Diabetes mellitus is the seventh leading cause of death (sixth leading cause of death by disease) in the US. Approximately 5.9% of the US population has diabetes and one-third of those with diabetes are unaware that they have the condition. Diabetes is the leading cause of adult blindness, end-stage renal disease, and non-traumatic lower extremity amputation.
The annual per-capita incremental cost of diabetes among employees compared with individuals without diabetes has been estimated at $US4410 (1998 values). Furthermore, more than 30% of the costs associated with diabetic employees are attributable to medically related work absences and disability, and this is estimated to cause a one-third reduction in earnings due to reduced workforce participation.
The incidence of diabetes and long term medical complications could be reduced through more effective diabetes education and patient self-management. Intensive management of diabetes can help workers remain productive, decrease costs associated with complications, and reduce associated costs for overtime. Policy complications from this review encourage employers and Medicare/Medicaid to invest in diabetes education and Wellness programs.
Glycemic Control American Diabetes Association Poor Glycemic Control Diabetes Education Diabetes Disease Management Program
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The authors wish to acknowledge the bibliographical and editorial contributions of Ms Jill Royston, WSU Health Policy and Administration Department Program Assistant and the bibliographical development and refinement work by Mr Dan Simonsen, Washington State University Graduate Student in the Health Policy and Administration Department. The authors received no funding for this manuscript and do not have any conflicts of interest directly relevant to the content of this review.
Centers for Disease Control and Prevention. Diabetes: disabling, deadly, and on the rise 2002. Atlanta (GA): National Center for Chronic Disease Prevention and Health Promotion, 2002Google Scholar
Boyle JP, Honeycutt AA, Narayan KM, et al. Projection of diabetes burden through 2050. Diabetes Care 2001; 24(11): 1936–40PubMedCrossRefGoogle Scholar
Sinha R, Fisch G, Teague B, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002; 346: 802–10PubMedCrossRefGoogle Scholar
Berg GD, Wadhwa S. Diabetes disease management in a community-based setting. Manag Care 2002; 11(6): 42–50PubMedGoogle Scholar
DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–86CrossRefGoogle Scholar
UK Prospective Diabetes Study Group. UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–53CrossRefGoogle Scholar
Centers for Disease Control and Prevention. Making a difference: the business community takes on diabetes. Atlanta (GA): US Department of Health and Human Services Public Health Services, National Center for Chronic Disease Prevention and Health Promotion; 1999. Report No.: NPDP pub #33Google Scholar
Tuomilehto J, Lindstrom J, Ericksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344(18): 1343–50PubMedCrossRefGoogle Scholar
Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346(6): 393–403CrossRefGoogle Scholar
Testa MA, Simonson DC. Health economic benefits and quality of life during improved glycemic control in patients with type 2 diabetes mellitus: a randomized, controlled, double-blind trial. JAMA 1998; 280(17): 1490–6PubMedCrossRefGoogle Scholar
Burton W, Connerty C. Evaluation of a worksite-based patient education intervention targeted at employees with diabetes mellitus. J Occup Environ Med 1998; 40: 702–6PubMedCrossRefGoogle Scholar
Trief PM, Aquilino C, Paradies K, et al. Impact of the work environment on glycemic control and adaptation to diabetes. Diabetes Care 1999; 22(4): 569–74PubMedCrossRefGoogle Scholar
Clark EA. A systematic approach to risk stratification and intervention within a managed care environment improves diabetes outcomes and patient satisfaction. Diabetes Care 2001; 25: 386–9Google Scholar
Gilmer T, O’Connor P, Manning W, et al. The cost to health plans of poor glycemic control. Diabetes Care 1997; 20: 1847–53PubMedCrossRefGoogle Scholar
Menzin J, Langley-Hawthorne C, Friedman M, et al. Potential short-term economic benefits of improved glycemic control. Diabetes Care 2001; 24: 51–5PubMedCrossRefGoogle Scholar
Sadur CN, Moline N, Costa M, et al. Diabetes management in a health maintenance organization: efficacy of care management using cluster visits. Diabetes Care 1999; 22(12): 2011–7PubMedCrossRefGoogle Scholar
Sidorov J, Shull R, Tomcavage J, et al. Does diabetes 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. Diabetes Care 2002; 25: 684–9PubMedCrossRefGoogle Scholar
Selecky C. Integrating technology and interventions in the management of diabetes. Dis Manage Health Outcomes 2001; 9 Suppl. 1: 39–52Google Scholar
National Institute of Health. Diabetes statistics. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases, 1999Google Scholar
Javitt J, Aiello L. Cost-effectiveness of detecting and treating diabetic retinopathy. Ann Intern Med 1996; 119: 36–41Google Scholar
CDC Diabetes Cost-Effectiveness Group. Cost-effectiveness of intensive glycemic control, intensified hypertension control, and serum cholesterol level reduction for type 2 diabetes. JAMA 2002; 287: 2542–51CrossRefGoogle Scholar
Harris M, Cowie CC, Stern MP, et al. Diabetes in America. 2nd ed. Washington, DC: Government Printing Office, 1995Google Scholar
Rodby R, Firth L, Lewis E. An economic analysis of captopril in the treatment of diabetes nephropathy. Diabetes Care 1996; 19: 1051–61PubMedCrossRefGoogle Scholar
Elixhauser A, Weschler J, Kitzmiller JL. Cost-benefit analysis of preconception care for women with established diabetes mellitus. Diabetes Care 1993; 16: 1146–57PubMedCrossRefGoogle Scholar
Healey BJ, Hromchak M, Akinci F, et al. Diabetes in the workplace. Proceedings of the Academy of Health Care Management. Las Vegas (NV): Allied Academics, 2002 Nov: 1–8Google Scholar
American Diabetes Association. Third-party reimbursement for diabetes care, self-management education, and supplies. Diabetes Care Suppl 2002; 25: S134–5CrossRefGoogle Scholar