Health service use and health system costs associated with diabetes during pregnancy in Australia.

BACKGROUND AND AIMS: In the context of the rising rate of diabetes in pregnancy in Australia, this study aims to examine the health service and resource use associated with diabetes during pregnancy. METHODS AND RESULTS: This project utilised a linked administrative dataset containing health and cost data for all mothers who gave birth in Queensland, Australia between 2012 and 2015 (n = 186,789, plus their babies, n = 189,909). The association between maternal characteristics and diabetes status were compared with chi-square analyses. Multiple logistic regression produced the odds ratio of having different outcomes for women who had diabetes compared to women who did not. A two-sample t-test compared the mean number of health services accessed. Generalised linear regression produced the mean costs associated with health service use. Mothers who had diabetes during pregnancy were more likely to have their labour induced at <38 weeks gestation (OR:1.39, 95% CI:1.29-1.50); have a cesarean section (OR: 1.26, 95% CI:1.22-1.31); have a preterm birth (OR:1.24, 95%: 1.18-1.32); have their baby admitted to a Special Care Nursery (OR: 2.34, 95% CI:2.26-2.43) and a Neonatal Intensive Care Unit (OR:1.25, 95%CI: 1.14-1.37). On average, mothers with diabetes access health services on more occasions during pregnancy (54.4) compared to mothers without (50.5). Total government expenditure on mothers with diabetes over the first 1000 days of the perinatal journey was significantly higher than in mothers without diabetes ($12,757 and $11,332). CONCLUSION: Overall, mothers that have diabetes in pregnancy require greater health care and resource use than mothers without diabetes in pregnancy.

Outcomes, care utilization, and expenditures in adolescent pregnancy complicated by diabetes.

BACKGROUND AND OBJECTIVE: Adolescence and pregestational diabetes separately increase risks of adverse pregnancy outcomes, but little is known about their combined effect. To analyze pregnancy outcomes, healthcare utilization, and expenditures in adolescent pregnancies with and without pregestational diabetes using a national claims database. METHODS: Retrospective study using Truven Health MarketScan Commercial Claims and Encounters Database, 2011 to 2015. Females 12 to 19 years old, continuously enrolled for at least 12 months before a livebirth until 2 months after, were included. Pregestational diabetes, diabetes complications (ketoacidosis, retinopathy, neuropathy, nephropathy), comorbidities, and pregnancy outcomes (preeclampsia, preterm delivery, high birthweight, cesarean delivery) were identified using claims data algorithms. Healthcare utilization and payer expenditure were tabulated per enrollee. Multivariate logistic regressions assessed pregnancy outcomes; multivariate OLS regression assessed payer expenditures. RESULTS: About 33 502 adolescents were included. Adolescents without diabetes had pregnancy outcomes consistent with national estimates. Adolescents with uncomplicated diabetes had increased odds of preeclampsia adjusted odds ratios 2.41 (95% confidence interval 1.93-3.02), preterm delivery 1.50 (1.21-1.87), high birthweight 1.84 (1.50-2.27), and cesarean delivery 1.81 (1.52-2.15). Diabetes with ketoacidosis and/or end-organ damage had higher odds of preeclampsia 5.62 (2.77-11.41), preterm delivery 5.81 (3.00-11.25), high birthweight 2.38 (1.08-5.24), and cesarean delivery 3.43 (1.78-6.64). Adolescents with diabetes utilized significantly more outpatient and inpatient care during pregnancy. Payer expenditures increased by 45.3% (34.8-55.9%) among adolescents with diabetes and by 82.6% (49.1-116.0%) among adolescents with diabetes complicated by ketoacidosis and/or end-organ damage. CONCLUSION: Compared with normal adolescent pregnancies, pregestational diabetes significantly increases risks of adverse pregnancy outcomes and significantly escalates healthcare utilization and cost.

A Prepregnancy Care Program for Women With Diabetes: Effective and Cost Saving.

