This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (172)  • Contact me when this article is cited  Related Content  • Related letter  • Related article  • Similar articles in JAMA  Social Bookmarking   What's this?

Edward H. Wagner, MD,MPH; Nirmala Sandhu, MPH; Katherine M. Newton, PhD; David K. McCulloch, MD; Scott D. Ramsey, MD,PhD; Louis C. Grothaus, MS

JAMA. 2001;285:182-189.

Context  Because of the additional costs associated with improving diabetes management, there is interest in whether improved glycemic control leads to reductions in health care costs, and, if so, when such cost savings occur.

Objective  To determine whether sustained improvements in hemoglobin A_1c (HbA_1c) levels among diabetic patients are followed by reductions in health care utilization and costs.

Design and Setting  Historical cohort study conducted in 1992-1997 in a staff-model health maintenance organization (HMO) in western Washington State.

Participants  All diabetic patients aged 18 years or older who were continuously enrolled between January 1992 and March 1996 and had HbA_1c measured at least once per year in 1992-1994 (n = 4744). Patients whose HbA_1c decreased 1% or more between 1992 and 1993 and sustained the decline through 1994 were considered to be improved (n = 732). All others were classified as unimproved (n = 4012).

Main Outcome Measures  Total health care costs, percentage hospitalized, and number of primary care and specialty visits among the improved vs unimproved cohorts in 1992-1997.

Results  Diabetic patients whose HbA_1c measurements improved were similar demographically to those whose levels did not improve but had higher baseline HbA_1c measurements (10.0% vs 7.7%; P<.001). Mean total health care costs were $685 to $950 less each year in the improved cohort for 1994 (P = .09), 1995 (P = .003), 1996 (P = .002), and 1997 (P = .01). Cost savings in the improved cohort were statistically significant only among those with the highest baseline HbA_1c levels (10%) for these years but appeared to be unaffected by presence of complications at baseline. Beginning in the year following improvement (1994), utilization was consistently lower in the improved cohort, reaching statistical significance for primary care visits in 1994 (P = .001), 1995 (P<.001), 1996 (P = .005), and 1997 (P = .004) and for specialty visits in 1997 (P = .02). Differences in hospitalization rates were not statistically significant in any year.

Conclusion  Our data suggest that a sustained reduction in HbA_1c level among adult diabetic patients is associated with significant cost savings within 1 to 2 years of improvement.

Author Affiliations: MacColl Institute for Healthcare Innovation (Drs Wagner and McCulloch and Ms Sandhu), Center for Health Studies (Dr Newton and Mr Grothaus), Group Health Cooperative of Puget Sound, and the Departments of Epidemiology (Dr Newton) and Health Services (Drs Wagner and Ramsey), School of Public Health and Community Medicine, and the Department of Medicine (Dr Ramsey), School of Medicine, University of Washington, Seattle.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTER

Glycemic Control and Health Care Costs for Patients With Diabetes
Len Pogach and Ed H. Wagner
JAMA. 2001;285(15):1963-1964.
EXTRACT | FULL TEXT  

RELATED ARTICLE

January 10, 2001
JAMA. 2001;285(2):229-230.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The burden of chronic disorders on hospital admissions prompts the need for new modalities of care: A cross-sectional analysis in a tertiary hospital
Hernandez et al.
QJM 2009;102:193-202.
ABSTRACT | FULL TEXT  

Costs and Benefits Associated With Diabetes Education: A Review of the Literature
Boren et al.
The Diabetes Educator 2009;35:72-96.
ABSTRACT | FULL TEXT  

Evidence On The Chronic Care Model In The New Millennium
Coleman et al.
Health Aff (Millwood) 2009;28:75-85.
ABSTRACT | FULL TEXT  

Third-Party Reimbursement for Diabetes Care, Self-Management Education, and Supplies
American Diabetes Association
Diabetes Care 2009;32:S85-S86.
FULL TEXT  

Characteristics of Diabetics with Poor Glycemic Control Who Achieve Good Control
Shani et al.
J Am Board Fam Med 2008;21:490-496.
ABSTRACT | FULL TEXT  

