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Individualizing blood glucose goals cuts costs, improves quality of life

Neda Laiteerapong

An individualized approach to glucose control for adults with type 2 diabetes in the United States resulted in reduced costs and increased quality of life compared with uniform intensive control approaches, according to data published in Annals of Internal Medicine.

“To date, the clinical implications and economic value of individualizing glycemic goals have not been examined,” Neda Laiteerapong, MD, MS, FACP, assistant professor of general internal medicine in the department of medicine and associate director of the Center for Chronic Disease Research and Policy at the University of Chicago, and colleagues wrote. “It is highly unlikely that diabetes trials will be designed to compare the lifetime effects of individualized vs. uniform intensive glycemic control. Without these analyses, the need for policymakers to prioritize individualized diabetes care is uncertain.”

According to the American Diabetes Association, diabetes costs an estimated $245 billion annually in the United States. Researchers compared average lifetime costs, life-years and quality-adjusted life-years (QALYs) between individualized glycemic control and uniform intensive control among patients with type 2 diabetes. They estimated the cost-effectiveness of the two approaches using data from the 2011 to 2012 National Health and Nutrition Examination Survey. There were 569 participants who met inclusion criteria, representing approximately 17.3 million U.S. adults with diabetes diagnosed at age 30 years or older.

In total, the individualized glycemic control strategy saved $13,547 per patient compared with the uniform intensive control approach ($105,307 vs. $118,854 lifetime costs), mostly because of lower medication costs ($34,521 vs. $48,763). Individualized control lowered life expectancy (20.63 vs. 20.73 years) because of an increase in complications; however, individualized control yielded more QALYs (16.68 vs. 16.58) due to fewer hypoglycemic events and medications. Sensitivity analysis showed that individualized control was cost-saving and generated more QALYs compared with uniform intensive control, excluding analyses where the disutility associated with taking diabetes drugs was cut by at least 60%. According to the researchers, the $13,547 saved per patient using an individualized glycemic control strategy could amount to a $234 billion lifetime savings nationwide.

“Individualizing blood glucose goals does not have to be hard,” Laiteerapong told Healio Internal Medicine. “For providers, it involves an understanding of each patient’s clinical history — how long have they had diabetes? Do they have complications from diabetes? Do they have other active chronic diseases? — and then a conversation with the patient about their preferences regarding medications and their blood sugars. However, if a health care system judges the quality of care based on uniform blood glucose goals, then it may be hard for providers to individualize goals, even if they wanted to.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.