CONTEXT: Only a minority of women with diabetes attend prepregnancy care service and the economic effects of providing this service are unclear. OBJECTIVE: The objective of the study was to design, put into practice, and evaluate a regional prepregnancy care program for women with types 1 and 2 diabetes. DESIGN: This was a prospective cohort and cost-analysis study. SETTING: The study was conducted at antenatal centers along the Irish Atlantic Seaboard. PARTICIPANTS: Four hundred fourteen women with type 1 or 2 diabetes participated in the study. INTERVENTIONS: The intervention for the study was a newly developed prepregnancy care program. MAIN OUTCOME MEASURES: The program was assessed for its effect on the risk of adverse pregnancy outcomes. The difference between program delivery cost and the excess cost of treating adverse outcomes in nonattendees was evaluated. RESULTS: In total, 149 (36%) attended: this increased from 19% to 50% after increased recruitment measures in 2010. Attendees were more likely to take preconception folic acid (97.3% vs 57.7%, P < .001) and less likely to smoke (8.7% vs 16.6%, P = .03) or take potentially teratogenic medications at conception (0.7 vs 6.0, P = .008). Attendees had lower glycated hemoglobin levels throughout pregnancy (first trimester glycated hemoglobin 6.8% vs 7.7%, P < .001; third trimester glycated hemoglobin 6.1% vs 6.5%, P = .001), and their offspring had lower rates of serious adverse outcomes (2.4% vs 10.5%, P = .007). The adjusted difference in complication costs between those who received prepregnancy care vs usual antenatal care only is €2578.00. The average cost of prepregnancy care delivery is €449.00 per pregnancy. CONCLUSIONS: This regional prepregnancy care program is clinically effective. The cost of program delivery is less than the excess cost of managing adverse pregnancy outcomes.

Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy.

BACKGROUND: Increasing diabetes prevalence affects a substantial number of pregnant women in the United States. Our aims were to evaluate health outcomes, medical costs, risks and types of complications associated with diabetes in pregnancy for mothers and newborns. METHODS: In this retrospective claims analysis, patients were identified from the Truven Health MarketScan(®) database (2004-2011 inclusive). Participants were aged 18-45 years, with ascertainable diabetes status [Yes/No], date of birth event >2005 and continuous health plan enrolment ≥21 months before and 3 months after the birth. RESULTS: In total, 839 792 pregnancies were identified, and 66 041 (7.86%) were associated with diabetes mellitus [type 1 (T1DM), 0.13%; type 2 (T2DM), 1.21%; gestational (GDM), 6.29%; and GDM progressing to T2DM (patients without prior diabetes who had a T2DM diagnosis after the birth event), 0.23%]. Relative risk (RR) of stillbirth (2.51), miscarriage (1.28) and Caesarean section (C-section) (1.77) was significantly greater with T2DM versus non-diabetes. Risk of C-section was also significantly greater for other diabetes types [RR 1.92 (T1DM); 1.37 (GDM); 1.63 (GDM progressing to T2DM)]. Risk of overall major congenital (RR ≥ 1.17), major congenital circulatory (RR ≥ 1.19) or major congenital heart (RR ≥ 1.18) complications was greater in newborns of mothers with diabetes versus without. Mothers with T2DM had significantly higher risk (RR ≥ 1.36) of anaemia, depression, hypertension, infection, migraine, or cardiac, obstetrical or respiratory complications than non-diabetes patients. Mean medical costs were higher with all diabetes types, particularly T1DM ($27 531), than non-diabetes ($14 355). CONCLUSIONS: Complications and costs of healthcare were greater with diabetes, highlighting the need to optimize diabetes management in pregnancy.

Preventable health and cost burden of adverse birth outcomes associated with pregestational diabetes in the United States.

OBJECTIVE: Preconception care for women with diabetes can reduce the occurrence of adverse birth outcomes. We aimed to estimate the preconception care (PCC)-preventable health and cost burden of adverse birth outcomes associated with diagnosed and undiagnosed pregestational diabetes mellitus (PGDM) in the United States. STUDY DESIGN: Among women of reproductive age (15-44 years), we estimated age- and race/ethnicity-specific prevalence of diagnosed and undiagnosed diabetes. We applied age and race/ethnicity-specific pregnancy rates, estimates of the risk reduction from PCC for 3 adverse birth outcomes (preterm birth, major birth defects, and perinatal mortality), and lifetime medical and lost productivity costs for children with those outcomes. Using a probabilistic model, we estimated the reduction in adverse birth outcomes and costs associated with universal PCC compared with no PCC among women with PGDM. We did not assess maternal outcomes and associated costs. RESULTS: We estimated 2.2% of US births are to women with PGDM. Among women with diagnosed diabetes, universal PCC might avert 8397 (90% prediction interval [PI], 5252-11,449) preterm deliveries, 3725 (90% PI, 3259-4126) birth defects, and 1872 (90% PI, 1239-2415) perinatal deaths annually. Associated discounted lifetime costs averted for the affected cohort of children could be as high as $4.3 billion (90% PI, 3.4-5.1 billion) (2012 US dollars). PCC among women with undiagnosed diabetes could yield an additional $1.2 billion (90% PI, 951 million-1.4 billion) in averted cost. CONCLUSION: Results suggest a substantial health and cost burden associated with PGDM that could be prevented by universal PCC, which might offset the cost of providing such care.