Synchronous Provider Visit and Self-management Education Improves Glycemic Control in Hispanic Patients With Long-Standing Type 2 Diabetes
Gold et al.
The Diabetes Educator 2008;34:990-995.
ABSTRACT | FULL TEXT  

Financial and Clinical Impact of Team-Based Treatment for Medicaid Enrollees With Diabetes in a Federally Qualified Health Center
Scanlon et al.
Diabetes Care 2008;31:2160-2165.
ABSTRACT | FULL TEXT  

Evaluation of pharmacist-managed diabetes mellitus under a collaborative drug therapy agreement
Anaya et al.
Am J Health Syst Pharm 2008;65:1841-1845.
ABSTRACT | FULL TEXT  

Health Care Use and Costs Associated With Use of a Health Club Membership Benefit in Older Adults with Diabetes
Nguyen et al.
Diabetes Care 2008;31:1562-1567.
ABSTRACT | FULL TEXT  

Effect of insulin pen devices on the management of diabetes mellitus
Meece
Am J Health Syst Pharm 2008;65:1076-1082.
FULL TEXT  

Spanish Diabetes Self-Management With and Without Automated Telephone Reinforcement: Two randomized trials
Lorig et al.
Diabetes Care 2008;31:408-414.
ABSTRACT | FULL TEXT  

Third-Party Reimbursement for Diabetes Care, Self-Management Education, and Supplies
American Diabetes Association
Diabetes Care 2008;31:S95-S96.
FULL TEXT  

Intimate Partner Violence and Health Care Costs and Utilization for Children Living in the Home
Rivara et al.
Pediatrics 2007;120:1270-1277.
ABSTRACT | FULL TEXT  

Disease Management: Panacea, Another False Hope, or Something in Between?
Geyman
Ann Fam Med 2007;5:257-260.
ABSTRACT | FULL TEXT  

Pharmacist membership in a medical group's diabetes health management program
Brooks et al.
Am J Health Syst Pharm 2007;64:617-621.
ABSTRACT | FULL TEXT  

Thiazolidinediones and Risk of Repeat Target Vessel Revascularization Following Percutaneous Coronary Intervention: A meta-analysis
Riche et al.
Diabetes Care 2007;30:384-388.
ABSTRACT | FULL TEXT  

Third-Party Reimbursement for Diabetes Care, Self-Management Education, and Supplies
American Diabetes Association
Diabetes Care 2007;30:S86-S87.
FULL TEXT  

Hypoglycemic events and glycosylated hemoglobin values in patients with type 2 diabetes mellitus newly initiated on insulin glargine or premixed insulin combination products
Bullano et al.
Am J Health Syst Pharm 2006;63:2473-2482.
ABSTRACT | FULL TEXT  

Development and clinical outcomes of pharmacist-managed diabetes care clinics.
Morello et al.
Am J Health Syst Pharm 2006;63:1325-1331.
ABSTRACT | FULL TEXT  

Bringing geriatricians to the front lines: evaluation of a quality improvement intervention in primary care.
Fenton et al.
J Am Board Fam Med 2006;19:331-339.
ABSTRACT | FULL TEXT  

Hospital Admission Rates for a Racially Diverse Low-Income Cohort of Patients With Diabetes: The Urban Diabetes Study
Robbins and Webb
Am. J. Public Health 2006;96:1260-1264.
ABSTRACT | FULL TEXT  

Impact of Office Systems and Improvement Strategies on Costs of Care for Adults With Diabetes.
Gilmer et al.
Diabetes Care 2006;29:1242-1248.
ABSTRACT | FULL TEXT  

An Intervention to Overcome Clinical Inertia and Improve Diabetes Mellitus Control in a Primary Care Setting: Improving Primary Care of African Americans With Diabetes (IPCAAD) 8.
Ziemer et al.
Arch Intern Med 2006;166:507-513.
ABSTRACT | FULL TEXT  

Triple Therapy in Type 2 Diabetes: Insulin glargine or rosiglitazone added to combination therapy of sulfonylurea plus metformin in insulin-naive patients.
Rosenstock et al.
Diabetes Care 2006;29:554-559.
ABSTRACT | FULL TEXT  

