Estimation of mortality savings due to a national program for diabetes care.

BACKGROUND: Diabetes-related complications can be reduced by better control of glycemia, lipid abnormalities and blood pressure. In recent years, efforts at improving diabetes care in Israel have been made. This study aims to estimate mortality savings related to a national program for diabetes care in Israel. METHODS: Total population data for Israel was projected to 2020. Current diabetes prevalence and disease management data were obtained from a national program of diabetes care. Projections of the program's effect were based on two models: improvement in glycemic control, reflected in Hb A1c levels, and improvement in overall diabetes care, reflected in the percentage with LDL<100 mg/dl, a proxy for multi-factorial control. Potential years of life lost (PYLL) and quality-adjusted life years (QALYs) saved were calculated. RESULTS: A drop in average Hb A1c values from 8.13% at baseline to 7.36% in 2020 is expected, and as a result 4216 deaths from diabetes will be prevented over the period 2001-2020, saving around 47,773 life years or 34,342 QALYs. Overall diabetes care, reflected in improving the control rate of LDL levels to <100 mg/dl from 36% in 2000 to 58% in 2020, is estimated to prevent around 4803 deaths from diabetes over the period 2001-2020., so the program will save around 47,127 PYLL or 32,862 QALYs. CONCLUSIONS: A nationwide program of diabetes care is estimated to result in significant reductions of overall, as well as CHD-related, mortality.

Do patients with diabetes and low socioeconomic status receive less care and have worse outcomes? A national study.

PURPOSE: The objective of the study was to assess the influence of socioeconomic status (SES) on the care of patients with diabetes. METHODS: Quality indicators for patients who were taking medication for diabetes were established. Overall compliance with the quality indicators, as well as prevalence of diabetes by age, were obtained from a national database. Patients with national tax exemptions (used as a marker for low SES) were compared to those without. RESULTS: Of 4,110,852 citizens aged 18-74, 210,988 (5.1%) were receiving medication for diabetes. The prevalence of diabetes reached 19.9% in people aged 65-74. 495,392 citizens had an exemption, and they had a higher prevalence of diabetes that those who did not (15.4% vs. 3.7%). Patients with an exemption had a higher rate of having a yearly HbA1c done, a yearly LDL level done, a yearly eye exam, a yearly urinary protein exam, of being treated with insulin for an elevated HbA1c than those without an exemption. In patients with an exemption there was a lower percentage with an HbA1c less than 7%, a higher percentage with an HbA1c greater than 9%, and a lower percentage with an LDL less than 130. Multivariate analysis showed that exemption status was a predictor of better performance on process measures (LDL test done, OR-1.03, 95% CI 1.01-1.06, HbA1c test done, OR 1.03, 95% CI- 1.01-1.05) and of worse outcomes (high LDL, OR 0.92, 95% CI, 0.90-0.95 and high HbA1c, OR, 0.85, 95% CI, 0.83-0.87). CONCLUSIONS: In a country with universal healthcare, patients from a lower SES had an increased prevalence of diabetes and had greater adherence to preventive healthcare measures However, they were less successful in meeting target treatment goals.