Assessment of excess medical costs for persons with type 2 diabetes according to age groups: an analysis of German health insurance claims data.

AIM: This cross-sectional study used a large nationwide claims data set to assess the excess medical costs of people with type 2 diabetes according to age group in 2015. METHODS: Data from 291 709 people with diabetes and 291 709 age- and sex-matched controls were analysed. Total costs (expressed as 2015 euros) of outpatient and inpatient services, medication, rehabilitation, and the provision of aids and appliances were examined. Overall and age-stratified excess costs of people with diabetes were estimated using gamma regression with a log-link. RESULTS: Overall, the estimated total direct costs of a person with type 2 diabetes are approximately double those of a person without diabetes: €4727 vs. €2196, respectively. Absolute excess costs were approximately the same in all age groups (around €2500), however, relative excess costs of persons with diabetes were much higher in younger (~ 334% for < 50 years) than in older age groups (~ 156% for ≥ 80 years). Regional costs, both absolute and excess, partly differed from the national level. CONCLUSIONS: This study complements and updates previous studies on the excess medical costs of people with diabetes in Germany. The results indicate the importance of preventing the development of type 2 diabetes, especially in younger age groups. Longitudinal and regional studies examining changes in prevalence and the development of excess costs in groups with different types of diabetes, and according to age, would be of interest to validate our findings and better understand the avoidable burden of having diabetes.

Time spent on self-management by people with diabetes: results from the population-based KORA survey in Germany.

AIMS: Time needed for health-related activities in people with diabetes is assumed to be substantial, yet available data are limited. Time spent on self-management and associated factors was analysed using cross-sectional data from people with diagnosed diabetes enrolled in a population-based study. METHODS: Mean total time spent on self-management activities was estimated using a questionnaire for all participants with diagnosed diabetes in the KORA FF4 study (n = 227, 57% men, mean age 69.7, sd 9.9 years). Multiple two-part regression models were fitted to evaluate associated factors. Multiple imputation was performed to adjust for bias due to missing values. RESULTS: Some 86% of participants reported spending time on self-management activities during the past week. Over the entire sample, a mean of 149 (sd 241) min/week were spent on self-management-activities. People with insulin or oral anti-hyperglycaemic drug treatment, better diabetes education, HbA1c 48 to < 58 mmol/mol (6.5% to < 7.5%) or lower quality of life, spent more time on self-management activities. For example, people without anti-hyperglycaemic medication invested 66 min/week in self-management, whereas those taking insulin and oral anti-hyperglycaemic drugs invested 269 min/week (adjusted ratio 4.34, 95% confidence interval 1.85-10.18). CONCLUSIONS: Time spent on self-management activities by people with diabetes was substantial and varied with an individual's characteristics. Because of the small sample size and missing values, the results should be interpreted in an explorative manner. Nevertheless, time needed for self-management activities should be routinely considered because it may affect diabetes self-care and quality of life.

The association between BMI and health-related quality of life in the US population: sex, age and ethnicity matters.

BACKGROUND: Obesity is a major public health problem. Detailed knowledge about the relationship between body mass index (BMI) and health-related quality of life (HRQL) is important for deriving effective and cost-effective prevention and weight management strategies. This study aims to describe the sex-, age- and ethnicity-specific association between BMI and HRQL in the US adult population. METHODS: Analyses are based on pooled cross-sectional data from 41 459 participants of the Medical Expenditure Panel Survey (MEPS) Household Component (HC) for the years 2000-2003. BMI was calculated using self-reported height and weight, and HRQL was assessed with the EuroQol five-dimensional questionnaire. Generalized additive models were fitted with a smooth function for BMI and a smooth-factor interaction for BMI with sex adjusted for age, ethnicity, poverty, smoking and physical activity. Models were further stratified by age and ethnicity. RESULTS: The association between BMI and HRQL is inverse U-shaped with a HRQL high point at a BMI of 22 kg m-2 in women and a HRQL high plateau at BMI values of 22-30 kg m-2 in men. Men aged 50 years and older with a BMI of 29 kg m-2 reported on average five-point higher visual analog scale (VAS) scores than peers with a BMI of 20 kg m-2. The inverse U-shaped association is more pronounced in older people, and the BMI-HRQL relationship differs between ethnicities. In Hispanics, the BMI associated with the highest HRQL is higher than in white people and, in black women, the BMI-HRQL association has an almost linear negative slope. CONCLUSIONS: The results show that a more differentiated use of BMI cutoffs in scientific discussions and daily practice is indicated. The findings should be considered in the design of future weight loss and weight management programs.

Association of serum vitamin D with change in weight and total body fat in a German cohort of older adults.

We examined the association of baseline serum 25-hydroxyvitamin D (25(OH)D) with change in weight and total body fat in a cohort of community-dwelling older adults from Southern Germany. A total of 735 participants of the population-based KORA-Age Study (2009-2012), aged 65-90 years, were followed for 2.9±0.1 years. Body fat was assessed with bioelectrical impedance analysis. Linear and multinomial logistic models, adjusted for baseline covariables, were used to examine the association of 25(OH)D with percentage weight and body fat change during follow-up. 25(OH)D levels were not associated with overall weight change or body fat loss. Higher 25(OH)D levels were associated with a lower likelihood of having gained >3% of body fat in women but not in men. As we cannot exclude residual confounding by outdoor physical activity and diet, our results are not sufficient to support a causal role of 25(OH)D in the etiology of obesity in Caucasian older adults.