Third-Party Reimbursement for Diabetes Care, Self-Management Education, and Supplies
American Diabetes Association
Diabetes Care 2006;29:S68-S69.
FULL TEXT  

Pharmacist Impact on Clinical Outcomes in a Diabetes Disease Management Program via Collaborative Practice
Kiel and McCord
The Annals of Pharmacotherapy 2005;39:1828-1832.
ABSTRACT | FULL TEXT  

An Endocrinologist-Supported Intervention Aimed at Providers Improves Diabetes Management in a Primary Care Site: Improving Primary Care of African Americans with Diabetes (IPCAAD) 7
Phillips et al.
Diabetes Care 2005;28:2352-2360.
ABSTRACT | FULL TEXT  

Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership: Improving Diabetes-Related Outcomes Among African American and Latino Adults
Two Feathers et al.
Am. J. Public Health 2005;95:1552-1560.
ABSTRACT | FULL TEXT  

The Effectiveness of an Interactive Small Group Diabetes Intervention in Improving Knowledge, Feeling of Control, and Behavior
Garrett et al.
Health Promot Pract 2005;6:320-328.
ABSTRACT  

Barriers to Diabetes Education in Urban Patients: Perceptions, Patterns, and Associated Factors
Rhee et al.
The Diabetes Educator 2005;31:410-417.
ABSTRACT | FULL TEXT  

Outcomes of Project Dulce: A Culturally Specific Diabetes Management Program
Gilmer et al.
The Annals of Pharmacotherapy 2005;39:817-822.
ABSTRACT | FULL TEXT  

Barriers to A1C Testing Among a Managed Care Population
Delaronde
The Diabetes Educator 2005;31:235-239.
ABSTRACT | FULL TEXT  

Predictors of Health Care Costs in Adults With Diabetes
Gilmer et al.
Diabetes Care 2005;28:59-64.
ABSTRACT | FULL TEXT  

Third-Party Reimbursement for Diabetes Care, Self-Management Education, and Supplies
American Diabetes Association
Diabetes Care 2005;28:S62-S63.
FULL TEXT  

Oral Antihyperglycemic Medication Nonadherence and Subsequent Hospitalization Among Individuals With Type 2 Diabetes
Lau and Nau
Diabetes Care 2004;27:2149-2153.
ABSTRACT | FULL TEXT  

Effectiveness Of A Disease Management Program For Patients With Diabetes
Villagra and Ahmed
Health Aff (Millwood) 2004;23:255-266.
ABSTRACT | FULL TEXT  

Pharmacy Costs and Glycemic Control in the Department of Veterans Affairs
Weinstock et al.
Diabetes Care 2004;27:B74-B81.
ABSTRACT | FULL TEXT  

Cost Analysis of Human Islet Transplantation for the Treatment of Type 1 Diabetes in the Swiss-French Consortium GRAGIL
Guignard et al.
Diabetes Care 2004;27:895-900.
ABSTRACT | FULL TEXT  

Inpatient to Outpatient Transfer of Care in Urban Patients With Diabetes: Patterns and Determinants of Immediate Postdischarge Follow-up
Wheeler et al.
Arch Intern Med 2004;164:447-453.
ABSTRACT | FULL TEXT  

Improvement in Diabetes Care of Underinsured Patients Enrolled in Project Dulce: A community-based, culturally appropriate, nurse case management and peer education diabetes care model
Philis-Tsimikas et al.
Diabetes Care 2004;27:110-115.
ABSTRACT | FULL TEXT  

Third-Party Reimbursement for Diabetes Care, Self-Management Education, and Supplies
Diabetes Care 2004;27:s136-137.
FULL TEXT  

The Contribution of Geriatric Health Services Research to Successful Aging
Kane
ANN INTERN MED 2003;139:460-462.
ABSTRACT | FULL TEXT  

The Impact of Verbal Communication on Physician Prescribing Patterns in Hospitalized Patients With Diabetes
Martin et al.
The Diabetes Educator 2003;29:827-836.
ABSTRACT  

