describes the characteristics of the patients. Mean age was 13.9 (SD 2.2) years, mean diabetes duration was 10.9 (SD 1.9) years. A total of 21.7% of the study patients were 8–11 years old, 58.2% were 12–15 years old, and 20.0% were 16–19 years old. Altogether 53.8% of the patients had a diabetes duration of 8–10 years and 46.2% of 11–14 years.
Description of the study population 2007.
Utilization of diabetes care
More than one third of the subjects (36.2%) were on CSII therapy, nearly three-quarters of those (73.0%) used insulin pump therapy throughout 2007, the others started CSII therapy in 2007. Mean insulin dose per kilogram body weight was 0.9 (SD 0.3) IU. Antihypertensive drugs were taken by 1.7%, lipid-lowering agents by 0.3%, and biguanides by 0.2% of the subjects, respectively.
Regarding outpatient consultations, half of the subjects had at least one contact per quarter-year (49.6%). The mean number of diabetes-related outpatient consultations was 4.2 per year. More than a third of the subjects (36.9%) were registered in a DMP.
During 2007, most of the subjects (71.4%) had no inpatient treatment because of diabetes. A quarter of the study patients had one stay (24.6%), 4.1% had more than one diabetes-related hospitalization. The average hospital stay lasted 8.8 days. In 2007, a total of 17.9% of the patients had a cumulative length of inpatient treatment of up to one week, 6.3% of >1–2 weeks, 1.2% of >2–3 weeks, and 3.3% of more than 3 weeks. Further details on the reasons for diabetes-related hospital admissions and days in hospital are reported in . Related to the whole study population, there was a mean of 0.35 diabetes-related hospital stays and 2.85 hospital days per person-year in 2007.
Factors associated with inpatient care or CSII therapy
summarizes the results of the first part of the applied two-part model and gives an overview of factors that were associated with hospitalization and CSII therapy. The risk for hospitalization was significantly lower in 16 to 19-year-olds compared with 8–11 year old patients (RR 0.67, 95% confidence interval (95%-CI) 0.48–0.94). Impaired and poor glycemic control were associated with significantly higher hospitalization (RR 1.60, 95%-CI 1.30–1.96 and 2.31, 95%-CI 1.87–2.86, respectively). Gender, diabetes duration, and migration background were not significantly associated with hospitalization (). The use of CSII therapy was significantly lower among male patients (RR 0.76, 95%-CI 0.67–0.87) and patients with migration background (RR 0.72, 95%-CI 0.57–0.92). Age, diabetes duration, and glycemic control were not associated with CSII ().
Factors associated with inpatient care and CSII therapy.
In 2007, average direct diabetes-related health care costs per study subject amounted to €3,745 (). The spread of individual total costs among study patients was considerable, ranging from €948 up to €34,498 (inter-quartile range: €1,943–4,881). The largest share of costs in the study cohort was attributable to SMBUG, followed by CSII and diabetes-related hospitalizations. Almost one fifth of the costs were spent for insulin. A total of 3.6% was spent for diabetes-related outpatient care. The percentage of diabetes-related costs for injection needles/syringes, glucagon sets, and other medication amounted to each at most 2% of total costs.
Diabetes-related costs per patient in the study population (age group 8–18 years, onset 1993–1999 at 0–4 years) in 2007.
Factors associated with diabetes-related costs
Associations between total costs or different cost categories and influencing factors are given in in terms of expected cost ratios and in in terms of expected costs and cost differences.
Factors associated with total direct medical costs and different cost categories per patient: Estimates of cost ratiosa.
Factors associated with total direct medical costs and different cost categories per patient: Estimates of cost and cost differencesa.
Total costs and costs for CSII therapy in male patients were 6.2% (€240) and 26% (€274) lower than in female patients, respectively. Reduced CSII costs among the male subgroup were mainly attributable to the reduced rate of CSII therapy in this group (). There were no significant gender differences with respect to the other single cost categories. Total costs, costs for hospitalizations, and CSII costs were highest in the age group of the 12 to 15-year-olds. In contrast, costs for insulin increased steadily and costs for SMBUG dropped steadily with increasing age. Patients with a diabetes duration of 11–14 years had 15% (€96) higher costs for insulin, but 4.1% (€42) lower costs for SMBUG compared with patients with 8–10 years of diabetes duration. Poor glycemic control was significantly associated with increased total costs, higher costs for hospitalization (up to three times higher costs) and higher costs for insulin, but with decreased costs for SMBUG. Glycemic control was not significantly associated with costs for CSII therapy. Patients with migration background had significantly lower total costs and lower costs for SMBUG and CSII therapy, but higher costs for hospitalization (not statistically significant).