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Early Intervention required to Prevent Diabetes, Heart Disease, Stroke, says study



SAN DIEGO, June 11 /PRNewswire/ -- Pre-diabetes is a marker for poor health and significantly elevated health care costs, many of which are attributable to angina, heart attacks, heart failure, and strokes, according to a report presented here today at the American Diabetes Association's 65th Annual Scientific Sessions.

"Annual health care costs for those with the highest pre-diabetes blood glucose levels were 31 percent above those with normal blood glucose levels, with many of the extra costs due to cardiovascular disease, which is expensive to treat but far less expensive to prevent," said Gregory A. Nichols, PhD, Senior Research Associate, Kaiser Permanente Center for Health Research, Portland, OR, in a recent interview. "The application of preventive medicine techniques, through early diagnostic testing and intervention, could lengthen lives and lower health care costs when pre-diabetes is spotted."

The nine-year study looked at a 28,000 patient population to compare the health care costs of people with two different levels of elevated blood glucose -- but still without diabetes -- to those with normal glucose levels.

"Early intervention in people with pre-diabetes is important to prevent or delay type 2 diabetes and cardiovascular disease and to reduce health care costs for the individual and the employer," said Dr. Nichols. "Doctors should be testing people for elevated blood glucose regularly and checking for other health problems in those found to have pre-diabetes."

More than 18 million Americans have diabetes, a group of serious diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin. Diabetes can lead to severely debilitating or fatal complications, such as heart disease, blindness, kidney disease, and amputations. It is the fifth leading cause of death by disease in the U.S. Type 2 diabetes involves insulin resistance -- the body's inability to properly use its own insulin. It usually occurs in those who are over 45 and overweight, but it has increasingly been seen in obese children
and teens in recent years.


Pre-diabetes is defined as blood glucose levels that are higher than normal but not high enough for a diabetes diagnosis. It may be called "impaired glucose tolerance" (IGT) or "impaired fasting glucose" (IFG), depending on which test was used to detect it. This study used IFG. 

Currently, the IFG cut-point for starting diagnosis of pre-diabetes is 100 mg/dl. However, prior to 2003, there had been a higher starting cut-point of 110 mg/dl. (In both instances, the cut-point for diagnosing actual diabetes remained the same at 126 mg/dl.)

The cut-point was lowered by an expert committee in order to identify more people who are at increased risk of developing type 2 diabetes. This decision was made because research has shown that people who are identified early can prevent or delay the progression from pre-diabetes to diabetes by up to 58 percent with lifestyle changes that include modest weight loss and regular exercise. Other research suggests that similar interventions are also of benefit in reducing the risk of cardiovascular disease.

The research being reported today compared people with normal blood glucose levels to people with elevated levels in the range of the current pre- diabetes cut-point vs. the old pre-diabetes cut-point, creating two elevated groups: 100-109 mg/dl vs. 110-125 mg/dl, which the authors called stage 1 or stage 2 of pre-diabetes for the purposes of this study. They used the Kaiser Permanente Northwest Regional Laboratory to identify 28,335 patients with two or more IFG blood tests in the nine year period ending December 2003. Based on a review of their charts, they excluded those with diagnosed diabetes.

Those with pre-diabetes averaged age 58

For the purposes of the study, each pre-diabetes subject was matched to another member of Kaiser Permanente Northwest, of the same age and sex, who had a normal fasting plasma glucose test.

All patients were then followed until they: recorded a blood test qualifying them for a higher stage; received an anti-hyperglycemic drug, indicating a diagnosis of diabetes; terminated health plan participation; or reached the end of the study on December 31, 2003. Most remained in a single stage throughout the years, but 3,281 progressed. Annual costs across the three groups were then compared.

Age and sex adjusted costs were $4,357 annually for patients with normal blood glucose levels, $4,580 for those with stage 1 pre-diabetes, and $4,960 among those with stage 2 pre-diabetes. However, costs for those with normal
blood glucose were only $3,799 annually when those who later progressed to IFG or diabetes are removed, thus yielding the 31 percent difference, Dr. Nichols cited.

"The increased costs are seen in inpatient, outpatient, and pharmacy expenses," reported Dr. Nichols. He and his research partner, Jonathan B. Brown, MPP, PhD, were able to identify the allocation of costs by looking at diagnostic codes. "We found a great prevalence of cardiovascular disease and obesity and therefore assume those are driving the costs."

The American Diabetes Association is the nation's leading voluntary health organization supporting diabetes research, information and advocacy. Founded in 1940, the Association has offices in every region of the country, providing
services to hundreds of communities. 

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