Comorbidities complicate the burden of diabetes

by Michael Fronstin | May 24, 2016

That diabetes is a worldwide health epidemic is no longer even debatable. We’ve moved far beyond “Is diabetes a problem?” to “What can we do to slow the acceleration of this trend and help control patients’ complications?”

Like in many countries, the United States has named diabetes as a priority for long-term health strategies. The Healthy People 2020 campaign has a goal to “reduce the disease and economic burden of diabetes mellitus and improve the quality of life for all persons who have, or at risk for, diabetes.”[1]

The campaign also mentions the very real concern of substantial increases in diabetes-related complications. Many comorbidities related to lack of disease control are associated with diabetes, but how do these actually affect patients’ lives and their use of healthcare resources?

New data from the National Health and Wellness Survey (NHWS), presented today at ISPOR’s annual international meeting, looks at the real-world impact of diabetes-related complications:

  • Neuropathy
  • Cardiovascular
  • Direct complications (macular edema, retinopathy, kidney disease, and/or foot/leg ulcer; excluding neuropathy and end-organ damage)
  • Combined complications (excluding end-organ damage)
  • End-organ damage

Neuropathy – or weakness, numbness and pain from nerve damage, typically in the hands and feet – is the most prevalent comorbid condition for diabetes patients. Unsurprisingly it also has a greatly negative affect on patients’ mental and physical quality of life; only patients with multiple complications have lower quality of life. People with diabetes and neuropathy also experienced worse work productivity and higher activity impairment compared with people with diabetes and no complications.

These unwanted health outcomes led to a greater burden on the healthcare system. Diabetes patients with comorbid neuropathy had nearly twice as many hospitalizations and ER visits as patients with no complications. However, the greatest burden on the healthcare system comes from patients with multiple complications and end-organ damage. People with diabetes and multiple complications or end-organ damage had approximately three times as many hospitalizations and ER visits.

Complications from diabetes not only place an undue burden on patients’ quality of life and ability to participate in activities they enjoy, but also on their employers through lost work and healthcare providers and payers through increased use of health resources. Understanding the types of complications that diabetes patients experience and their real-world impact can help improve targeted, effective management of the disease and the overall health outcomes of patients.

[1] Office of Disease Prevention and Health Promotion. 2020 Topics & Objectives: Diabetes.  https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes. Accessed 11 May 2016.

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