Tuesday, January 18, 2011

Complications Double Cost of Diabetes Care

The cost of caring for patients with type 2 diabetes who have microvascular or macrovascular complications is twice that for a patient without complications, genetical researchers involved in the Cost of Diabetes in Europe Type 2 (CODE 2) study reported.

Efforts to improve blood glucose control and thereby prevent complications are urgently needed to reduce the cost of care, they said. The researchers collected demographic, clinical, and economic data on more than 7,000 patients and analyzed the results of surveys completed by more than 500 physicians, which provided information on direct use of health care, time spent in hospital, physician visits, and prescription drug use.

They found that the major factors driving health care costs were use of insulin (an indicator of disease progression) and the presence of microvascular and macrovascular complications, both of which increased the cost of health care.

Wednesday, December 22, 2010

Medical Errors In Type 2 Diabetes Care

How Frequent Are Medical Errors In The Management of Type 2 Diabetes

Medical errors by both patients and health care providers are extremely frequent. Most of the errors are not injurious, and, in fact, many errors are actually potential errors because they are corrected. But if you look at more important errors, such as medication errors, it is clear that these are very frequent as well.

For instance, 15% of all medications given in the hospital are given incorrectly in some way. The figure is probably even higher when it comes to insulin administration in hospitals. The dose may be wrong, the type of insulin used may be wrong, or the timing may be wrong, and there may be other problems as well. These errors result in less than optimal care.

What Other Types Of Errors Can Cccur?

There are many more types of errors that are important besides medication errors. For example, a person may wear shoes that are too tight and get a foot ulcer as a result. These are very important issues, and, in fact, some of them can be devastating to the patient.

In a 14-year cohort study of 823 patients, we established that errors were very common in the long-term follow-up of diabetic patients, and they had an important and deleterious effect on their outcome (Table 1).1 We reviewed the charts of the 283 patients who died and found that errors were commonly associated with their deaths. A major error that
caused disability, complications, increased morbidity, or, in some cases, death was
identified for almost 18% of those who died, and, in about 4%, the immediate
cause of death was directly related to a major medical error.

Table 1—Provider Error and Diabetes Outcomes

20.5% of 243 patients had a major error intheir care that caused at least one of these

• Excessive morbidity
• Complications
• Disability
• Death

4.2% of patients had a major error that was an immediate cause of death.