Diabetes & Metabolism Journal

Original Articles

Economic Impact of Combining Metformin with Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients with Renal Impairment in Spanish Patients: Antoni Sicras-Mainar, Ruth Navarro-Artieda; Diabetes Metab J. 2015;39(1):74-81. Published online February 16, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.1.74

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Background

To evaluate resource use and health costs due to the combination of metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with diabetes and renal impairment in routine clinical practice.

Methods

An observational, retrospective study was performed. Patients aged ≥30 years treated with metformin who initiated a second oral antidiabetic treatment in 2009 to 2010 were included. Two groups of patients were analysed: metformin+DPP-4 inhibitors and other oral antidiabetics. The main measures were: compliance, persistence, metabolic control (glycosylated hemoglobin< 7%) and complications (hypoglycemia, cardiovascular events) and total costs. Patients were followed up for 2 years.

Results

We included 395 patients, mean age 70.2 years, 56.5% male: 135 patients received metformin+DPP-4 inhibitors and 260 patients received metformin+other oral antidiabetics. Patients receiving DPP-4 inhibitors showed better compliance (66.0% vs. 60.1%), persistence (57.6% vs. 50.0%), and metabolic control (63.9% vs. 57.3%), respectively, compared with those receiving other oral antidiabetics (P<0.05), and also had a lower rate of hypoglycemia (20.0% vs. 47.7%) and lower total costs (€ 2,486 vs. € 3,002), P=0.001.

Conclusion

Despite the limitations of the study, patients with renal impairment treated with DPP-4 inhibitors had better metabolic control, lower rates (association) of hypoglycaemia, and lower health costs for the Spanish national health system.

Citations

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Characteristics of Hypoglycemia Pateints Visiting the Emergency Department of a University Hospital
Sang-Hyeon Choi, Deok-Ki Youn, Moon-Gi Choi, Ohk-Hyun Ryu
The Journal of Korean Diabetes.2016; 17(3): 202. CrossRef
Response: Economic Impact of Combining Metformin with Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients with Renal Impairment in Spanish Patients (Diabetes Metab J2015;39:74-81)
Antoni Sicras-Mainar, Ruth Navarro-Artieda
Diabetes & Metabolism Journal.2015; 39(2): 173. CrossRef
Dipeptidyl Peptidase 4: A New Link between Diabetes Mellitus and Atherosclerosis?
Wellington Santana da Silva Júnior, Amélio Fernando de Godoy-Matos, Luiz Guilherme Kraemer-Aguiar
BioMed Research International.2015; 2015: 1. CrossRef
Letter: Economic Impact of Combining Metformin with Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients with Renal Impairment in Spanish Patients (Diabetes Metab J2015;39:74-81)
Hannah Seok
Diabetes & Metabolism Journal.2015; 39(2): 171. CrossRef

Severe Hypoglycemia Is a Serious Complication and Becoming an Economic Burden in Diabetes: Won Chul Ha, Su Jin Oh, Ji Hyun Kim, Jung Min Lee, Sang Ah Chang, Tae Seo Sohn, Hyun Shik Son; Diabetes Metab J. 2012;36(4):280-284. Published online August 20, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.4.280

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Background

The prevalence of hypoglycemia is increasing due to the growing incidence of diabetes and the latest strict guidelines for glycated hemoglobin (HbA1c) levels under 7%. This study examined the clinical characteristics, causal factors, and medical costs of severely hypoglycemic patients in an emergency room (ER) of Uijeongbu St. Mary's Hospital.

Methods

The study consisted of a retrospective analysis of the characteristics, risk factors, and medical costs of 320 severely hypoglycemic patients with diabetes who presented to an ER of Uijeongbu St. Mary's Hospital from January 1, 2006 to December 31, 2009.

Results

Most hypoglycemic patients (87.5%, 280/320) were over 60 years old with a mean age of 69.5±10.9 years and a mean HbA1c level of 6.95±1.46%. Mean serum glucose as noted in the ER was 37.9±34.5 mg/dL. Renal function was decreased, serum creatinine was 2.0±2.1 mg/dL and estimated glomerular filtration rate (eGFR) was 48.0±33.6 mL/min/1.73 m². In addition, hypoglycemic patients typically were taking sulfonylureas or insulin and a variety of other medications, and had a long history of diabetes.

Conclusion

Severe hypoglycemia is frequent in older diabetic patients, subjects with low HbA1c levels, and nephropathic patients. Therefore, personalized attention is warranted, especially in long-term diabetics with multiple comorbidities who may not have been properly educated or may need re-education for hypoglycemia.

