title: Direct diabetes-related costs in young patients with early-onset, long-lasting type 1 diabetes.
abstract: OBJECTIVE
  To estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany.
  
  
  METHODS
  Data of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0-4 years of age within the years 1993-1999 were included (mean age 13.9 (SD 2.2) years, mean diabetes duration 10.9 (SD 1.9) years, as of 31.12.2007). Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV). Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance). Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors.
  
  
  RESULTS
  Mean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943-4,881). Costs for glucose self-monitoring were the main cost category (28.5%), followed by costs for continuous subcutaneous insulin infusion (25.0%), diabetes-related hospitalizations (22.1%) and insulin (18.4%). Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs.
  
  
  CONCLUSIONS
  Main cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group.
authors: Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany. christina.baechle@ddz.uni-duesseldorf.de
authors: Christina
authors: C
authors: Bächle
authors: Andrea
authors: A
authors: Icks
authors: Klaus
authors: K
authors: Straßburger
authors: Marion
authors: M
authors: Flechtner-Mors
authors: Andreas
authors: A
authors: Hungele
authors: Peter
authors: P
authors: Beyer
authors: Kerstin
authors: K
authors: Placzek
authors: Ulrich
authors: U
authors: Hermann
authors: Andrea
authors: A
authors: Schumacher
authors: Markus
authors: M
authors: Freff
authors: Anna
authors: A
authors: Stahl-Pehe
authors: Reinhard W
authors: RW
authors: Holl
authors: Joachim
authors: J
authors: Rosenbauer
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000191:economics* / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs; D006297:Health Services Accessibility; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000191:economics / Q000627:therapeutic use; D008297:Male; D012307:Risk Factors
chemical_list: D007328:Insulin
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