Resource use associated with type 2 diabetes in 24 countries in Asia, Latin America, the Middle East and Africa

MECHICHE S; RINGBORG A; LINDGREN P; BENGT T; RAMACHANDRAN A; GAGLIARDINO JJ

Rome

Congreso; 44th EASD Annual Meeting; 2008

Background and aims: There is a paucity of data on the economic burden imposed by type 2 diabetes (T2DM) in the developing world. The aim of this study was to estimate average quantities of diabetes-related resource use among T2DM patients in 24 countries in Asia, Latin America, the Middle East and Africa and to investigate predktors of resource use in each region. Materials and methods: Cross-sectional observational data on diabetes-related resource use were col!ected from 15,016 patients with T2DM within the second wave of the International Diabetes Management Practkes Study (IDMPS). Mean (SD) and median (min-max) annual quantities were determined using a prevalence-based approach and predictors of diabetes-related resource use investigated using negative binomial regression. Analyses were conducted using available-case/complete-case methods as well as with missing values imputed. Results: The mean (SD) age of study patients recruited in Asia (n=4678), Latin Amerka (n=6090) and the Middle East & Afrka (n=4248) was 57 (12), 60 (12) and 57 (11) years, respectively, and mean diabetes duration was 8 (7), 10(9) and 8 (7) years. On average, patients made 3.4, 5.4 and 2.5 GP visits per year while the average number of specialist visits was 8.2, 6.3 and 5.0 per year in Asia, Latin Amerka and the Middle East & Afrka, respectively. Among patients visiting a GP during the 3-month recal! period, the median (min-max) numberofvisits was 2 (1-20), 2 (1-24) and I (1-12) in the respective regions and among those visiting a specialist the median (min-max) number of visits per 3 months was 2 (1 -30), 2 (1 -12) and I (1 -18). Thefrequency ofhospitalisation was 8.5%, 6.5% and 8.8% and the mean (SD) number of inpatient days amounted to 3.8 (18.1), 2.2 (13.9) and 2.6 (13.5) per year in the respective regions. Results of the negative binomial regression models pointed to the major influence of diabetes- related complications on resource use. The proportion of patients with mkrovascular complications was 51% in Asia, 40% in Latin America and 40% in the Middle East & Africa and the corresponding proportions with macrovascular complications were 20%, 22% and 23%. In Asia, the presence of macrovascular complications was associated with a 5.5 times higher expected annual rate of inpatient days (incidence rate ratio (IRR) 5.5,95% CI 2.8-10.9, n=3243). In the Middle East & Africa, the expected rate of inpatient days was 7.9 times greater for patients with macrovascular complications (IRR 7.9, 95% CI 3.9-15.8, n=2622) and 2.4 times greater for patients with microvascular complications (IRR 2.4, 95% CI 1.5-3.5, n=2630). The etfect of complications on resource use was equal!y pronounced in Latin America, where inadequate glycemic control (HbAlc2:7%) was identified as an additional predictor of hospitalisation. Conclusion: The status of mkro- and macrovascular complications as major predictors of resource use in T2DM demonstrates the heaIth economic importance of early diagnosis and treatment.