Comparison of maternal morbidity and medical costs during pregnancy and delivery between patients with gestational diabetes and patients with pre-existing diabetes.

AIMS: To evaluate the effects of gestational diabetes and pre-existing diabetes on maternal morbidity and medical costs, using data from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. METHODS: Delivery cases in 2010, 2011 and 2012 (459 842, 442 225 and 380 431 deliveries) were extracted from the Health Insurance Review and Assessment Service database. The complications and medical costs were compared among the following three pregnancy groups: normal, gestational diabetes and pre-existing diabetes. RESULTS: Although, the rates of pre-existing diabetes did not fluctuate (2.5, 2.4 and 2.7%) throughout the study, the rate of gestational diabetes steadily increased (4.6, 6.2 and 8.0%). Furthermore, the rates of pre-existing diabetes and gestational diabetes increased in conjunction with maternal age, pre-existing hypertension and cases of multiple pregnancy. The risk of pregnancy-induced hypertension, urinary tract infections, premature delivery, liver disease and chronic renal disease were greater in the gestational diabetes and pre-existing diabetes groups than in the normal group. The risk of venous thromboembolism, antepartum haemorrhage, shoulder dystocia and placenta disorder were greater in the pre-existing diabetes group, but not the gestational diabetes group, compared with the normal group. The medical costs associated with delivery, the costs during pregnancy and the number of in-hospital days for the subjects in the pre-existing diabetes group were the highest among the three groups. CONCLUSIONS: The study showed that the rates of pre-existing diabetes and gestational diabetes increased with maternal age at pregnancy and were associated with increases in medical costs and pregnancy-related complications.

[Costs of temporary disability in Spain related to diabetes mellitus and its complications]. / Costes por incapacidad temporal en España derivados de la diabetes mellitus y sus complicaciones.

INTRODUCTION AND OBJECTIVES: To ascertain the socioeconomic impact of diabetes, it is essential to estimate overall costs, including both direct and indirect costs (premature retirements, working hours lost, or sick leaves). This study analyzed indirect costs for temporary disability (TD) due to diabetes and its complications in Spain in 2011 by assessing the related ICD-9 MC codes. MATERIAL AND METHOD: For this purpose, the number of TD processes and their mean duration were recorded. The indirect costs associated to loss of working days were also estimated. RESULTS: In 2011, diabetes and its complications were related to 2.567 TD processes, which resulted in the loss of 154.214 days. In terms of costs, this disease represented for Spanish public health administrations an expense of 3,297.095.3 €, with an estimated cost per patient and year of 141 €. CONCLUSIONS: These data suggest an urgent need to devise plans for prevention and early diagnosis of diabetes and its complications, as well as programs to optimize the available health care resources by creating multidisciplinary teams where occupational medical services assume an important role. A decrease in absenteeism would result in benefits for diabetic patients, society overall, and companies or public institutions.

The challenge of multidisciplinary research: improving diabetic pregnancy together.

Improving diabetic pregnancy outcome is a goal shared by many involved specialists. Despite proper glucose control, the incidence of maternal and perinatal complications is very high, including a high risk for pre-eclampsia, congenital malformations, perinatal mortality and macrosomia. To improve outcome, not only collaborating in the doctor's office is required but also participation in critical evaluation of our treatment strategies by means of randomised clinical trials.

Modeling the independent effects of gestational diabetes mellitus on maternity care and costs.