Citations

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The individualisation of glycaemic targets in response to patient characteristics in type 2 diabetes: a scoping review
Samuel J Westall, Ram Prakash Narayanan, Simon Watmough, Greg Irving, Niall Furlong, Sid McNulty, Sumudu Bujawansa, Kevin Hardy
Clinical Medicine.2022; 22(3): 257. CrossRef
Analysis of recurrent hypoglycemic events
Chenchen Ma, Yongming Qu, Haoda Fu
Journal of Biopharmaceutical Statistics.2021; 31(1): 5. CrossRef
ROLE OF OCTREOTIDE IN MANAGEMENT OF SULPHONYLUREA - INDUCED REFRACTORY HYPOGLYCEMIA : A CASE REPORT
Akshay Kothari, Kiran Shah
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH.2021; : 3. CrossRef
Hospitalization Costs Due to Hypoglycemia in Patients with Diabetes: A Microcosting Approach
João P. Ferreira, Francisco Araújo, Jorge Dores, Lèlita Santos, Estevão Pape, Mónica Reis, Árcia Chipepo, Edite Nascimento, Ana Baptista, Vanessa Pires, Carlos Marques, Adriana S. Lages, João Conceição, Pedro A. Laires, João Pelicano-Romano, Sílvia Alão
Diabetes Therapy.2020; 11(10): 2237. CrossRef
The Burden of Hypoglycemia in Patients With Insulin-Treated Diabetes Mellitus in China: Analysis of Electronic Medical Records From 4 Tertiary Hospitals
Xiaomeng Yue, Jiuhong Wu, Zhen Ruan, Michael L. Wolden, Lanting Li, Yong Lin
Value in Health Regional Issues.2020; 21: 17. CrossRef
A closer look at the 2019 Beers criteria
Rishabh Sharma, Malika Arora, Ravinder Garg, Parveen Bansal
Drugs & Therapy Perspectives.2020; 36(3): 116. CrossRef
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Jee Hee Yoo, Jae Hyeon Kim
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Comparison of clinical pharmacy specialists and usual care in outpatient management of hyperglycemia in Veterans Affairs medical centers
Heather L Ourth, Kwan Hur, Anthony P Morreale, Francesca Cunningham, Bharat Thakkar, Sherrie Aspinall
American Journal of Health-System Pharmacy.2019; 76(1): 26. CrossRef
Cost‐effectiveness of the psycho‐educational blended (group and online) intervention HypoAware compared with usual care for people with Type 1 and insulin‐treated Type 2 diabetes with problematic hypoglycaemia: analyses of a cluster‐randomized controlled
M. de Wit, S. M. P. A. Rondags, M. W. van Tulder, F. J. Snoek, J. E. Bosmans
Diabetic Medicine.2018; 35(2): 214. CrossRef
Dynamin-related protein 1 mediates low glucose-induced endothelial dysfunction in human arterioles
Michael J. Tanner, Jingli Wang, Rong Ying, Tisha B. Suboc, Mobin Malik, Allison Couillard, Amberly Branum, Venkata Puppala, Michael E. Widlansky
American Journal of Physiology-Heart and Circulatory Physiology.2017; 312(3): H515. CrossRef
Hazardous factors besides infection in hypoglycemia
Yu-Jang Su, Yen-Chun Lai, Chia-Jung Liao
Biomedical Reports.2017; 6(4): 480. CrossRef
Economic Burden of Hypoglycemia in Patients with Type 2 Diabetes Mellitus from Korea
Gyuri Kim, Yong-ho Lee, Mi Hye Han, Eui-Kyung Lee, Chong Hwa Kim, Hyuk Sang Kwon, In Kyung Jeong, Eun Seok Kang, Dae Jung Kim, Massimo Pietropaolo
PLOS ONE.2016; 11(3): e0151282. CrossRef
Costs associated with emergency care and hospitalization for severe hypoglycemia
G. Veronese, G. Marchesini, G. Forlani, S. Saragoni, L. Degli Esposti, E. Centis, A. Fabbri
Nutrition, Metabolism and Cardiovascular Diseases.2016; 26(4): 345. CrossRef
Risk of hospitalization for hypoglycemia among older Korean people with diabetes mellitus
Hyun Min Kim, Jong-Mi Seong, Jaetaek Kim
Medicine.2016; 95(42): e5016. CrossRef
Risk factors of severe hypoglycemia requiring medical assistance and neurological sequelae in patients with diabetes
Ja Young Jeon, Se Ran Kim, Hae Jin Kim, Dae Jung Kim, Kwan-Woo Lee, Jung-Dong Lee, Seung Jin Han
Medicine.2016; 95(47): e5365. CrossRef
Effectiveness of HypoAware, a Brief Partly Web-Based Psychoeducational Intervention for Adults With Type 1 and Insulin-Treated Type 2 Diabetes and Problematic Hypoglycemia: A Cluster Randomized Controlled Trial
Stefanie M.P.A. Rondags, Maartje de Wit, Jos W. Twisk, Frank J. Snoek
Diabetes Care.2016; 39(12): 2190. CrossRef
The cost of managing severe hypoglycemic episodes in Type 2 diabetic patients
