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To the Editor: Dr Wagner and colleagues¹ use cost data from a health maintenance organization to assess whether enrollees with diabetes who achieve sustained improvement in glycemic control (at least a 1% decrease in hemoglobin A_1c [HbA_1c] level over 1 year that was maintained for a second year) have lower health care utilization and costs than individuals whose HbA_1c improvement was less than 1% or was not sustained. Their results demonstrate that cost savings can be achieved, but only for individuals with the highest baseline HbA_1c values (>10%). These results are entirely consistent with the finding of Testa and Simonson² that improved glycemic control is associated with improved quality of life.

However, because of the absence of critical clinical covariates, I urge caution in accepting the authors' inference that improved glycemic control is the sole driver of the cost savings. The authors argue that the differences in costs were . . . [Full Text of this Article]

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Effect of Improved Glycemic Control on Health Care Costs and Utilization
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