2型糖尿病并发症对患者治疗费用的影响评估

目的 测量与评估中国大城市2型糖尿病并发症对患者年治疗费用的影响。方法 将2型糖尿病患者分为无并发症组、仅有微血管并发症组、仅有大血管并发症组以及同时伴有大、小血管并发症组，并分别计算四组患者的年治疗费用。结果 ①在医院接受治疗的患者中，仅46．7％的患者无任何并发症；而53．3％的患者至少伴有一种并发症。其中仅有大血管并发症的患者占13．3％，仅有微血管并发症的患者占22．3％，同时伴有大、小血管并发症的患者占17．7％。②在微血管并发症患者中，外周神经病变占39．55％，视网膜病变37．69％，肾病13．81％，糖尿病足6．16％。在大血管并发症患者中，短暂性脑缺血发作38．24％，心绞痛31．01％，脑卒中16．80％，慢性心衰6．20％。⑧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。但是，若同时伴有大、小血管并发症的2型糖尿病患者年直接医疗费用则是无并发症的10．35倍。④中国大城市2001年治疗2型糖尿病及其并发症的直接医疗总费用为187．5亿元，占卫生总费用3．94％。其中81％的费用用于治疗与2型糖尿病相关的并发症，治疗无并发症的直接医疗费用仅占19％。结论研究结果证明并发症是影响2型糖尿病年治疗费用的重要因素。

Assessing the impact of complications on the costs of Type 2 diabetes in urban China

Objective To assess the total cost of treating patients with type 2 diabetes complications in urban China. Methods Patients were divided into four broad groups, including patients with no complications, microvascular complications, macrovascular complications and both microvascular and macrovascular complications. The annual total healthcare cost of each group was calculated. Results (1) 46.7% of patients in this study had no complications, 53.3% had at least one complication, with 13.3% having macrovascular only, 22.3% having microvascular only and 17.7% having both microvascular and macrovascular complications. (2) In patients with microvascular complications, 39.55% had peripheral neuropathy, 37.69% retinopathy, 13.81% renal damage and 6.16% diabetic foot. In patients with macrovascular complications, 38.24% had TIA, 31.01% had angina, 16.80% had stroke and 6.20% had chronic heart failure. (3) The annual direct medical cost of patient with complications was increased by 3.71 times compared to those without complications. But in patients with both microvascular & macrovascular complications, it was increased by up to 10.35 times compared to those without complications. (4) The total direct medical costs for treating Type2 diabetes and its complications in urban China were 18.75 billion RMB, which accounted for 3.94% of total China healthcare expenditure in 2001. The cost of managing type 2 diabetic complications accounted for 81% of the total direct medical cost, but the cost for no complications only accounted for 19%. Conclusion Diabetic complications creates the main cost in treating type 2 diabetes disease.