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[IP] FW: JAMA Table of Contents - January 10, 2001

>From this weeks JAMA.  I've only read the abstract so far (copied below),
and my only comment (so far) about the conclusion is "I think we probably
already knew that (but it's good to have data)".  I believe JAMA is still
available on line at no cost.

Jim Handsfield
mailto:email @ redacted OR
mailto:email @ redacted

The opinions expressed are my own and do not necessarily represent those of
my wife who runs this house and makes more important decisions than I do.

Effect of Improved Glycemic Control on Health Care Costs and Utilization
     E. H. Wagner, N. Sandhu, K. M. Newton,
     D. K. McCulloch, S. D. Ramsey, L. C. Grothaus 
Because of the additional costs associated with improving diabetes
management, there is interest in whether improved glycemic control leads to
reductions in health care costs, and, if so, when such cost savings occur.

To determine whether sustained improvements in hemoglobin A1c (HbA1c) levels
among diabetic patients are followed by reductions in health care
utilization and costs.

Design and Setting  
Historical cohort study conducted in 1992-1997 in a staff-model health
maintenance organization (HMO) in western Washington State.

All diabetic patients aged 18 years or older who were continuously enrolled
between January 1992 and March 1996 and had HbA1c measured at least once per
year in 1992-1994 (n = 4744). Patients whose HbA1c decreased 1% or more
between 1992 and 1993 and sustained the decline through 1994 were considered
to be improved (n = 732). All others were classified as unimproved (n =

Main Outcome Measures  
Total health care costs, percentage hospitalized, and number of primary care
and specialty visits among the improved vs unimproved cohorts in 1992-1997.

Diabetic patients whose HbA1c measurements improved were similar
demographically to those whose levels did not improve but had higher
baseline HbA1c measurements (10.0% vs 7.7%; P<.001). Mean total health care
costs were $685 to $950 less each year in the improved cohort for 1994 (P =
.09), 1995 (P = .003), 1996 (P = .002), and 1997 (P = .01). Cost savings in
the improved cohort were statistically significant only among those with the
highest baseline HbA1c levels (10%) for these years but appeared to be
unaffected by presence of complications at baseline. Beginning in the year
following improvement (1994), utilization was consistently lower in the
improved cohort, reaching statistical significance for primary care visits
in 1994 (P = .001), 1995 (P<.001), 1996 (P = .005), and 1997 (P = .004) and
for specialty visits in 1997 (P = .02). Differences in hospitalization rates
were not statistically significant in any year.

Our data suggest that a sustained reduction in HbA1c level among adult
diabetic patients is associated with significant cost savings within 1 to 2
years of improvement.

JAMA. 2001;285:182-189
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