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Sarah B. Laditka, PhD; Melanie P. Mastanduno, RN, MPH; James N. Laditka, DA, MPA

Arch Intern Med. 2001;161:1301-1308.

Background  Individuals with diabetes use more health care resources than those without the disease. Much less is known about such differences associated with different forms of diabetes.

Methods  People with types 1 and 2 diabetes were identified from claims of a commercial insurer with an enrollment of 828 208. Age- and sex-adjusted rates and observed-to-expected ratios for health care services use, costs, and relative value units were compared for individuals with diabetes and the total plan population.

Results  We identified 13 563 individuals with diabetes (including 4349 with type 1 and 8810 with type 2 diabetes). The diabetic population was 1.6% of the total population, but had 9.4% of costs. Individuals with both types of diabetes had higher rates for use of inpatient, outpatient, and professional services. Compared with the total population, inpatient rates for the total diabetic population (for those with type 1 diabetes), were 4.9 (8.3) times higher for established complications of diabetes such as acute myocardial infarction, 9.8 (22.1) times higher for heart failure, 5.6 (8.3) times higher for coronary artery bypass, and 5.1 (8.9) times higher for cardiac catheterization (P < .001 for all). The following relative value unit ratios for physician services were substantially higher for the total diabetic population (for those with type 1 diabetes): 13.2 (27.9) times higher for endocrinologists, 6.3 (12.9) for ophthalmologists, and 9.4 (27.8) for nephrologists.

Conclusions  Use, costs, and intensity of resources used were substantially higher for individuals with diabetes, and markedly higher for the population with type 1 diabetes. Our findings show that people with type 1 diabetes are at substantially higher risk for serious complications than those with type 2 diabetes.

From the Center for Health and Aging, State University of New York Institute of Technology at Utica/Rome (Dr S. Laditka); Dartmouth Hitchcock Medical Center, Lebanon, NH (Ms Mastanduno); and the Center for Policy Research, Syracuse University, Syracuse, NY (Dr J. Laditka).

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