Type 2 diabetes is a chronic metabolic condition where blood sugar levels are increased. It is a costly disease mainly because over time, patients develop complications such as kidney, liver or eye problems which require significant use of healthcare resources. The reasons behind why some patients develop complications and some not are not fully understood. It is believed that not achieving low average levels of blood sugars are the main responsible behind these complications but other factors such as sex, ethnicity and deprivation have been shown to take a part as well. To date, the estimations of how much treating diabetes costs are outdated. Most studies estimate it in a particular moment in time, when the way the disease progresses suggests the costs will increase over time. In this study, we aim to assess how much the costs of treating diabetes changes up to 10 years following diagnosis. We will focus on how variables such as sex, ethnicity and deprivation impact these costs and their progression. Knowing the exact point where complications start arising and health care costs increasing, might help us to better understand how and when to intervene to decrease complications and their associated costs.
The rapidly increasing prevalence of type 2 diabetes (T2D) impacts severely health care systems use resulting in high costs. At least 10% of the NHS budget is devoted to treat the condition and its complications. Despite lifestyle changes and pharmacological interventions, some patients fail to achieve optimal HbA1c levels leading to complications and higher costs. Social variables such as sex, ethnicity and socioeconomic status have been associated with poor treatment outcomes. While there is data on the costs associated with treating T2D, these are point and prevalence estimates that do not take into account the progressive nature of the disease. Furthermore, the extent to which glycaemic control impacts healthcare resource use over time has not been clearly assessed. This project aims to evaluate how healthcare resource use and costs of treating T2D changes over the course of the disease. Patients with newly diagnosed T2D will be matched with non T2D patients by GP surgery and age. Healthcare resource use and costs for each year following the diagnosis of T2D will be quantified and the effect of IMD, and ethnicity assessed on glycaemic control, on the excess costs of diabetes and on health outcomes. For costs of healthcare resource utilisation, we will calculate absolute costs as total mean individual annual costs with 95% confidence intervals. Healthcare resource use and cost profiles by ethnicity and IMD will be generated to estimate single year's per capita health care expenditure and then transformed into a longitudinal pattern of expenditure to assess changes over time. The relevance of the study lies on the need to assess the trajectory and progression of the costs associated to T2D treatment, identifying the moment where these costs start increasing and its accelerators. These data would help identify where interventions are needed to decrease costs and improve health outcomes.
The primary outcome will be change in healthcare resource use from diagnosis to follow up (between 1 – 10 years).
The secondary outcomes will be
i) Number of primary care consultations;
ii) Number of referrals to secondary care;
iii) Inpatient admissions;
iv) Outpatient attendance;
v) Average length of stay:
vi) Change in prescriptions:
vii) Diagnoses of other health conditions;
viii) Time to diabetes complications;
ix) Time to insulin initiation
Khalida Ismail - Chief Investigator - King's College London (KCL)
Dulce Alarcon-Yaquetto - Corresponding Applicant - King's College London (KCL)
Alex Dregan - Collaborator - King's College London (KCL)
James Shearer - Collaborator - King's College London (KCL)
HES Admitted Patient Care;HES Outpatient;Patient Level Index of Multiple Deprivation