Pedro Almeida Laires, João Conceição, Francisco Araújo, Jorge Dores, Catarina Silva, Larry Radican, Ana Nogueira
Expert Review of Pharmacoeconomics & Outcomes Research.2016; 16(2): 315. CrossRef
HypoAware: development and pilot study of a brief and partly web‐based psychoeducational group intervention for adults with Type 1 and insulin‐treated Type 2 diabetes and problematic hypoglycaemia
S. M. P. A. Rondags, M. de Wit, F. J. Snoek
Diabetic Medicine.2016; 33(2): 184. CrossRef
Hypoglycemia and Health Costs
Yong-ho Lee, Gyuri Kim, Eun Seok Kang
The Journal of Korean Diabetes.2016; 17(1): 11. CrossRef
Avoiding or coping with severe hypoglycemia in patients with type 2 diabetes
Jae-Seung Yun, Seung-Hyun Ko
The Korean Journal of Internal Medicine.2015; 30(1): 6. CrossRef
1,5-Anhydroglucitol as a Useful Marker for Assessing Short-Term Glycemic Excursions in Type 1 Diabetes
Hannah Seok, Ji Hye Huh, Hyun Min Kim, Byung-Wan Lee, Eun Seok Kang, Hyun Chul Lee, Bong Soo Cha
Diabetes & Metabolism Journal.2015; 39(2): 164. CrossRef
Intensive Individualized Reinforcement Education Is Important for the Prevention of Hypoglycemia in Patients with Type 2 Diabetes
Yun-Mi Yong, Kyung-Mi Shin, Kang-Min Lee, Jae-Young Cho, Sun-Hye Ko, Min-Hyang Yoon, Tae-Won Kim, Jong-Hyun Jeong, Yong-Moon Park, Seung-Hyun Ko, Yu-Bae Ahn
Diabetes & Metabolism Journal.2015; 39(2): 154. CrossRef
Hypoglycaemia in elderly patients with type 2 diabetes mellitus: a review of risk factors, consequences and prevention
Badieh Jafari, Mary E. Britton
Journal of Pharmacy Practice and Research.2015; 45(4): 459. CrossRef
HypoAware-a brief and partly web-based psycho-educational group intervention for adults with type 1 and insulin-treated type 2 diabetes and problematic hypoglycaemia: design of a cost-effectiveness randomised controlled trial
Stefanie MPA Rondags, Maartje de Wit, Maurits W van Tulder, Michaela Diamant, Frank J. Snoek
BMC Endocrine Disorders.2015;[Epub] CrossRef
Hypoglycemia in Emergency Department
Yu-Jang Su, Chia-Jung Liao
Journal of Acute Disease.2015; 4(1): 59. CrossRef
Should Sulfonylureas Remain an Acceptable First-Line Add-on to Metformin Therapy in Patients With Type 2 Diabetes? Yes, They Continue to Serve Us Well!
Martin J. Abrahamson
Diabetes Care.2015; 38(1): 166. CrossRef
Association Between Hypoglycemia and Fall-Related Events in Type 2 Diabetes Mellitus: Analysis of a U.S. Commercial Database
Sumesh Kachroo, Hugh Kawabata, Susan Colilla, Lizheng Shi, Yingnan Zhao, Jayanti Mukherjee, Uchenna Iloeje, Vivian Fonseca
Journal of Managed Care & Specialty Pharmacy.2015; 21(3): 243. CrossRef
Continuous subcutaneous delivery of exenatide via ITCA 650 leads to sustained glycemic control and weight loss for 48 weeks in metformin-treated subjects with type 2 diabetes
Robert R. Henry, Julio Rosenstock, Douglas Logan, Thomas Alessi, Kenneth Luskey, Michelle A. Baron
Journal of Diabetes and its Complications.2014; 28(3): 393. CrossRef
Management of Diabetes Medications for Patients Undergoing Ambulatory Surgery
Mary Ann Vann
Anesthesiology Clinics.2014; 32(2): 329. CrossRef
Principales factores asociados al coste de la diabetes mellitus tipo 2: revisión de la literatura
Silvia Paz, Diego González Segura, Anna Raya Torres, Luis Lizan
Avances en Diabetología.2014; 30(2): 34. CrossRef
Incidence of hypoglycaemia associated with transient loss of consciousness. A retrospective cohort study
A. Lagi, S. Cencetti, F. Lagi
International Journal of Clinical Practice.2014; 68(8): 1029. CrossRef
Hypoglycemia in Patients with Type 1 Diabetes: Epidemiology, Pathogenesis, and Prevention
Omodele Awoniyi, Rabia Rehman, Samuel Dagogo-Jack
Current Diabetes Reports.2013; 13(5): 669. CrossRef
Diabetes: support for those at risk of malnutrition in the community
Siobhan Hughes
British Journal of Community Nursing.2012; 17(11): 529. CrossRef
Diabetes patients at risk of malnutrition
Siobhan Hughes
Independent Nurse.2012;[Epub] CrossRef
Type 2 diabetes: the evolution of a disease
Harold E Lebovitz
The British Journal of Diabetes & Vascular Disease.2012; 12(6): 290. CrossRef
Severe Hypoglycemia in Patients with Diabetes
Jae Seung Yun, Seung-Hyun Ko
Diabetes & Metabolism Journal.2012; 36(4): 273. CrossRef