OBJECTIVE: To explore the independent effects of gestational diabetes mellitus (GDM) on maternity care and costs. RESEARCH DESIGN AND METHODS: Estimates for maternity care resource activity and costs for 4,372 women, of whom 354 (8.1%) were diagnosed with GDM, were generated from data from the Atlantic Diabetes in Pregnancy (ATLANTIC DIP) database. Multivariate regression analysis was applied to explore the effects of GDM on 1) mode of delivery, 2) neonatal unit admission, and 3) maternity care cost, while controlling for a range of other demographic and clinical variables. RESULTS: Women with a diagnosis of GDM had significantly higher levels of emergency caesarean section (odds ratio [OR] 1.75 [95% CI 1.08-2.81]), their infants had significantly higher levels of neonatal unit admission (3.14 [2.27-4.34]), and costs of care were 34% greater (25-43) than in women without GDM. Other variables that significantly increased costs were weight, age, primiparity, and premature delivery. CONCLUSIONS: GDM plays an independent role in explaining variations in rates of emergency caesarean section, neonatal unit admission, and costs of care, placing a substantial economic burden on maternity care services. Interventions that prevent the onset of GDM have the potential to yield substantial economic and clinical benefits.

Costs of recalled and recommended diets for pregnant women with type 1, type 2 and gestational diabetes.

OBJECTIVE: The costs associated with nutritious foods may be a barrier to healthy dietary choices and of particular concern to pregnancies complicated by diabetes. Therefore, a survey was conducted in a tertiary care diabetes and pregnancy clinic to compare the associated costs of actual food choices versus the cost of a constructed recommended diet. METHODS: Women with types 1, 2 and gestational diabetes mellitus (GDM) completed 24-hour dietary recalls under the supervision of the research coordinator (Actual Diet). A Recommended Diet for this population was constructed independent of participant responses. Actual and Recommended Diets were standardized per 2000 kcal, priced and compared for content and cost. RESULTS: Seventy-five women participated: 27 with GDM, 29 with type 1 diabetes and 19 with type 2 diabetes. There were no significant cost differences between Recommended and Actual Diets food choices expressed per 2000 kcal: Recommended Diet $10.14±3.72; Actual Diet GDM: $11.30±3.88; Actual Diet type 1 diabetes: $9.00±3.16; Actual Diet type 2 diabetes: $10.24±3.92. Percentage of fibre intake was lower for Actual Diets than Recommended Diet for all groups, while percentage of protein intake was lower in Actual than Recommended Diet for women with type 1 diabetes. CONCLUSION: Clinical recommendations for healthy food choices may not be more expensive than actual choices made by pregnant women with diabetes.

Care cost for pregnant and parturient women with diabetes and mild hyperglycemia / Custo da assistência de gestantes e parturientes diabéticas e com hiperglicemia leve / Costo de la asistencia de gestantes y parturientas diabéticas y con hiperglicemia leve

OBJECTIVE: To compare inpatient and outpatient care costs for pregnant/parturient women with diabetes and mild hyperglycemia. METHODS: A prospective observational quantitative study was conducted in the Perinatal Diabetes Center in the city of Botucatu, Southeastern Brazil, between 2007 and 2008. Direct and indirect costs and disease-specific costs (medications and tests) were estimated. Thirty diet-treated pregnant women with diabetes were followed up on an outpatient basis, and 20 who required insulin therapy were hospitalized. RESULTS: The cost of diabetes disease (prenatal and delivery care) was US$ 3,311.84 for inpatients and US$ 1,366.04 for outpatients. CONCLUSIONS: Direct and indirect costs as well as total prenatal care cost were higher for diabetic inpatients while delivery care costs and delivery-postpartum hospitalization were similar. Prenatal and delivery-postpartum care costs were higher for these patients compared to those paid by Brazilian National Health System.

OBJETIVO: Comparar custos de hospitalização e de atenção ambulatorial em gestantes/parturientes diabéticas e com hiperglicemia leve. MÉTODOS: Estudo observacional, prospectivo, quantitativo descritivo realizado em centro de diabete perinatal em Botucatu, SP, entre 2007 e 2008. Foram estimados os custos por absorção diretos e indiretos disponíveis na instituição e os custos específicos para a doença (medicamentos e exames). As 30 gestantes diabéticas tratadas com dieta foram acompanhadas em ambulatório e 20 tratadas com dieta mais insulina foram hospitalizadas. RESULTADOS: O custo da doença diabete (para a assistência pré-natal e parto) foi de US$ 3,311.84 para as gestantes hospitalizadas e de US$ 1,366.04 para as acompanhadas em ambulatório. CONCLUSÕES: Os custos diretos e indiretos e o custo total da assistência pré-natal foram mais elevados nas gestantes diabéticas hospitalizadas enquanto os custos da assistência ao parto e hospitalização para parto e puerpério foram semelhantes. Os custos da assistência pré-natal como no parto/puerpério foram superiores aos valores pagos pelo Sistema Único de Saúde.

