Unclear evidence on the costs of improving glycemic control in type 2 diabetes.

The Centre for Reviews and Dissemination (CRD) reports an economic evaluation of the impact of helping more patients to achieve their HbA1c target.

Clinical question:

In type 2 diabetes, what are the costs of improving glycemic control from a health service perspective?

The evidence

This economic evaluation was a decision model based on:

  • effectiveness data for “usual care” derived from medical records
  • effectiveness data for “improved care” derived from a search of Pubmed
  • cost data from health insurance claims.

The study authors reported that the incremental annual cost of improved care, compared with usual care, $1,128 per additional patient achieving their goal of HbA1c <7%.  This was based on an annual care cost estimate of $503 for usual care and $830 for improved care.

Other analyses were reported for HbA1c targets of 8% and 9% respectively.

Appraisal hints

Users of this research are advised to consider

  • The lack of a direct comparison in the source literature.  In particular, the source of effectiveness data appears to be  retrospective outcomes research.
  • The narrow perspective of the analysis, which does not include individual or societal perspectives.
  • The explicit advice from the CRD to view this evidence with caution, due to methodological limitations.


Read the full text of the critical appraisal by the CRD.

Original article: Nuckols TK, McGlynn EA. Cost implications to health care payers of improving glucose management among adults with type 2 diabetes. Health Serv Res. 2011 Aug;46(4):1158-79.

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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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