The Association between Midnight Salivary Cortisol and Metabolic Syndrome in Korean Adults: Yun-Mi Jang, Eun Jung Lee, Dong Lim Kim, Suk Kyeong Kim, Kee-Ho Song; Diabetes Metab J. 2012;36(3):245-250. Published online June 14, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.3.245

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Background

The common characteristics of metabolic syndrome (MetS) and Cushing's syndrome suggest that excess cortisol may be involved in the pathogenesis of MetS. Salivary cortisol measurements are simple and can be surrogates for plasma free cortisol, which is the most biologically active form. We evaluated the association between levels of midnight salivary cortisol and MetS in Korean adults.

Methods

A total of 46 subjects, aged 20 to 70 years, who visited the Health Care Center at Konkuk University Hospital from August 2008 to August 2009 were enrolled. We compared the levels of midnight salivary cortisol in subjects with MetS with those in subjects without MetS. We analyzed the associations between midnight salivary cortisol levels and components of MetS.

Results

Midnight salivary cortisol levels were higher in the MetS group (70±42.4 ng/dL, n=12) than that in the group without MetS (48.1±36.8 ng/dL, n=34) (P=0.001). Positive correlations were observed between midnight salivary cortisol levels and waist circumference, fasting blood glucose, and homeostasis model assessment of insulin resistance. The risk for MetS was significantly higher in subjects with midnight salivary cortisol levels ≥100 ng/dL than in those with levels <50 ng/dL (odds ratio, 5.9; 95% confidence interval, 2.35 to 36.4).

Conclusion

The results showed a positive correlation between midnight salivary cortisol levels and MetS, suggesting that hypercortisolism may be related to MetS.

Citations

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Evaluation of salivary endothelin-1 as a biomarker for oral cancer and precancer
Sumaiya Irfan, Noorin Zaidi, Kshama Tiwari, Nirupma Lal, Anand Narayan Srivastava, Shivangi Singh
Journal of Cancer Research and Therapeutics.2023;[Epub] CrossRef
Association of primary allostatic load mediators and metabolic syndrome (MetS): A systematic review
Francis Osei, Andrea Block, Pia-Maria Wippert
Frontiers in Endocrinology.2022;[Epub] CrossRef
Salivary cortisol levels during Ramadan fasting in hydrocortisone-treated secondary adrenal insufficiency patients
Melika Chihaoui, Wiem Madhi, Meriem Yazidi, Bessem Hammami, Ibtissem Oueslati, Nadia Khessairi, Wafa Grira, Amina Bibi, Moncef Feki, Fatma Chaker
Endocrine.2020; 70(2): 404. CrossRef
Basal cortisol levels and metabolic syndrome: A systematic review and meta-analysis of observational studies
Anderson Garcez, Heloísa Marquardt Leite, Elisabete Weiderpass, Vera Maria Vieira Paniz, Guilherme Watte, Raquel Canuto, Maria Teresa Anselmo Olinto
Psychoneuroendocrinology.2018; 95: 50. CrossRef
Is salivary gland function altered in noninsulin-dependent diabetes mellitus and obesity–insulin resistance?
Jitjiroj Ittichaicharoen, Nipon Chattipakorn, Siriporn C. Chattipakorn
Archives of Oral Biology.2016; 64: 61. CrossRef
The Role of Cortisol in the Pathogenesis of the Metabolic Syndrome
In-Kyung Jeong
Diabetes & Metabolism Journal.2012; 36(3): 207. CrossRef