OBJETIVO: Comparar costos de hospitalización y de atención por ambulatorio en gestantes/parturientas diabéticas y con hiperglicemia leve. MÉTODOS: Estudio observacional, prospectivo, cuantitativo descriptivo realizado en centro de diabetes perinatal en Botucatu, Sureste de Brasil, entre 2007 y 2008. Se estimaron los costos por absorción directos e indirectos disponibles en la institución y los costos específicos para la enfermedad (medicamentos y exámenes). Las 30 gestantes diabéticas tratadas con dieta fueron acompañadas en ambulatorio y 20 tratadas con dieta más insulina fueron hospitalizadas. RESULTADOS: El costo de la enfermedad diabetes (para asistencia prenatal y parto) fue de US$ 3,311.84 para las gestantes hospitalizadas y de US$ 1,366.04 para las acompañadas en ambulatorio. CONCLUSIONES: Los costos directos e indirectos y el costo total de la asistencia prenatal fueron más elevados en las gestantes diabéticas hospitalizadas mientras que los costos de la asistencia al parto y hospitalización para parto y puerperio fueron semejantes. Los costos de la asistencia prenatal como en el parto/puerperio fueron superiores a los valores pagados por el Sistema Único de Salud.

Care cost for pregnant and parturient women with diabetes and mild hyperglycemia.

OBJECTIVE: To compare inpatient and outpatient care costs for pregnant/parturient women with diabetes and mild hyperglycemia. METHODS: A prospective observational quantitative study was conducted in the Perinatal Diabetes Center in the city of Botucatu, Southeastern Brazil, between 2007 and 2008. Direct and indirect costs and disease-specific costs (medications and tests) were estimated. Thirty diet-treated pregnant women with diabetes were followed up on an outpatient basis, and 20 who required insulin therapy were hospitalized. RESULTS: The cost of diabetes disease (prenatal and delivery care) was US$ 3,311.84 for inpatients and US$ 1,366.04 for outpatients. CONCLUSIONS: Direct and indirect costs as well as total prenatal care cost were higher for diabetic inpatients while delivery care costs and delivery-postpartum hospitalization were similar. Prenatal and delivery-postpartum care costs were higher for these patients compared to those paid by Brazilian National Health System.

Gestational diabetes guidelines in a HAPO world.

The impact of gestational diabetes on maternal and fetal health has been increasingly recognized. However, universal consensus on the diagnostic methods and thresholds has long been lacking. Published guidelines from major societies differ considerably from one another, ranging in recommendations from aggressive screening to no routine screening at all. As a result, real-world practice is equally varied. The recently published Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, and two randomized controlled trials evaluating treatment of mild maternal hyperglycemia, have served to confirm the findings of smaller, nonrandomized studies solidifying the link between maternal hyperglycemia and adverse perinatal outcomes. In response to these studies, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) has formulated new guidelines for screening and diagnosis of diabetes in pregnancy. Key components of the IADPSG guidelines include the recommendation to screen high-risk women at the first encounter for pre-gestational diabetes, to screen universally at 24-28 weeks' gestation, and to screen with use of the 75-g oral glucose tolerance test interpreting abnormal fasting, 1-h, and 2-h plasma glucose concentrations as individually sufficient for the diagnosis of gestational diabetes. Furthermore, to translate the continuous association between maternal glucose and adverse outcomes demonstrated in the HAPO cohort, they recommend thresholds for positive screening tests at which the odds of elevated birth weight, cord C-peptide, and fetal percent body fat are 1.75 relative to odds of those outcomes at mean glucose values. Opponents to the IADPSG recommendations will likely be those who favor risk-based screening in addition to those who endorse the 50-g glucose challenge test followed by the 100-g oral glucose tolerance test as a more cost-effective, familiar, and possibly, well-validated screening tool. Others may argue that the diagnostic thresholds chosen by the IADPSG are arbitrary and will continue to miss many cases of abnormal glucose metabolism and therefore leave open the possibility of adverse perinatal outcomes due to untreated gestational diabetes. Finally, the potential economic impact of the IADPSG guidelines are unknown, and with minimal long-term data yet available on the offspring of the HAPO cohort, a true cost-effectiveness analysis will be difficult to perform accurately. Given these potential points of contention, the responses of professional and international groups to the IADPSG guidelines are difficult to gauge. Regardless, these guidelines serve to advance the discussion on appropriate screening and diagnosis of diabetes in pregnancy.

