Type 2 diabetes and impaired fasting blood glucose in rural Bangladesh: a population-based study.

BACKGROUND: Diabetes is a fast expanding global health problem but more so in the developing countries. Therefore, it is of particular interest to study the epidemiological transition of the state and to identify the risk factors in order to recognize the extent of the problem. METHODS: A random sample of 5000 rural individuals (age >/=20 years) were included in a cross-sectional study. Fasting capillary blood glucose levels were measured from 4757 individuals. Height, weight, waist, hips including blood pressure and demographic information was collected. RESULTS: The study population was lean [mean body mass index (BMI) 19.4] with a low prevalence of type 2 diabetes but relatively high impaired fasting glucose. No relationship between type 2 diabetes and BMI in men, but an overall relationship was observed for women (P = 0.04) (data not shown). Age, sex, and waist/hip ratio appeared to be important risk factors for the occurrence of type 2 diabetes in this population. CONCLUSIONS: Low prevalence of type 2 diabetes and relative high impaired fasting blood glucose was observed. The factors associated with the occurrence of diabetes in this population appeared to differ than its known relations with BMI. This may indicate that the risk factors for type 2 diabetes are likely to differ in different population. Our results are likely to be in line with the Indian data suggesting that a revised guideline for anthropometric measures in the South Asian population is called for, in order to classify people at risk.

A comparison of hospital costs with reimbursement received for patients undergoing the Norwood procedure for hypoplasia of the left heart.

OBJECTIVES: To determine whether the present system of reimbursement, based on diagnosis-related groups and regular financial budgeting, covers the costs incurred during hospitalisation of 7 children undergoing the three stages of the Norwood sequence for surgical treatment of hypoplastic left heart syndrome. METHODS: Between January and September 2003, 7 patients underwent initial surgical palliation with the Norwood procedure at the Rikshospitalet University Hospital. A prospective methodology was developed by our group to measure the costs associated with each individual patient. The patients were closely observed, and the relevant data was collected during their stay in hospital. The stay was divided into four different periods of requirements of resources, defined as heavy intensive care, light intensive care, intermediate care, and ordinary care. At each stage, we recorded the number of staff involved and the duration of surgery and other major procedures, as well as the cost of pharmaceuticals and other consumables. Based on these data, we calculated the cost for each patient. These costs were compared with the corresponding revenue received by the hospital for each of the patients. RESULTS: We found the total mean cost for the three stages of the Norwood sequence was 138,934 American dollars, while the corresponding revenue received by the hospital was 43,735 American dollars. During this period, one patient died during the first stage of the Norwood sequence. CONCLUSIONS: Our study shows that steps involved in the Norwood sequence are low-volume but high-cost procedures. The reimbursement received by our hospital for the procedures was less than one-third of the recorded costs.

A comparison of actual cost, DRG-based cost, and hospital reimbursement for liver transplant patients.

The financing of health care services in Norway has been changed from a system of global budgeting to a system partly based on Diagnosis-Related Groups (DRG). The government has decided to derive a part of the hospital revenue from DRG-based, per-patient financing. The aim of this study is to determine whether the present remuneration system covers the actual hospital expenses of liver transplant patients, and whether the present method of calculating DRG-costs is adequate for our institution. Our group developed a prospective method of determining the actual cost per patient. We closely observed and collected the data of eight liver transplant patients during their hospital stay. We divided each of the patients' resource requirements into four categories; heavy intensive care, light intensive care, intermediate care, and ordinary care. In addition, we recorded the number of staff involved, the duration of surgery, the major procedures, and the medical- and material costs. The actual cost of each patient was calculated, based on these data. The actual cost was compared with the corresponding hospital remuneration for each patient. Median cost for liver transplantation was NOK 536.785 (range: NOK 295.113-NOK 844.345) (1$=7,5 NOK), while the corresponding hospital refund was NOK 457.785 (range: NOK 436.465-NOK 483.040). The difference is not statistically significant ( P=0.2). The average 100% DRG-based cost of a liver transplantation was NOK 730.321, which is significantly higher than the actual cost ( P=0.02). The hospital's reimbursement for liver transplantation did not differ significantly from the actual registered cost. The computed cost was significantly lower than the DRG-based cost.

Postprandial glycemic control with biphasic insulin aspart in patients with type 1 diabetes.

We sought to investigate the ability of biphasic insulin aspart 30 (BIAsp 30) to control postprandial hyperglycemia and hyperlipidemia in a meal-test comparison with biphasic human insulin 30 (BHI 30). In this randomised crossover trial, 50 patients with type 1 diabetes (mean age, 35.7 +/- 9.4 years; body mass index [BMI], 24.0 +/- 2.6 kg/m(2); HbA(1c), 8.6% +/- 1.1%) were studied on 3 separate days, where the following treatments were given in random order: BIAsp 30 injected immediately before a standard breakfast, BHI 30 injected 30 minutes before breakfast (BHI 30(t=-30)), and BHI 30 injected immediately before breakfast (BHI 30(t=0)). The dose was 0.40 U/kg for all 3 treatments. BIAsp 30 reduced the area under the baseline adjusted 4-hour postprandial serum glucose curve (AUC(0-4h)) by 23% compared with BHI 30(t=0) (P <.0001) and by 9% compared with BHI 30(t=-30) (P =.013). Maximum serum glucose concentration (C(max)) was lower for BIAsp 30 compared with BHI 30(t=0) (14.0 +/- 2.4 v 16.5 +/- 2.8 mmol/L, P <.0001), and time to maximal serum glucose concentration (t(max)) was approximately 20 minutes shorter for BIAsp 30, irrespective of timing of BHI 30 injection (P <.0001). There were no significant differences among the 3 treatments with respect to postprandial levels of free fatty acids or triglycerides. The pharmacokinetic results were consistent with the above observations, ie, significantly larger insulin AUC(0-4h), higher C(max) and shorter t(max) were observed for BIAsp 30 compared with BHI 30, irrespective of timing of BHI 30 injection. We conclude that postprandial glycemic control was more effective with BIAsp 30 than with BHI 30, irrespective of timing of BHI 30 injection.

[High-risk pregnancy, costs and DRG reimbursement]. / Risikofødende, kostnader og DRG-refusjon.

BACKGROUND: The aim of this study was to measure actual costs of delivery of women with high-risk pregnancies in Norway. We calculated the cost difference between Caesarean section delivery and vaginal delivery and compared costs and the reimbursement received by hospitals. The present Norwegian financial system for hospitals has two components: a government reimbursement based on diagnosis-related groups (DRG) covering, in principle, half of hospital costs, and a basic budget received as a block grant. MATERIAL AND METHOD: The study included 75 high-risk pregnant women. We used a prospective, individual bottom-up method based on: 1) hospital stay and the resources required, 2) operating theatre costs, 3) other major procedures, and 4) material and medication costs. Overhead costs (basic and general costs) were added on the basis on five key variables: 1) number of admittances (length of stay), 2) number of discharges, 3) number of employees, 4) floor space, and 5) number of PCs. The total cost for each patient was compared with the reimbursement received. RESULTS: We found that the reimbursement did not cover actual costs. Calculations were made for Caesarean and vaginal deliveries respectively: Mean cost of a Caesarean delivery was NOK 96,556, compared to a DRG reimbursement of NOK 47,137; mean cost of a vaginal delivery was NOK 62,136, with a DRG reimbursement of NOK 27,146.