title: Impact of concurrent macrovascular co-morbidities on healthcare utilization in patients with type 2 diabetes in Europe: a matched study.
abstract: OBJECTIVE
  To examine and to quantify the impact of concurrent macrovascular co-morbidities (MVC) on healthcare resource utilization among patients with type 2 diabetes mellitus (T2DM) in Europe.
  
  
  METHODS
  This is a matched cohort study based on the Real-Life Effectiveness and Care Patterns of Diabetes Management study, a multicentre, observational study with retrospective medical chart reviews of T2DM patients in Spain, France, UK, Norway, Finland, Germany and Poland. Included patients were aged > or =30 years at time of diagnosis of T2DM who added a sulfonylurea or a PPARgamma agonist to failing metformin monotherapy (index date) and had concurrent MVC (cases). A control cohort with T2DM but without concurrent MVC was identified using 1:1 propensity score matching. Logit models were used to identify the relationship between concurrent MVC and the likelihood of emergency room admission, receiving medical/surgical procedures, and hospitalization during the study period after controlling for baseline demographics, clinical information and baseline treatment. Negative binomial models were used to predict the number of office visits and length of hospital stay per year attributable to the concurrent MVC.
  
  
  RESULTS
  Relative to controls, patients with MVC were significantly more likely to have emergency department admissions [odds ratio (OR) 2.69; 95% CI: 1.56-4.65], receiving medical/surgical procedures (OR 2.57; 95% CI: 1.56-4.21) and hospitalizations (OR 2.58; 95% CI: 1.64-4.07) after controlling for other predictors. Similarly, MVC were associated with 1.49 additional office visits per year (p = 0.036) and 0.32 days of hospital stay per year (p = 0.023).
  
  
  CONCLUSIONS
  Within a seven-country European sample, this study showed that T2DM patients with MVC were more likely to use healthcare resources compared with T2DM patients without MVC.
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, USA. fuz@ccf.org
authors.forename: A Z
authors.initials: AZ
authors.lastname: Fu
authors.forename: Y
authors.initials: Y
authors.lastname: Qiu
authors.forename: L
authors.initials: L
authors.lastname: Radican
authors.forename: D D
authors.initials: DD
authors.lastname: Yin
authors.forename: P
authors.initials: P
authors.lastname: Mavros
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics / Q000453:epidemiology*; D003925:Diabetic Angiopathies / Q000191:economics / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D006442:Glycated Hemoglobin; D005102:Health Expenditures; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics*; D014652:Vascular Diseases / Q000191:economics / Q000453:epidemiology*
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents