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Background: Newer classes of oral anti-diabetic medications affect not only HbA1c but also weight and blood pressure (BP); however, the use and effects may be limited in patients with chronic kidney disease (CKD). To better understand the potential value of newer anti-diabetic medications, we assessed the individual and collective contribution of these co-existing conditions on healthcare resource utilization (HRU) and costs within a large US T2DM patient population. Methods: This study analyzed electronic health records from integrated delivery networks across the US between 2008 and 2012. Beginning at first evidence of T2DM diagnosis, adults with T2DM and medical and laboratory data observed were categorized by CKD, BP, HbA1c, and obesity status as observed in the 12-month post-index period.CKD stage 5 patients were excluded. HRU was assessed during the 12-month post-index period (i.e., physician office, outpatient, and emergency room [ER) visits and hospitalizations). Unit costs were assigned to HRU to estimate total medical costs. Regression models were performed to assess the association between clinical variables and HRU/costs. Results: The final study sample included 23,492 T2DM patients (mean age: 60.7 years; female: 52.2%). More advanced CKD and a higher systolic BP were associated with a higher risk of hospitalization/ER visits and more outpatient/physician visits. Higher HbA1c levels were associated with a higher risk of hospitalization/ER visits. The relationship between body mass index (BMI) and HRU varied. Compared to overweight patients, normal/underweight patients had significantly greater risk of being hospitalized and ER visits, while patients with obesity classes 1-3 had similar risk. CKD stage 1, 2, 3A, 3B, and 4 had total costs of 1.18, 1.17, 1.44, 1.54, and 1.80 times those of patients without CKD (all p Conclusions: Among T2DM patients, t here is a positive relationship between CKD, BP, and HbA1c on HRU/costs. These findings highlight the importance of managing comorbid conditions in T2DM patients. Future studies should investigate reasons for the relationships we observed between BMI and HRU/costs.

Background: Poor glycemic and blood pressure (BP) control in patients with type 2 diabetes mellitus (T2DM) may lead to higher risk of complications with varying healthcare resource utilization (HRU). We hypothesize that poor glycemic and BP control are associated with higher HRU/costs. Methods: This study analyzed electronic health records from integrated delivery networks across the US between 2008 and 2012. Adult T2DM patients with at least two HbA1c and BP measures over a 12-month baseline period were selected. The end of this baseline period marks the index date. Patients were required to have an additional 12-month follow-up after the index date to evaluate HRU/costs. Uncontrolled HbA1c was defined as ≥ 1 HbA1c measure that was ≥7% during the baseline period. Uncontrolled BP was defined as ≥ 2 measures with systolic BP ≥ 130mmHg or diastolic BP ≥ 80mmHg during the baseline period. Descriptive analysis was conducted to compare HRU/costs across study cohorts. Unit cost approach was applied to derive total medical encounter costs. Logistic regression models were performed to assess the association between uncontrolled HbA1c/BP and HRU. Results: Of the 96,312 T2DM patients included in this study (mean age: 62.4 years; female: 51.5%), 55.9% had uncontrolled HbA1c (mean age: 61.2 years; female: 49.4%) and 74.6% had uncontrolled BP (mean age: 62.3 years; female: 52.8%). Patients with uncontrolled HbA1c had a higher proportion of hospitalizations (16.6% vs. 15.0%) , ER visits (21.0% vs. 18.3%), and higher total medical encounter costs ($4,168 vs. $3,773) than controlled patients, but lower utilization of outpatient visits (28.5% vs. 33.1%) and physician office visits (93.9% vs. 94.3%) (all p Conclusions: T2DM patients with uncontrolled HbA1c or BP had higher HRU in inpatient/ER settings and incurred higher costs. The findings highlight the clinical/economic significance of managing HbA1c and co-morbid hypertension among T2DM patients.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a concerning epidemic, and sub-optimal glycemic control could lead to higher risk of complications and needs for additional care. Hypertension and obesity are common comorbid conditions, yet their impact on glycemic control has not been quantified. We hypothesize that comorbid hypertension and/or obesity are associated with a higher likelihood of uncontrolled glycemic level. METHODS: Data from a nationally representative sample of US population participating in the National Health and Nutrition Examination Survey (NHANES) 2003-2010 were analyzed in a cross-sectional retrospective observational study. Adults aged 20 years or older with self-reported diabetes and anti-diabetes medication use were included. Pregnant women were excluded. T2DM was defined by excluding diabetes patients who were diagnosed before age 30 and took only insulin. Uncontrolled hypertension was defined as blood pressure of ≥130 mmHg (systolic) or ≥80 mmHg (diastolic) based on American Diabetes Association’s guidance for hypertension in diabetes patients. Obesity was determined if body mass index ≥30 kg/m 2 . Uncontrolled glycemic level was defined as HbA1c ≥7%. We estimated the prevalence of uncontrolled hypertension and obesity among T2DM patients. Rates of uncontrolled glycemic level were reported and compared by uncontrolled hypertension and/or obesity status using Chi-square tests. Population weights were applied to account for multi-stage sampling design to produce nationally representative estimates. RESULTS: After applying the population weights to the 2,203 respondents with T2DM, findings from these respondents were extrapolated to an estimated 15.4 million T2DM patients in the US (prevalence of T2DM=7.4%), of which 61.1% were obese. Among US T2DM patients, the prevalence of uncontrolled hypertension was 52.6%. Among US T2DM patients, the prevalence of patients who had uncontrolled hypertension and who were obese was 31.2%. No statistically significant differences were found in uncontrolled glycemic level rates between those with and without uncontrolled hypertension (44.0% vs. 41.0%; p=0.31). Obese patients had a statistically significant higher rate of uncontrolled glycemic level than non-obese (44.5% vs. 37.9%; p=0.03). T2DM patients with comorbid uncontrolled hypertension and obesity had a statistically significant higher rate of uncontrolled glycemic level than the rest of the T2DM patients (47.1% vs. 40.0%; p=0.02). CONCLUSIONS: Prevalence of uncontrolled hypertension and obesity was high in US adults with T2DM. Obese patients, especially those who had uncontrolled blood pressure, had sub-optimal glycemic control. Interventions targeting these patients should be considered.