Public Release: 

Personalized blood glucose goals could save billions of dollars over time

American College of Physicians

1. Personalized blood glucose goals could save billions nationally, mainly due to decreased medication costs
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0537
URLs go live when the embargo lifts

An individualized approach to glucose control in type 2 diabetes can save billions of dollars over time nationwide due to decreased medication costs and would slightly improve quality of life compared with uniform intensive control (HbA1C level < 7 percent). Findings from a cost analysis study are published in Annals of Internal Medicine.

Diabetes is a substantial public health and financial burden in the U.S., costing an estimated $245 billion annually. As such, understanding the cost-effectiveness of treatment is imperative. Previously, the American Diabetes Association (ADA) recommended intensive glycemic control for all patients with type 2 diabetes, in part based on cost-effectiveness data. Since then, several studies have shown that intensive glycemic control may be associated with more harm than benefit for some patients and, therefore, a more individualized approach could be warranted. However, the cost-effectiveness of this approach is not known.

Researchers at the University of Chicago Medicine used a statistical model that calculated health care costs over the average expected lifetime for 569 patients in the National Health and Nutrition Examination Survey (NHANES) who were 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.

The model showed that 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 diabetes, this could amount to a $234 billion lifetime savings nationwide.

Media contacts: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Neda Laiteerapong, MD, MS, FACP, please contact Matt Wood at Matthew.Wood@uchospitals.edu or 773-702-5894.

2. Collaboration between EMS and primary care physicians could reduce unnecessary emergency transport for fallen seniors
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0969
Editorial Abstract: http://annals.org/aim/article/doi/10.7326/M17-2968
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A protocol that couples paramedic assessment with primary care physician consultation and timely follow up significantly reduced unnecessary ambulance transport for fallen elderly residents of assisted living facilities. The findings of a prospective cohort study are published in Annals of Internal Medicine.

Unintentional falls are the leading cause of nonfatal injury for adults aged 65 years or older who are treated in emergency departments in the United States. Residents of assisted living facilities who fall may not be seriously hurt, but policy still dictates that they be transported to the emergency department. These policies burden the health care system and place patients at risk for harms, such as unnecessary tests or exposure to infection. Therefore, limiting unnecessary transport is desirable.

Researchers from Wake County Emergency Medical Services sought to determine whether unnecessary transport to the emergency department could safely be avoided for patients who experienced a ground-level fall in an assisted living facility. Wake County Emergency Medical Services collaborated with Doctors Making Housecalls, a group of primary care physicians specializing in home care for older adults, to develop a protocol for specially trained paramedics to identify a subset of patients who would not be transported to the emergency department but instead would be scheduled for a visit with a primary care provider within 18 hours of the call for emergency medical services.

The study involved a convenience sample of 953 residents, 359 of whom had 840 ground-level falls over 43 months. The protocol recommended nontransport after 553 falls, which marked a substantial decrease (62.9 percent) in transports. The researchers concluded that 98 to 99 percent of nontransported patients received safe, appropriate care. If implemented on a widespread basis, this approach could potentially avoid large numbers of unnecessary ambulance transports to the emergency department for simple falls.

Media contacts: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Jefferson G. Williams, MD MPH, please contact Jeffrey Hammerstein at jeffrey.hammerstein@wakegov.com or 919-856-6579.

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URLs go live when the embargo lifts

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