An Analysis of Medical Costs of Diabetic Patients in a University Hospital (1996~2005).: Ki Hong Chun, Kwan Woo Lee, Dae Jung Kim, Hae Jin Kim, Kyung Won Paek, Soo Jin Lee; Korean Diabetes J. 2008;32(4):366-376. Published online August 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.4.366

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Abstract PDF

BACKGROUND
The aim of this research was to find out the costs of diabetes, as research in a prospective cohort study looking into the development of diabetic complications followed by treatment intervention by a medical institution. The research compared the changes in medical costs by following-up on the treatment details of diagnosed diabetes for the last 10 years in a university hospital. METHODS: The research used data of outpatient, inpatient, pharmaceutical and total medical costs, from 1996 to 2005, of individual patients who were diagnosed with diabetic patients, to analyze the outpatient and inpatient total medical cost changes over the years. RESULTS: After antidiabetic drug, in the case of outpatient treatment, pharmaceutical costs increased on average by about 25,000 won a month for diabetic patients without complications and by 35,000 won for diabetic patients with microvascular complications. Outpatient medical costs were affected after drug treatment by as much of an increase as created by the pharmaceutical costs. The total medical costs, that is the sum of inpatient and outpatient costs, decreased by 30~40% compared to that before drug treatment. In the case of total medical cost, MI or ESRD cost 2~3 times more in pharmaceutical costs than before the development of complications. The total medical costs of diabetic patients with CVA, MI and ESRD complications increased in the first year after development of the complication, and this was followed by a decrease in the next year, showing a tendency to remain constant with no increase or decrease over subsequent years. This means that the total medical costs of patients with complications remain continuously large throughout the life of the diagnosed patient. CONCLUSION: For diabetic patients, pharmaceutical costs are the most important factor in determining outpatient medical costs.

Citations

Citations to this article as recorded by

Outcome Research in Diabetes
Kwan Woo Lee
Journal of Korean Diabetes.2011; 12(1): 2. CrossRef
Costs of Diabetes Mellitus in Korea
Kwan Woo Lee
Diabetes & Metabolism Journal.2011; 35(6): 567. CrossRef

Clinical Characteristics and Direct Medical Costs of Type 2 Diabetic Patients.: Eun Joon Moon, Young Eun Jo, Tae Chin Park, Yun Kyung Kim, Sun Hye Jung, Hae Jin Kim, Dae Jung Kim, Yoon Sok Chung, Kwan Woo Lee; Korean Diabetes J. 2008;32(4):358-365. Published online August 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.4.358

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Abstract PDF

BACKGROUND
Type 2 diabetes mellitus is an expensive chronic metabolic disorder and its prevalence has been increasing rapidly in South Korea, owing to a westernized lifestyle. We analyzed the annual direct medical costs attributable to type 2 diabetes and its chronic complications in Korea retrospectively. METHODS: We randomly selected 1,051 patients with type 2 diabetes who visited Ajou University Hospital as an outpatient in 2005. Clinical characteristics, duration of diabetes, and microvascular and macrovascular complications were assessed from a medical chart review. The annual direct medical costs included insurance covered and uncovered medical costs. RESULTS: Of the 1,051 patients with type 2 diabetes, 48.2% had at least one microvascular complication, 5.6% had at least one macrovascular complication, and 12.4% of the patients had both microvascular and macrovascular complications. The average annual direct medical cost was found to be 3,348,488won per patient. In patients with microvascular complications, the total cost of management was increased 1.4 times compared to those without complications. Direct medical costs for patients with macrovascular complications were 2.1-fold as high as patients with no complications. Those patients with both microvascular and macrovascular complications, increased costs by 3.1-fold over those without complications. CONCLUSION: Chronic complications have a substantial impact on the direct medical costs of type 2 diabetes. The prevention of chronic diabetic complications will not only influence the mortality and morbidity of patients with type 2 diabetes, but also potentially reduce medical costs.