Insulin Glargine: a review 8 years after its introduction.

Insulin Glargine was the first long-acting insulin analog produced by recombinant DNA technology, approved for use by the US FDA in April 2000 and by the European Agency for the Evaluation of Medicinal Products in June, 2000. It has become the most widely used insulin in the USA owing to its long duration of action without a pronounced peak. The principal advantage of insulin Glargine over neutral protamine Hagedorn (NPH) insulin is in a lower frequency of hypoglycemic reactions, thus affording improved safety. It is used in both type 1 and type 2 diabetes, usually as a single daily dose. In type 2 patients, it is often the first insulin introduced as a single daily dose. Although insulin Glargine is typically administered as a single nighttime dose, it can be given in the morning or at any other time convenient for the patient. In labile type 1 diabetes, it is often most effective given as two daily injections. In obese, insulin-resistant patients, it may be best to administer insulin Glargine in two separate doses, owing to the high volumes of injected insulin required. Insulin Glargine does not treat postprandial hyperglycemia. It is necessary to supplement with short-acting insulin at mealtimes to control glucose surges after meals. Insulin Glargine is effective in hospitalized and postsurgical patients on account of its lack of pronounced insulin peaks and long duration of action. Although there is considerable use of Glargine in pregnant diabetic women, there is no definitive study to confirm its benefits. Insulin Glargine is thought to coprecipitate supplementary short-acting insulins when co-administered in the same syringe. Therefore, more injections are typically needed in the usual treatment regimen for insulin requiring diabetes. In many cases, constant basal insulin levels may be achieved with multiple overlapping doses of NPH insulin given together with short-acting insulin at mealtimes. Such a therapy may be less costly, but the major advantage of insulin Glargine remains the greater safety of a lower frequency of hypoglycemic reactions.

Costs of NHS maternity care for women with multiple pregnancy compared with high-risk and low-risk singleton pregnancy.

OBJECTIVE: To compare antenatal and obstetric costs for multiple pregnancy versus singleton pregnancy risk groups and to identify factors driving cost differentials. DESIGN: Observational study over 15 months (2001-02). SETTING: Four district hospitals in southeast England. POPULATION: Consecutive women with multiple pregnancy and singleton women with risk factors for fetal congenital heart disease (CHD) (pregestational diabetes, epilepsy, or family history of CHD) or Down syndrome, and a sample of low-risk singleton women. METHODS: Clinical care was audited from the second trimester anomaly scan until postnatal discharge, and the resource items were costed. Multiple regression analysis determined predictors of costs. MAIN OUTCOME MEASURES: NHS mean costs of antenatal and obstetric care for different types of pregnancy. RESULTS: A total of 959 pregnancies were studied. Three percent of 243 women with multiple pregnancy reached 40 weeks of gestation compared with 54-55% of 163 low-risk and 322 Down syndrome risk women and 36% of 231 cardiac risk women. Antenatal costs for cardiac risk (1,153 pounds sterling) and multiple pregnancy (1,048 pounds sterling) were nearly double the costs for other two groups (P < 0.001). As 63% of multiple births were delivered by caesarean section, the obstetric cost for multiple pregnancy (3,393 pounds sterling) was 1,000 pounds sterling greater overall. Pregestational diabetes was the most influential factor driving singleton costs, resulting in similar total costs for multiple pregnancy women (4,442 pounds sterling) and for women with diabetes (4,877 pounds sterling). CONCLUSIONS: Our analyses confirm that multiple pregnancies are substantially more costly than most singleton pregnancies. Identifying women with diabetes as equally costly is pertinent because of the findings of the Confidential Enquiry into Maternal and Child Health that standards of maternal care for diabetics often are inadequate.

The business case for preconception care: methods and issues.

