Chicago—Primarily because of decreased medication costs, individualizing treatment plans for diabetes patients based on age and health history means significant healthcare savings and, likely, greater patient satisfaction, new research finds.

The savings was $13,546 per patient over their average lifetime when compared with treatment plans that stick closer to uniform national standards, according to a study in Annals of Internal Medicine.

“People don’t want to be treated by a standard value or an algorithm, they want to be treated like individuals,” explained lead author Neda Laiteerapong, MD, assistant professor of medicine at University of Chicago Medicine. “I think this model will give evidence to physicians that individualized glycemic control is something to consider. It can help save our health system money, and it’s in line with what many patients want.”

In 2012, the American Diabetes Association and the European Association for the Study of Diabetes published a statement recommending that physicians individualize blood sugar goals based on several factors, including age, life expectancy, complications and how long a patient has had diabetes, instead of insisting all patients adhere to the standard goal of a hemoglobin A1C of less than 7%.

This study used a statistical model that calculated healthcare costs over the average expected lifetime of the patients, using data from 569 patients in the National Health and Nutrition Examination Survey (NHANES); those subjects are representative of U.S. adults over the age of 30 years with type 2 diabetes. 

Taking into account variables such as age, duration of diabetes, and history of complications such as heart disease, hypertension, stroke, retinopathy, and kidney disease, the model assigned costs for typical type 2 diabetes treatment regimens with drugs including metformin, insulin, and sulfonylureas. It also included standard values from the research literature for the cost of treating major events like a heart attack or stroke.

Based on 2,500 simulations for the expected remaining lifetime of each patient with both treatment strategies, the study team compared a personalized A1C value that changed over a lifetime to a standard, uniform A1C value less than 7%.

Results indicate that the lifetime costs for an individualized control strategy versus a uniform strategy were $105,307 versus $118,853. Lower medication costs made up most of that—$34,521 versus $48,763.

Extrapolated over the approximately 17.3 million adults aged more than 30 who years have type 2 diabetes in the United States, the study authors point out that would mean $234 billion in lifetime savings to the national healthcare system.

While the model predicted a 36-day decrease in overall life expectancy with the personalized strategy, Laiteerapong said that could be attributed to statistical limitations in the model that don’t account for long-term, cumulative benefits of treatment.

“The differences in life expectancy and complication rates were very small, but choosing a personalized A1C goal can reduce medications by half per year,” Laiteerapong said. “If I told my patients they could take half as many medications but maybe there’s a small chance they might live a month less, I’m pretty sure many of them would sign up for it.”
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