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Importance of family history of diabetes in computing a diabetes risk score in Korean prediabetic population
Morena Ustulin, Sang Youl Rhee, Suk Chon, Kyu Keung Ahn, Ji Eun Lim, Bermseok Oh, Sung-Hoon Kim, Sei Hyun Baik, Yongsoo Park, Moon Suk Nam, Kwan Woo Lee, Young Seol Kim, Jeong-Taek Woo
Scientific Reports.2018;[Epub] CrossRef
Features of Long-Standing Korean Type 2 Diabetes Mellitus Patients with Diabetic Retinopathy: A Study Based on Standardized Clinical Data
Sejeong Park, Sang Youl Rhee, Su Jin Jeong, Kiyoung Kim, Suk Chon, Seung-Young Yu, Jeong-Taek Woo
Diabetes & Metabolism Journal.2017; 41(5): 393. CrossRef
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Cho-Rong Kim, Yun-Mi Song, Jin-Young Shin, Wook Gim
Korean Journal of Family Medicine.2016; 37(1): 51. CrossRef
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Kyoung Hwa Ha, Dae Jung Kim
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Jin-Won Noh, Young Dae Kwon, Jin-Hee Jung, Kang Hee Sim, Hee-Sook Kim, Minjae Choi, Jumin Park
The Journal of Korean Diabetes.2015; 16(4): 293. CrossRef
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Eun-Kyong Kim, Sang Gyu Lee, Youn-Hee Choi, Kyu-Chang Won, Jun Sung Moon, Anwar T Merchant, Hee-Kyung Lee
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Kwan Woo Lee
Journal of Korean Diabetes.2011; 12(1): 2. CrossRef
Costs of Diabetes Mellitus in Korea
Kwan Woo Lee
Diabetes & Metabolism Journal.2011; 35(6): 567. CrossRef
The Epidemiology of Diabetes in Korea
Dae Jung Kim
Diabetes & Metabolism Journal.2011; 35(4): 303. CrossRef
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Korean Diabetes Journal.2009; 33(5): 357. CrossRef
Management of Diabetic Mellitus in Low-income Rural Patients
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The Korean Journal of Gastroenterology.2009; 54(3): 167. CrossRef

Direct Medical Costs of Type 2 Diabetic Patients in the Tertiary Hospital.: Joo An Hwang, Tae Chin Park, Sun Hye Jung, Hae Jin Kim, Dae Jung Kim, So Hun Kim, Moon Suk Nam, Tae Hyun Kim, Moon Kyu Lee, Kwan Woo Lee; Korean Diabetes J. 2008;32(3):259-268. Published online June 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.3.259

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Abstract PDF

BACKGROUND
Type 2 diabetes mellitus is a common, chronic and costly disease. Its prevalence is rapidly increasing worldwide. Diabetes has big economic burden mainly because of its chronic complications. We analyzed the annual direct medical costs of type 2 diabetic patients, including the costs associated with its complications in Korea retrospectively. METHODS: We enrolled 531 type 2 diabetic patients who had been treated in the 3 Tertiary Hospital in 2005. Clinical characteristics, duration of diabetes, modality of glycemic control, and presence of microvascular and macrovascular complications were assessed by the review of medical records. The annual direct medical costs were assessed using the hospital electronic database and included insurance covered and uncovered medical costs. RESULTS: The annual direct medical costs of type 2 diabetic patients without any complications was 1,184,563 won (95% CI for mean: 973,006~1,396,121 won). Compared to diabetic patients without complications, annual total medical costs increased 4.7-fold, 10.7-fold, and 8.8-fold in patients with microvascular complications, macrovascular complications and both complications, respectively. Hospitalization costs largely increased by 78.7-fold and 61.0-fold in patients with macrovascular complications and both complications, respectively. Major complications to increase medical costs were kidney transplantation (23.1-fold), dialysis (21.0-fold), PTCA or CABG (12.4-fold), and leg amputation (11.8-fold). The total medical costs dramatically increased according to the stage of diabetic retinopathy and nephropathy. CONCLUSION: Diabetic complications have a substantial impact on the direct medical costs of type 2 diabetic patients. The prevention of diabetic complications will benefit the patients as well as the overall healthcare expenditures.