Only a limited number of economic evaluations have addressed the costs and benefits of preconception care. In order to persuade health care providers, payers, or purchasers to become actively involved in promoting preconception care, it is important to demonstrate the value of doing so through development of a "business case". Perceived benefits in terms of organizational reputation and market share can be influential in forming a business case. In addition, it is standard to include an economic analysis of financial costs and benefits from the perspective of the provider practice, payer, or purchaser in a business case. The methods, data needs, and other issues involved with preparing an economic analysis of the likely financial return on investment in preconception care are presented here. This is accompanied by a review or case study of economic evaluations of preconception care for women with recognized diabetes. Although the data are not sufficient to draw firm conclusions, there are indications that such care may yield positive financial benefits to health care organizations through reduction in maternal and infant hospitalizations. More work is needed to establish how costs and economic benefits are distributed among different types of organizations. Also, the optimum methods of delivering preconception care for women with diabetes need to be evaluated. Similar assessments should also be conducted for other forms of preconception care, including comprehensive care.

[Diabetes mellitus in Spain: death rates, prevalence, impact, costs and inequalities]. / La diabetes mellitus en España: mortalidad, prevalencia, incidencia, costes económicos y desigualdades.

OBJECTIVE: Describing the situation of diabetes mellitus (DM) in Spain from a public health perspective. MATERIAL AND METHOD: manual review of books and other documents on diabetes mellitus in Spain was conducted. In addition, a specific research of articles published using MeSH terms diabetes mortality, prevalence, incidence, cost, inequalities and Spain was conducted in Medline through Internet (PubMed). Minimun Basic Data Set was utilized as source for complication description by Communities Autonomus. RESULTS: DM is one of the leading cause of mortality and the third one in women. With regard to Autonomous Communities, Canary Islands, Ceuta y Melilla and Andalusia show the greatest mortality with a downward trend. Diabetics present greater mortality than non diabetic patients, being complications the main cause of the over-mortality, especially ischemic heart disease. Estimations of prevalence for DM2 range from 4.8% to 18.7% and for DM1, from .08% to .2%. In pregnancy, it has been noted a prevalence ranging from 4.5% to 16.1%. With respect to incidence per year, it is estimated a range from 146 to 820 per 100,000 inhabitants for DM2 and a range from 10 to 17 new cases annually per 100,000 inhabitants for DM1. Costs for DM1 show very different results, averaging between 1,262 and 3,311 euro per people and year. There are differences for DM2 costs as well, averaging between 381 and 2,560 euro per patient and year. Total costs estimated range from 758 to 4,348 euro per person and year. Relationship between a low socioeconomic level (LSL) and DM2 risk has been proved. Moreover, it has been noted that the less LSL the worse is the disease control, coupled with a greater frequency and more frequent factors of DM2 risk. CONCLUSIONS: The knowledge about the situation of the DM as a Public Health problem in Spain is limited. Mortality data available does not gather its real magnitude, and prevalence, incidence, costs and inequalities research are very poor and hardly comparable. In spite of this degree of incertitude, we can state that DM is an important public health problem with a continuous increase, especially DM2, if the appropriate prevention and control measures are not taken.

La diabetes mellitus en España: mortalidad, prevalencia, incidencia, costes económicos y desigualdades / Mellitus diabetes in Spain: death rates, prevalence, impact, costs and inequalities

Objetivo: Describir la situación de la diabetes mellitus (DM) en España desde una perspectiva de salud pública. Material y método: Se ha realizado una búsqueda manual de libros y otros documentos sobre DM en España, además una búsqueda específica de artículo usando los términos MeSH diabetes mortality, morbidity, cost, inequalities and Spain, realizada en Medline a través de PubMed. También se han utilizado los últimos datos disponibles de mortalidad y del Conjunto Mínimo Básico de Datos Hospitalarios por Comunidad Autónoma. Resultados: La DM es una de las primeras causas de mortalidad, en las mujeres ocupa el tercer lugar. Por Comunidades Autónomas, Canarias junto con Andalucía y las ciudades autónomas de Ceuta y Melilla presentan la mayor mortalidad, con una tendencia descendente. Los diabéticos tienen una mayor mortalidad que los no diabéticos, sus complicaciones son las principales causas de la mayor mortalidad, sobre todo la enfermedad isquémica del corazón. Las estimaciones de prevalencia de DM tipo 2 (DM2) en España varían entre el 4,8 y el 18,7%, las de DM tipo 1 (DM1) entre el 0,08 y el 0,2%. Para la DM en el embarazo se han descrito prevalencias entre el 4,5 y el 16,1%. En cuanto a incidencia anual, se estima entre 146 y 820 por 100.000 personas para la DM2 y entre 10 y 17 nuevos casos anuales por 100.000 personas para la DM1. Los costes económicos de la DM1 van de 1.262 a 3.311 €/persona/ año. Los costes de la DM2 oscilan entre 381 y 2.560 €/paciente/ año. Los estudios que estiman costes totales los sitúan entre 758 y 4.348 €/persona/año. Se ha demostrado que a menor nivel socioeconómico peor es el control de la enfermedad y mayores su frecuencia y los otros factores de riesgo de DM2. Conclusiones: Se puede afirmar que la DM es un importante problema de salud pública que irá incrementándose en los próximos años (fundamentalmente la DM2) si no se toman las medidas de prevención y control oportunas (AU)