Pediatricians' Perceptions and Practices Regarding Prevention and Treatment of Type 2 Diabetes Mellitus in Children and Adolescents
Ditmyer et al.
Arch Pediatr Adolesc Med 2003;157:913-918.
ABSTRACT | FULL TEXT  

Effect of Nurse-Directed Diabetes Care in a Minority Population
Davidson
Diabetes Care 2003;26:2281-2287.
ABSTRACT | FULL TEXT  

The Direct Medical Cost of Type 2 Diabetes
Brandle et al.
Diabetes Care 2003;26:2300-2304.
ABSTRACT | FULL TEXT  

Multiple Hospitalizations for Patients With Diabetes
Jiang et al.
Diabetes Care 2003;26:1421-1426.
ABSTRACT | FULL TEXT  

The Case for "Outsourcing" Diabetes Care
Davidson
Diabetes Care 2003;26:1608-1612.
FULL TEXT  

International Comparison of Health Resource Utilization in Subjects With Diabetes: An analysis of Canadian and American national health surveys
Klarenbach and Jacobs
Diabetes Care 2003;26:1116-1122.
ABSTRACT | FULL TEXT  

A Proposal for Electronic Medical Records in U.S. Primary Care
Bates et al.
J. Am. Med. Inform. Assoc. 2003;10:1-10.
ABSTRACT | FULL TEXT  

Social Inequality in Childhood Diabetes--A Population-Based Follow-up Study in Germany
Icks et al.
Pediatrics 2003;111:222-224.
FULL TEXT  

Third-Party Reimbursement for Diabetes Care, Self-Management Education, and Supplies
Diabetes Care 2003;26:s143-144.
FULL TEXT  

Improving Primary Care for Patients With Chronic Illness: The Chronic Care Model, Part 2
Bodenheimer et al.
JAMA 2002;288:1909-1914.
ABSTRACT | FULL TEXT  

The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus
Brown et al.
Fam Pract 2002;19:344-349.
ABSTRACT | FULL TEXT  

Association of Health Literacy With Diabetes Outcomes
Schillinger et al.
JAMA 2002;288:475-482.
ABSTRACT | FULL TEXT  

Predictors of Ketoacidosis and Severe Hypoglycemia in Type I Diabetes
Foster and Bratton
AAP Grand Rounds 2002;8:3-4.
FULL TEXT  

Does Diabetes Disease Management Save Money and Improve Outcomes? : A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization-sponsored disease management program among patients fulfilling health employer data and information set criteria
Sidorov et al.
Diabetes Care 2002;25:684-689.
ABSTRACT | FULL TEXT  

Lifetime Costs of Complications Resulting From Type 2 Diabetes in the U.S.
Caro et al.
Diabetes Care 2002;25:476-481.
ABSTRACT | FULL TEXT  

Oral Antihyperglycemic Therapy for Type 2 Diabetes: Clinical Applications
Holmboe
JAMA 2002;287:373-376.
ABSTRACT | FULL TEXT  

Costs of Treatment for Elderly Women With Early-Stage Breast Cancer in Fee-for-Service Settings
Warren et al.
JCO 2002;20:307-316.
ABSTRACT | FULL TEXT  

Strong in Body and Spirit: Lifestyle intervention for Native American adults with diabetes in New Mexico
Gilliland et al.
Diabetes Care 2002;25:78-83.
ABSTRACT | FULL TEXT  

A Systematic Approach to Risk Stratification and Intervention Within a Managed Care Environment Improves Diabetes Outcomes and Patient Satisfaction
Clark et al.
Diabetes Care 2001;24:1079-1086.
ABSTRACT | FULL TEXT  

Glycemic Control and Health Care Costs for Patients With Diabetes
Pogach and Wagner
JAMA 2001;285:1963-1964.
FULL TEXT  

Evidence-Based or Hassle-Based Medicine?
Hirsch
Clin. Diabetes 2001;19:49-49.
FULL TEXT  

The National Diabetes Education Program, Changing the Way Diabetes Is Treated: Comprehensive diabetes care
Clark et al.
Diabetes Care 2001;24:617-618.
FULL TEXT