Time to insulin treatment and factors associated with insulin prescription in Swedish patients with type 2 diabetes.

AIMS: The purpose of this study was to investigate the time between the start of OAD treatment and the initiation of insulin therapy and to identify the factors associated with insulin prescription among Swedish patients with type 2 diabetes in Uppsala County. METHODS: Retrospective, population-based, primary-care data gathered within the Swedish RECAP-DM study were used to identify type 2 diabetic patients who initiated OAD treatment. A Kaplan-Meier survival estimate for time to initiation of insulin therapy was generated and factors associated with insulin prescription were tested using a Cox proportional-hazards model. RESULTS: Within 6 years of starting OAD treatment, an estimated 25% of Swedish patients with type 2 diabetes will be prescribed insulin (95% CI: 0.23-0.26) and, within 10 years, this figure will rise to 42% (95% CI: 0.39-0.45). The probability of insulin prescription was increased in patients aged less than 65 years (HR=1.24, 95% CI: 1.03-1.50) and in those who initiated OAD treatment with more than one agent (HR=2.71, 95% CI: 2.15-3.43). HbA(1c) at the time of starting OAD treatment was also related to the probability of insulin prescription (HR=1.20, 95% CI: 1.146-1.25). CONCLUSION: Many type 2 diabetic patients who begin treatment with an OAD will eventually be prescribed insulin. Age, disease severity and the type of prior treatment may affect the rate of the transition.

Resource use associated with type 2 diabetes in Asia, Latin America, the Middle East and Africa: results from the International Diabetes Management Practices Study (IDMPS).

AIMS: To estimate diabetes-related resource use and investigate its predictors among individuals with type 2 diabetes in 24 countries in Asia, Latin America, the Middle East and Africa. METHODS: Cross-sectional observational data on diabetes-related resource use were collected from 15,016 individuals with type 2 diabetes within the second wave of International Diabetes Management Practices Study. Mean (SD) annual quantities were determined and predictors of diabetes-related hospitalisations, inpatient days, emergency room visits and absenteeism were investigated using negative binomial regression. RESULTS: Patients in Asia (n = 4678), Latin America (n = 6090) and the Middle East and Africa (n = 4248) made a mean (SD) of 3.4 (6.9), 5.4 (6.7) and 2.5 (4.4) General Practitioner visits per year. The mean (SD) number of inpatient days amounted to 3.8 (18.1), 2.2 (13.9) and 2.6 (13.5) per year. Results of the regression analysis showed the major influence of diabetes-related complications and inadequate glycaemic control on resource use. The expected annual rate of hospitalisation of patients with macrovascular complications compared with those without was 4.7 times greater in Asia [incidence rate ratio (IRR) = 4.7, 95% CI: 2.8-7.8, n = 2551], 5.4 times greater in Latin America (IRR = 5.4, 95% CI: 3.0-9.8, n = 3228) and 4.4 times greater in the Middle East and Africa (IRR = 4.4, 95% CI: 2.8-6.9, n = 2630). CONCLUSIONS: Micro- and macrovascular complications and inadequate glycaemic control are significant predictors of resource use in people with type 2 diabetes of developing countries. This knowledge confirms the health economic importance of early diagnosis of diabetes, education of patients and glycaemic control.

Prevalence and incidence of Type 2 diabetes and its complications 1996-2003--estimates from a Swedish population-based study.

AIMS: To determine the prevalence and incidence of Type 2 diabetes and its complications in Uppsala county, Sweden between 1996 and 2003. METHODS: Retrospective population-based study of patients with Type 2 diabetes identified in computerized medical records at 26 county primary care centres. Prevalence and incidence of Type 2 diabetes were estimated in the population aged 30-39, 40-49, 50-59, 60-69, 70-79 and > or = 80 years. Mortality, prevalence and incidence of complications in patients with Type 2 diabetes were determined through linkage to national inpatient, uraemia and cause-of-death registers. RESULTS: Crude prevalence of Type 2 diabetes increased from 2.2 to 3.5% between 1996 and 2003. In the population aged > or = 30 years, the age- and sex-adjusted period increase was 53%[odds ratio (OR) 1.53, 95% confidence interval (CI) 1.47-1.58]. Crude population incidence was approximately stable after 1997 (3.7 cases/1000 residents in 1997 compared with 3.8/1000 in 2003). Age- and sex-adjusted mortality rates in Type 2 diabetic patients decreased by 4% per year (OR 0.96, 95% CI 0.94-0.97). Prevalence rates of cardiovascular disease in Type 2 diabetic patients were essentially stable, affecting 13.8% of females and 18.0% of males in 2003. No trend was detected for prevalence of renal failure or incidence of acute myocardial infarction, stroke and amputation. CONCLUSIONS: Prevalence of Type 2 diabetes increased in Uppsala county between 1996 and 2003 as a consequence of approximately stable incidence since 1997 and declining mortality. Rates of diabetes-related complications, notably cardiovascular disease, continued to impose a substantial burden.

Resource use and costs of type 2 diabetes in Sweden - estimates from population-based register data.

AIMS: To examine medical resource use of Swedish patients with type 2 diabetes during 2000-2004 and to estimate annual costs of care. METHODS: Retrospective population-based cohort study of patients with type 2 diabetes identified in computerised medical records at 26 primary care centres in Uppsala county, Sweden. Annual quantities of medical resources were determined for prevalent cases during 2000-2004 using register data from outpatient primary care, outpatient hospital care, the National Inpatient Register and a national register for treatment of uraemia. Average costs of care of patients with type 2 diabetes were estimated based on year 2004 resource quantities of 8230 prevalent study cases. RESULTS: Annual quantities of medical resource use were stable in outpatient primary care and outpatient hospital care, with patients making an average of two General Practitioner visits and 3.5 outpatient hospital visits each year. Higher rates of hospitalisation [12% in 2000 (n = 6711) compared with 16% in 2004 (n = 8230)] led to an increase in the mean (SD) number of inpatient days from 2.3 (11.8) to 2.7 (11.9) (p = 0.040) between 2000 and 2004. Mean (SD) total costs of care in 2004 were EUR 3602 (EUR 9537). Inpatient care was the major contributor to costs, accounting for 57% of total costs while drug costs accounted for an average 7%. CONCLUSIONS: Swedish type 2 diabetic patients in this large sample from Uppsala county required steady annual amounts of outpatient care and increasing amounts of inpatient care during 2000-2004. The associated costs in 2004 were substantial, with inpatient care identified as the most important component.