Objective: Describing the situation of diabetes mellitus (DM) in Spain from a public health perspective. Matherial and method: A manual review of books and other documents on diabetes mellitus in Spain was conduced. In addition, a specific research of articles published using MeSH terms diabetes mortality, prevalence, incidence, cost, inequalities and Spain was conduced in Medline through Internet(PubMed). Minimun Basic Data Set was utilized as source for complication description by Communities Autonomus. Results: DM is one of the leading cause of mortality and the third one in women. With regard to Autonomous Communities, Canary Islands, Ceuta y Melilla and Andalusia show the greatest mortality with a downward trend. Diabetics present grater mortality than non diabetic patients, being complications the main cause of the over-mortality, especially ischemic heart disease. Estimations of prevalence for DM2 range from 4.8% to 18.7% and for DM1, from.08% to.2%. In pregnancy, it has been noted a prevalence ranging from 4.5% to 16.1%. With respect to incidence per year, it is estimated a range from 146 to 820 per 100 000 inhabitants for DM2 and a range from 10 to 17 mew cases annually per 100 000 inhabitants for DM1. Costs for DM1 show very different results, averaging between 1,262 and 3,311 e per people and year. There are differences for DM2 costs as well, averaging between 381 and 2,560 e per patient and year. Total costs estimated range from 758 to 4,348 e per person and year. Relationship between a low socioeconomic level (LSL) and DM2 risk has been proved. Moreover,it has been noted that the less LSL the worse is the disease control, coupled with a greater frequency and more frequent factors of DM2 risk. Conclusions: The knowledge about the situation of the DM as a Public Health problem in Spain is limited. Mortality data available does not gather its real magnitude, and prevalence, incidence, costs and inequalities research are very poor and hardly comparable. In spite of this degree of incertitude, we can state that DM is an important public health problem with a continuous increase, especially DM2, if the appropriate prevention and control measures are not taken (AU)

Epidemiology of infants of diabetic mothers in indigent Micronesian population-Guam experience.

Diabetes complicating pregnancy has not yet been properly evaluated in Guam and the prevalence and morbidity of infants of diabetic mothers (IDM) in Micronesian population on Guam is described. The prevalence of IDM among the Micronesian population is 5.0% vs non-Micronesian's 3.7%. 82.5% were gestational diabetic mothers (GDM) diet controlled, 10.2% were GDM insulin controlled and 6.9% had Insulin Dependent Diabetes Mellitus. LGAs were 11% of IDMs in contrast to 6.4% of total births. Ten infants (NICU) spent total of 29 days on ventilator. Cesarean delivery, LGA, oxygen and ventilatory requirements were higher in Micronesian IDMs than in the non-Micronesian IDMs. The incidence is also higher in the Micronesian population (5.0%) compared to non Micronesian population (3.7%) on Guam. Micronesian IDMs were at higher risk for cesarean delivery, recurrent hypoglycemia, oxygen and ventilatory requirements than their non-Micronesian counterparts were. There is also a higher incidence of LGA among the Micronesian population and Chuukese had the highest incidence probably because they seek late or no prenatal care. We report 5.0% prevalence of diabetes during pregnancy in Micronesian population on Guam which imposes a significant economic burden on the local government's hospital resources. Micronesian IDMs were at higher risk for cesarean delivery, LGA, recurrent hypoglycemia, oxygen and ventilatory requirements than their non-Micronesian counterparts were. Chuukese had the highest LGA incidence in the study group. About 2/3rd of the IDM stayed 1110 extra days in hospital. IDMs accounted for the majority of expensive off-island transports.