title: Changing healthcare utilization patterns in diabetes mellitus: case-control studies 1 year and 8 years after diagnosis.
abstract: OBJECTIVE
  To describe healthcare utilization patterns in young and middle-aged patients with diabetes 1 year and 8 years after diagnosis and to compare with the general population at two time points, 16 years apart.
  
  
  METHODS
  Four cohorts with disease duration of 1 year or 8 years were selected from the Diabetes Incidence Study in Sweden, which registers all incident cases of diabetes in the 15- to 34-year age group. Control subjects were selected from the population register matched by age, sex and county of residence. A postal questionnaire was sent to the 1983 and 1992 cohorts in 1991 and 1993, and to the 1999 and 2008 cohorts in 2007 and 2009. Nine hundred and thirteen patients with diabetes and 1679 control subjects responded.
  
  
  RESULTS
  One year after diagnosis, 49% of patients with diabetes in the 1992 cohort compared with 4.2% in the 2008 cohort reported visits to departments of internal medicine and endocrinology. A similar pattern was seen 8 years after diagnosis. The use of day care was 4-5 times higher among patients with diabetes compared with control subjects. Utilization of outpatient hospital care was higher among patients with diabetes compared with control subjects, even when excluding visits to diabetes clinics.
  
  
  CONCLUSIONS
  Excess use of health care among patients with diabetes remained 16 years after the first follow-up. Utilization patterns were stable, except for a major decrease in inpatient care 1 year after diagnosis and an increase in day care 8 years after diagnosis. Observed changes probably reflect successive reforming of diabetes care in Sweden.
authors: Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden. vibeke.sparring@ki.se
authors: V
authors: V
authors: Sparring
authors: L
authors: L
authors: Nyström
authors: J
authors: J
authors: Östman
authors: R
authors: R
authors: Wahlström
authors: K
authors: K
authors: Burström
authors: P M
authors: PM
authors: Jonsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000191:economics / Q000706:statistics & numerical data*; D001294:Attitude to Health; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult