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The Burden of Diabetes on Health Services

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (15 July 2020) | Viewed by 20222

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Prof. Dr. Tommaso Staniscia

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Guest Editor

Unit of Epidemiology and Public Health, Department of Medicine and Science of Ageing, University of G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
Interests: epidemiology; public health; health services research; preventive medicine; vaccine
Special Issues, Collections and Topics in MDPI journals

Dr. Giuseppe Di Martino

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1. Department of Medicine and Ageing Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
2. Unit of Hygiene, Epidemiology and Public Health, ASL Pescara, 65100 Pescara, Italy
Interests: epidemiology; public health; non-communicable diseases; health services research; outcomes research; vaccines
Special Issues, Collections and Topics in MDPI journals

Dr. Fabrizio Cedrone

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Department of Medicine and Ageing Sciences, School of Hygiene and Preventive Medicine, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
Interests: epidemiology; public health; non-communicable diseases; health services research; occupational medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Chronic noncommunicable diseases (CNCDs) are an important cause of morbidity
and mortality in the world. Among the CNCDs, diabetes mellitus (DM) is considered epidemic, affecting worldwide over 415 million adults. Population aging, growing obesity prevalence, sedentary lifestyle, and urbanization are considered the leading factors in the increase in DM incidence and prevalence worldwide. This scenario is having a high social and financial impact on patients and health systems, since DM is also associated with such complications as renal failure, lower limb amputation, blindness, and cardiovascular disease. In particular, people with DM have more outpatient visits, use more medications, have a higher probability of being hospitalized, and are more likely to require emergency and long-term care than people without the disease. Estimates of the current and future burden on the healthcare system can assist decision-makers in understanding the magnitude of the problem and prioritize research efforts. This Special Issue aims to summarize the latest research addressing the impact of DM on health services. In particular, papers that examine diabetes-related hospitalization, the impact of diabetes and its complications on hospital outcomes, and the effect of different pharmacological therapies on disease management are welcomed. Papers which examine the epidemiology of DM, primary care, out-hospital management of the disease, the impact of DM on other diseases, and the economic burden of DM will also be considered.

Prof. Dr. Tommaso Staniscia
Dr. Giuseppe Di Martino
Dr. Fabrizio Cedrone
Guest Editors

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Keywords

Diabetes
Type 2 diabetes
Type 1 diabetes
Cardiovascular disease
Comorbidities
Hyperglycemia
Lifestyle modification
Obesity
Diabetes related treatments
Diabetes-related complications
Longitudinal analysis
Healthcare costs
Morbidity
Pharmacological therapy
Life expectancy

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Published Papers (4 papers)

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Research

11 pages, 279 KiB

Open AccessArticle

Increased Mortality Risk in People with Type 2 Diabetes Mellitus in Lithuania

by Donata Linkeviciute-Ulinskiene, Auguste Kaceniene, Audrius Dulskas, Ausvydas Patasius, Lina Zabuliene and Giedre Smailyte

Int. J. Environ. Res. Public Health 2020, 17(18), 6870; https://doi.org/10.3390/ijerph17186870 - 20 Sep 2020

Cited by 14 | Viewed by 2646

Abstract

This retrospective cohort study aimed to analyze overall and cause-specific mortality risk in people with type 2 diabetes mellitus (T2DM) in Lithuania. Information on the diagnosis of T2DM and glucose-lowering medication was obtained from the National Health Insurance Fund database, causes of death–from death certificates. Sex, age, and calendar period-standardized mortality ratios (SMRs) were calculated. In addition, 89,512 patients were followed-up between 2010 and 2017, contributing to the observation period of 592,321 person-years. Overall mortality risk was increased for both sexes (overall SMR = 1.35, 95% confidence interval (CI) 1.34–1.37). Greatest mortality risk was in the age group of 40–49 years at diabetes diagnosis (SMR = 1.68, 95% CI 1.60–1.76) and among those who had died before the age of 50 (SMR = 22.04, 95% CI 18.82–25.81). Patients treated with insulin only had the highest SMR (2.43, 95% CI 2.32–2.55). Mortality risk increased with increasing diabetes duration and was higher in women in all these groups. The highest cause-specific SMRs were infection-related causes (SMR = 1.44), particularly septicemia (SMR = 1.78), diseases of the circulatory system (SMR = 1.42), especially ischemic heart (SMR = 1.46) and cerebrovascular diseases (SMR = 1.38), as well as diseases of the digestive system (SMR = 1.35). Cancer mortality risk was elevated for women (SMR = 1.13), but not for men (SMR = 0.93). In conclusion, people with T2DM had an excess mortality risk, which was higher in women compared to men, younger people, in those who were diagnosed with T2DM at a younger age, had longer diabetes duration, and who required treatment with insulin. Full article

(This article belongs to the Special Issue The Burden of Diabetes on Health Services)

16 pages, 1683 KiB

Open AccessArticle

An Exploratory Research of 18 Years on the Economic Burden of Diabetes for the Romanian National Health Insurance System

by Claudiu Morgovan, Smaranda Adina Cosma, Madalina Valeanu, Anca Maria Juncan, Luca Liviu Rus, Felicia Gabriela Gligor, Anca Butuca, Delia Mirela Tit, Simona Bungau and Steliana Ghibu

Int. J. Environ. Res. Public Health 2020, 17(12), 4456; https://doi.org/10.3390/ijerph17124456 - 21 Jun 2020

Cited by 15 | Viewed by 4078

Abstract

The prevalence of diabetes mellitus (DM) rises constantly each year worldwide. Because of that, the funds allocated for the DM treatment have increased over time. Regarding the number of DM cases, Romania is among the top ten countries in Europe. Based on the National Diabetes Programme (NDP), antidiabetic drugs and other expenditures (Self-monitoring blood glucose (SMBG) test, HbA1c, insulin pumps/insulin pumps supplies) are free of charge. This programme has undergone many changes in drugs supply, in the last two decades: re-organizing the NDP, authorization of new molecules with high prices (e.g., SGLT-2 inhibitors, etc.) or new devices (e.g., insulin pumps, etc.) The main purpose of this study is to identify and analyse the impact of the DM costs on the Romanian health budget and to highlight the evolution of these costs. A retrospective longitudinal research on the official data regarding the DM costs from 2000 to 2017 was performed. The DM funds (DMF) were adjusted with the inflation rate. In this period, the average share of DMF in the total funds allocated for health programmes was 21.3 ± 3.4%, and DMF average growth rate was 25.4% (r = 0.488, p = 0.047). On the other hand, the DMF increased more than 14 times, in spite of the patients’ number having increased only about 2.5 times. Referring to the structure of DMF, the mean value of the antidiabetic drugs cost was of 96,045 ± 67,889 thousand EUR while for other expenditures it was of 11,530 ± 7922 thousand EUR (r = 0.945, p < 0.001). Between 2008 and 2017, the total DMF was 181,252 ± 74,278 thousand EUR/year. Moreover, the average patients’ number was 667,384 ± 94,938 (r = 0.73, p = 0.016), and the cost of treatment was 215 ± 36 EUR/patient/year. Even if the cost is rising, the correct and optimal treatment is a main condition for the diabetic patient’s health and for the prevention of its complications, which have multiple socio-economic repercussions. Full article

(This article belongs to the Special Issue The Burden of Diabetes on Health Services)

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9 pages, 588 KiB

Open AccessArticle

Distal Symmetric and Cardiovascular Autonomic Neuropathies in Brazilian Individuals with Type 2 Diabetes Followed in a Primary Health Care Unit: A Cross-Sectional Study

by Mozania Reis de Matos, Daniele Pereira Santos-Bezerra, Cristiane das Graças Dias Cavalcante, Jacira Xavier de Carvalho, Juliana Leite, Jose Antonio Januario Neves, Sharon Nina Admoni, Marisa Passarelli, Maria Candida Parisi and Maria Lucia Correa-Giannella

