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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
Edward H. Wagner, Nirmala Sandhu, Katherine M. Newton, David K. McCulloch, Scott D. Ramsey, and Louis C. Grothaus
JAMA. 2001;285(2):182-189.
ABSTRACT | FULL TEXT