Routine diabetes screenings could cut health-care costs

Screening adults for diabetes could result in significant cost-savings for health care systems compared to the costs of not screening individuals at all.

Emory University researchers will present the findings of their diabetes screening cost analysis today at the annual meeting of the American Diabetes Association in New Orleans.

“The economic costs of diabetes threaten the financial integrity of our health care systems,” says study co-author Lawrence S. Phillips, MD, Emory University School of Medicine Professor of Medicine, Division of Endocrinology. “We asked whether there is economic justification for screening for prediabetes and unrecognized diabetes since early treatment could help prevent or delay development of diabetes and its complications and reduce associated costs.”

Phillips and his research team screened 1,259 adults who had never been diagnosed with diabetes. The volunteer participants underwent four screening tests, including random plasma and capillary glucose, and a 50g oral glucose challenge test (without a prior fast, at different times of the day) with plasma and capillary glucose measured one hour after the glucose drink. All participants also had a definitive 75g oral glucose tolerance test (OGTT) performed in the morning after an overnight fast.

The researchers found that 24 percent of the adults screened had either diabetes or prediabetes. In addition, they concluded that costs for screening and three years of treatment with metformin, or change in lifestyle for individuals found to have prediabetes or previously unrecognized diabetes, would be lower than costs for not screening.

The costs of two-step screening (only positive screens would have the OGTT) were projected to include the costs of testing, costs for false negatives (in individuals where the diagnosis would be missed), and costs for treatment of true positives (people found to have diabetes or prediabetes, treated with metformin, or change in lifestyle).

Projected health system costs for diabetes screening and management over a three-year period ranged from about $180,000 to $186,000 — all lower than costs for no screening, which would be about $206,000.

“We found that projected health system costs for screening and either treatment would be less than costs for no screening,” says Phillips. “These data suggest that screening with preventive management should be implemented widely and that use of the glucose challenge test may be cost-effective.”

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life.

According to the American Diabetes Association, 23.6 million U.S. children and adults, or 7.8 percent of the population, have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, 5.7 million people are unaware that they have the disease.

Pre-diabetes is a condition that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes.

In addition to Phillips, study authors were: K.M. Venkat Narayan, MD, MSc, MBA, and Joseph Lipscomb, PhD, of Emory University; and Ranee Chatterjee, MD, of the Johns Hopkins University School of Medicine. Chatterjee was lead study author.

The research was supported in part by the National Institutes of Health and the National Center for Research Resources.

The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service. Its components include the Emory University School of Medicine, Nell Hodgson Woodruff School of Nursing, and Rollins School of Public Health; Yerkes National Primate Research Center; Emory Winship Cancer Institute; and Emory Healthcare, the largest, most comprehensive health system in Georgia. Emory Healthcare includes: The Emory Clinic, Emory-Children’s Center, Emory University Hospital, Emory University Hospital Midtown, Wesley Woods Center, Emory University Orthopaedics & Spine Hospital, the jointly owned Emory-Adventist Hospital, and EHCA, a limited liability company created with Hospital Corporation of America. EHCA includes two joint venture hospitals, Emory Eastside Medical Center and Emory Johns Creek Hospital. The Woodruff Health Sciences Center has a $2.3 billion budget, 18,000 employees, 2,500 full-time and 1,500 affiliated faculty, 4,300 students and trainees, and a $5.5 billion economic impact on metro Atlanta.

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