Int. J. Environ. Res. Public Health 2020, 17(9), 3232; https://doi.org/10.3390/ijerph17093232 - 6 May 2020

Cited by 6 | Viewed by 2932

Abstract

The paucity of epidemiological data regarding diabetes complications in Brazil motivated us to evaluate the prevalence rates of distal symmetric polyneuropathy (DSP) and of cardiovascular autonomic neuropathy (CAN) in individuals with type 2 diabetes (T2D) followed in a primary care unit. A total of 551 individuals (59.3% women, 65 years old; diabetes duration of 10 years; HbA1c of 7.2%, medians) were included in this cross-sectional study. DSP was diagnosed by sum of the Neuropathy Symptoms Score (NSS) and Modified Neuropathy Disability Score (NDS) and by the Semmes–Weinstein monofilament. CAN was diagnosed by cardiovascular autonomic reflex tests combined with spectral analysis of heart rate variability. The prevalence rates of DSP were 6.3% and 14.3%, as evaluated by the sum of NSS and NDS and by the Semmes–Weinstein monofilament, respectively. Those with DSP diagnosed by monofilament presented longer diabetes duration, worse glycemic control and a higher stature. The prevalence rates of incipient and definitive CAN were 12.5% and 10%, respectively. Individuals with definitive CAN presented a higher frequency of hypercholesterolemia and of arterial hypertension. The higher prevalence rate of DSP with the use of the monofilament suggests that it may be a more appropriate tool to diagnose DSP in the primary care setting in Brazil. Full article

(This article belongs to the Special Issue The Burden of Diabetes on Health Services)

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8 pages, 436 KiB

Open AccessArticle

The Prevalence and Risk Factors of Type 2 Diabetes Mellitus (DMT2) in a Semi-Urban Saudi Population

by Mohammed Abdullah Al Mansour

Int. J. Environ. Res. Public Health 2020, 17(1), 7; https://doi.org/10.3390/ijerph17010007 - 18 Dec 2019

Cited by 50 | Viewed by 9774

Abstract

(1) Background: Diabetes mellitus is a common health problem in Saudi Arabia, causing a huge burden for individuals, families, and communities. The objectives of the current study were to determine the prevalence and risk factors of type 2 diabetes mellitus among a semi-urban population of Saudi Arabia. (2) Research methods: The research design was cross-sectional, and the research was conducted in five primary health care centers (PHCC) in Majmaah, Saudi Arabia. The sample size was calculated as 353. A pre-tested questionnaire was used to collect data after obtaining ethical approval. Blood samples were taken to assess glucose levels and other variables. SPSS version 21 was used to analyze data. (3) Results: The prevalence of type 2 diabetes mellitus was 34.6%. The disease was more prevalent among the older respondents compared with the younger age groups (44.6% versus 15.6%). We found that females acquire the disease at a slightly higher rate than males (34.9% versus 34.2%), but this difference is not statistically significant. The sociodemographic risk factors of the disease were as follows: old age (44%), business and private occupation (38.5%), divorced or widowed (56.3%), and low income (42.4%). The health behaviors factors were as follows: overweight or obese status (42.3%), high triglycerides (TG) (43.4%), low high-density lipoprotein (HDL) (37.3%), and high total cholesterol (23.7%). There was a statistically significant difference in these risk factors between patients with and without diabetes. (4) Conclusion: The prevalence of type 2 diabetes mellitus among the semi-urban population of Saudi Arabia is high. The disease is more prevalent among elderly respondents and is associated with obesity, high TG, low HDL, and high total cholesterol. Full article

(This article belongs to the Special Issue The Burden of Diabetes on Health Services)

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