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Sera Lee, Miyoung Ock, Hun‐Sung Kim, Hyunah Kim
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The effect of continuity of care on the incidence of end-stage renal disease in patients with newly detected type 2 diabetic nephropathy: a retrospective cohort study
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The Journal of Korean Diabetes.2016; 17(1): 11. CrossRef
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Kwan Woo Lee
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Costs of Diabetes Mellitus in Korea
Kwan Woo Lee
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How Much Amount of Socioeconomic Loss Is Caused by Digestive Diseases?
Kyung Sik Park
The Korean Journal of Gastroenterology.2011; 58(6): 297. CrossRef

Current Status of the Continuity of Ambulatory Diabetes Care and its Impact on Health Outcomes and Medical Cost in Korea Using National Health Insurance Database.: Jaiyong Kim, Hyeyoung Kim, Hwayoung Kim, Kyung Wan Min, Seok Won Park, Ie Byung Park, Jeong Hyun Park, Sei Hyun Baik, Hyun Shik Son, Chul Woo Ahn, Jee Young Oh, Sunhee Lee, Juneyoung Lee, Choon Hee Chung, Kyung Mook Choi, Injeoung Choi, Dae Jung Kim; Korean Diabetes J. 2006;30(5):377-387. Published online September 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.5.377

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Abstract PDF

BACKGROUND
The continuity of care in chronic diseases, especially in diabetes, was emphasized from many studies. But large scale studies with long-term observation which confirm the impact of continuity of care on health outcomes are rare. This study tried national level 3 year observation to find differences in hospitalization, mortality and medical costs among patient groups with different utilization pattern. METHODS: The 1,088,564 patients with diabetes diagnosis and diabetes drug prescription in 2002, from 20 to 79 years old, and survived until the end of 2004 were included. Annual drug prescription days, number of visited clinics and quarterly continuity of care were measured. Gender, age group, living area, health insurance premium level (as a proxy of the income level), years of first DM diagnosis, five co-morbidities (hypertension, heart disease, stroke, renal disease, admission with DM), hospitalization experience and the type of main attending clinic were adjusted. Hospitalization, mortality and high costs group (top quintile) in 2005 were predicted by multiple logistic regression model. RESULTS: Patients who failed in continuity of care in 2003 and 2004 showed higher hospitalization (OR =1.29), higher mortality (OR =1.75) and they are more likely to be high costs group (OR =1.34) in 2005 than who fulfilled the continuity of care. Patients who have single attending clinic also showed lower hospitalization, lower mortality and lower cost. Completeness in diabetic drug prescription were correlated with lower hospitalization, lower mortality but with higher cost. Possible cost saving from continual care with single attending clinic was estimated at Won 417 billion (Dollar 1 = Won 943.7). Possible expenditure from complete drug prescription was Won 228 billion. So, net saving was Won 139 billion in our study population. CONCLUSION: Continual care and single attending clinic saves patient's life and national costs. Fragmented primary care system in Korea should be reformed for more effective care of chronic diseases. National Health Insurance Database in Korea enables nationwide long-term observation study which overcomes the many limitations found in hospital-based studies and cross-sectional surveys.

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Current Status of Diabetic Foot in Korean Patients Using National Health Insurance Database.: Choon Hee Chung, Dae Jung Kim, Jaiyong Kim, Hyeyoung Kim, Hwayoung Kim, Kyung Wan Min, Seok Won Park, Jeong Hyun Park, Sei Hyun Baik, Hyun Shik Son, Chul Woo Ahn, Jee Young Oh, Sunhee Lee, Juneyoung Lee, Kyung Mook Choi, Injeoung Choi, Ie Byung Park; Korean Diabetes J. 2006;30(5):372-376. Published online September 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.5.372

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Abstract PDF

BACKGROUND
Foot ulcer diseases are more prevalent in diabetic patients than that those of non-diabetic patients. Several reports showed the risk of amputation and the medical cost were increased when foot ulcer developed. Therefore, strict glycemic control from the initial period of diabetes is necessary. Since there is no enough epidemiologic data, large scaled studies for medical and economic consequences about diabetic foot ulcer are needed. METHODS: This study was based on health insurance claims submitted to the National Health Insurance Review Agency during the period from December 1994 through December 2002. We investigated the incidence and medical cost of foot disorders in Korean population using the disease-classification codes on the health insurance claim forms. RESULTS: The incidences of foot disorders (per 100,000 of population) were 49.7 for amputations, 99.7 for ulcers, and 1,051 for injuries in diabetic patients, and 4.2 for amputations, 10.3 for ulcers, and 943 for injuries in non-diabetic patients. Relative risk of the incidences of foot amputation, ulcer, and injury in diabetic patients comparing with non-diabetic patients were 11.7, 9.7, and 1.1, respectively. Total medical costs (per capita) of foot amputation, ulcer, and injury in diabetic patients were 2.0, 1.7, and 2.1 times higher, respectively, than those of non-diabetic patients. Mean hospital stay of foot amputation, ulcer, and injury in diabetic patients were 1.6, 1.3, and 1.7 times more, respectively, than those of non-diabetic patients. CONCLUSION: In diabetic patients, the incidences of foot amputation and ulcer are higher than those of non-diabetic patients. To reduce those incidences, we need to early strict glycemic control as well as government based management.

