showed that the annual direct cost of care significantly increased with age, monthly household income, duration of diabetes, and the number of co-morbidities/complications. However, results of multivariable analysis showed that, except age, all other remained significant (p?<?0.001) explanatory variable of direct cost. The annual cost of diabetes care per person in the outpatient department of a tertiary care facility was US$314. Based on this finding, it is estimated that the total annual burden of some 5.1 million diabetic patients will be US$1.5 billion, which is a large burden for a developing country like Bangladesh. Primary prevention should be in focus to combat the economic burden of diabetes.     

Neither the presence of metabolic syndrome as defined by the IDF guideline nor an increased waist circumference increased the risk of microvascular or macrovascular complications in Japanese patients with type 2 diabetes

The aim of this study was to evaluate the relationship between the diagnosis of metabolic syndrome (MetS) or its components and the prevalence of microvascular and macrovascular complications in 130 Japanese type 2 diabetic patients. Out of the 130 patients, 58.5% satisfied the criteria of the MetS as defined by the IDF guideline. The results of logistic regression analysis with adjustment for three variables (age, gender and duration of diabetes) revealed that the presence of MetS as defined by the IDF guideline was not independently related to the presence of proliferative retinopathy, proteinuria, neuropathy, or macrovascular disease in the diabetic patients. The waist circumference per se was not associated with diabetic neuropathy, retinopathy, nephropathy, or macrovascular diseases. These results suggest that neither the presence of MetS, as defined by the IDF guideline, nor the waist circumference was associated with the presence of either microvascular or macrovascular complications in Japanese type 2 diabetic patients.     

Major complications have an impact on total annual medical cost of diabetes: results of a database analysis

BACKGROUND: Type 2 diabetes mellitus is a common, chronic, and costly disease, and its prevalence is increasing in major industrialized countries. Diabetes has indeed a high social impact mainly because of its chronic complications. OBJECTIVE: The aim of this study was to analyze the direct medical costs attributable to Type 2 diabetes mellitus and its determinants, as assessed in a diabetologic center (DC) in Italy. METHODS: We conducted a retrospective longitudinal cost of care study; Type 2 diabetic patients who visited between January 2001 and August 2002 were randomly selected from the database of the DC of Portogruaro. Cost data collected included hospitalizations, visits, diagnostics, and pharmacological therapies and were quantified and analyzed in the perspective of the National Health Service (NHS). RESULTS: Two hundred ninety-nine diabetic patients were extracted, with a mean/patient follow up of 476 days. Mean age was 67.5 years and males represented 67.2% of the sample. The average annual health care cost was found to be euro1909.67 per patient; pharmacological therapies accounted for the greatest proportion of direct medical costs (52%), followed by hospitalization (28%) and diagnostic exams (11%). Annual costs increased with the number of diabetes related comorbidities, from euro1039 to 3141 per patient in participants with none or more than two complications, respectively. CONCLUSION: Long-term complications carry a considerable impact on total annual medical cost. Our study demonstrates that an increase in the number of comorbidities is directly associated with an increase of Type 2 diabetes cost. Strategies aimed at preventing the onset of diabetic complications are likely to reduce medical costs in the long run, while improving patients' health.