Science & the Public

Janet Raloff
Science & the Public

The high cost of diabetes

Almost one-in-four hospital dollars go to treat people with the metabolic disorder.

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Although an estimated 7.8 percent of Americans have been diagnosed with diabetes, patients with this metabolic disease rack up 23 percent of hospital costs nationwide, a new federal analysis finds. Their collective hospital bill in 2008, the most recent year for which data were available: almost $83 billion.

The average hospital stay for someone with diabetes averages roughly a day longer (5.3 days) than in someone free of the disease. And that stay costs about $10,940 — or roughly $2,200 more than the average for people without the disease, according to Taressa Fraze and her colleagues at the Agency for Healthcare Research and Quality. Her group has synopsized its findings in an August statistical brief issued by their agency, a division of the Department of Health and Human Services.

Only about one in 14 hospital stays identified diabetes as the primary cause for a patient's admission. Many people were instead hospitalized for conditions that could — and probably were — fostered by diabetes, such as impaired circulation or heart disease. Or patients may have landed in the hospital with conditions (such as poor wound healing) that had been exacerbated by their disorder.

Indeed, Fraze’s group observes, circulatory disorders — congestive heart failure, hardening of the arteries, heart attacks, nonspecific chest pain and abnormal pacing of heart beats — constitute five of the top 10 reasons for people with diabetes to be hospitalized.

The new analysis finds that people with diabetes also tend to have an average of 2.6 additional and potentially complicating illnesses — twice the number typically seen in people without the disorder. Chief among these additional conditions is high blood pressure, followed by fluid and electrolyte disorders, chronic pulmonary disease, anemia, kidney failure and obesity.

Rates of hospitalization for diabetics differs by income bracket, with the most well-heeled patients being admitted at a rate of 1,762 per 100,000 — a little more than half the rate typical of the poorest diabetics. Hospitalization rates also vary by region, with the highest prevalence in the South and Northeast, and lowest in the West.

Everyone pays the cost of these hospitalizations through tax dollars (for Medicare, which covered 60 percent of diabetics’ hospitalizations in 2008) and higher premiums for private insurance. So it behooves all of us to help fight the development of this disease within our own households (through exercise, weight management and healthy diets) and to encourage it in older at-risk family and friends.

And if someone we know is diagnosed with the disease, we must remind them to remain vigilant so that they can catch complications early. I have an otherwise robust diabetic family member who ignored a tiny toe infection, last year, and ended up hospitalized on and off for the better part of 6 months with IV-antibiotics and near-daily wound treatment.

His costs were astronomical, although paid almost entirely by insurance and Medicare. So for him, the direct fiscal costs were not an issue. But being laid up for half a year by what initially seemed an inconsequential infection stunned him and frightened his wife and kids.

Because most people with diabetes don’t know it, both the medical community and the public need to reach out and encourage monitoring for hints of the disease. And we must all encourage assiduous monitoring for infections and other co-morbidities among those we know whose bodies no longer remain sensitive to blood sugar levels.

With health care costs spiraling out of control, here is one way we can all work to control them — and keep diabetic friends and family at home and symptomfree.

See also: Traffic may drive some people to diabetes

Citations

Fraze, T., H.J. Jiang and J. Burgess. Hospital stays for patients with diabetes, 2008. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality Statistical Brief #93.
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