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Regional Variation in the Incidence of Diabetes-Related Lower Limb Amputations and Its Relationship with the Regional Factors
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The Quality of Medical Care Provided to Homeless Diabetes Patients in a General Hospital in Seoul, and the Prevalence of Diabetes Comorbidities
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Chong Rye Song, Yong Soon Kim, Jin Hyun Kim
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Ie Byung Park, Jaiyong Kim, Dae Jung Kim, Choon Hee Chung, Jee-Young Oh, Seok Won Park, Juneyoung Lee, Kyung Mook Choi, Kyung Wan Min, Jeong Hyun Park, Hyun Shik Son, Chul Woo Ahn, Hwayoung Kim, Sunhee Lee, Im Bong Lee, Injeoung Choi, Sei Hyun Baik
Diabetes & Metabolism Journal.2013; 37(4): 233. CrossRef
Treatment of Diabetic Foot Ulcer Using Matriderm In Comparison with a Skin Graft
Hyojin Jeon, Junhyung Kim, Hyeonjung Yeo, Hoijoon Jeong, Daegu Son, Kihwan Han
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Current Status of Diabetic End-Stage Renal Disease Using Korean Health Insurance Database.: Dae Jung Kim, Jaiyong Kim, Hyeyoung Kim, Kyung Wan Min, Seok Won Park, Ie Byung Park, Jeong Hyun Park, Sei Hyun Baik, Hyun Shik Son, Chul Woo Ahn, Jee Young Oh, Sunhee Lee, Juneyoung Lee, Choon Hee Chung, Kyung Mook Choi, Injeoung Choi, Hwayoung Kim; Korean Diabetes J. 2006;30(5):355-362. Published online September 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.5.355

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Abstract PDF

BACKGROUND
Diabetes is becoming one of the main causes of end-stage renal disease (ESRD) worldwide. We studied the prevalence and incidence of end-stage renal disease (ESRD) in the Korean population based on health insurance claims submitted to the Health Insurance Review Agency. We also investigated the proportion of medications taken by the ESRD patients, and frequency of hospital admission or visits, and medical expenses between ESRD patients with and without diabetes. METHODS: This study was based on health insurance claims submitted to the Health Insurance Review Agency during the period from January 2001 through December 2003. Using the disease-classification codes on the health insurance claim forms, those who were diagnosed with chronic renal disease (N18 or N19) and received dialysis-related treatment (Z49), treatment with a kidney dialysis machine (Z99.2), or kidney transplantation (Z94.0) were defined as ESRD patients. Among the ESRD patients, those who were diagnosed with diabetes (E10-E14) and/or took anti-diabetic drugs were defined as ESRD patients with diabetes. RESULTS: The ESRD patients totaled 33,870 in 2001, 37,894 in 2002, and 41,167 (858.3 per million population) in 2003. ESRD patients with diabetes increased to 56.7% in 2003. The number of ESRD patients in whom renal replacement therapy was initiated was 8,134 in 2002 and 8,322 (173.5 per million population) in 2003. ESRD patients with diabetes used more anti-hypertensive drugs (1.2 times as many), lipid-lowering drugs (1.6 times), and anti-platelet agents (1.8 times) than did ESRD patients without diabetes. In 2003, 66.5% of the ESRD patients with diabetes were hospitalized, which was 1.6 times the hospital admissions of ESRD patients without diabetes. ESRD patients with diabetes also had hospital stays that were 1.6 times longer per patient and inpatient service expenses that were 1.6times greater per patient, compared with those reported for ESRD patients without diabetes. CONCLUSION: The incidence of ESRD accompanied by diabetes has risen rapidly. Given the burden of medical treatment costs placed on ESRD patients with diabetes, more aggressive interventions should be implemented to prevent diabetes and renal complications among patients with diabetes.

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International Journal of Nursing Practice.2015; 21(6): 780. CrossRef
The Quality of Medical Care Provided to Homeless Diabetes Patients in a General Hospital in Seoul, and the Prevalence of Diabetes Comorbidities
Sun Hee Beom, Moo Kyung Oh, Chul Woo Ahn
Korean Journal of Medicine.2014; 86(5): 585. CrossRef
Diabetes Epidemics in Korea: Reappraise Nationwide Survey of Diabetes "Diabetes in Korea 2007"
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Diabetes & Metabolism Journal.2013; 37(4): 233. CrossRef
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Hye Soo Kim, Suk Young Kim
Korean Journal of Transplantation.2009; 23(2): 123. CrossRef

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