Strategies to Reduce the Cost of Renal Complications in Patients With Type 2 Diabetes

Abstract

Diabetes is a common and costly chronic disease, and diabetes-related complications are a major driver of health care costs in the United States. In 2007, 17.9 million U.S. residents were diagnosed with diabetes at a cost to the economy of $174 billion; $58 billion of which was directly attributable to diabetes-related complications (1). The most common microvascular complications include chronic kidney disease (affecting 27.8% of persons with diagnosed diabetes), foot problems (22.9%), and eye damage (18.9%) (2). The most common macrovascular complications include heart attacks (9.8%), chest pain (9.5%), and coronary heart disease (9.1%). Notably, specific racial and ethnic subgroups have higher rates of complications. For example, chronic kidney disease affects 35.2% of African Americans and 37.6% of Latinos with diabetes. Twenty-five percent of persons with diabetes report having two or more diabetes-related complications. The lifetime prevalence of these complications is much higher than these cross-sectional estimates suggest, and about 65% of those with type 2 diabetes die of a myocardial infarction or a stroke (3). In this issue of Diabetes Care , Nichols, Vupputuri, and Lau report on the medical care costs associated with progression of diabetic nephropathy (4). They use administrative data from Kaiser Permanente Northwest to follow 7,758 patients with diabetes and hypertension for progression of nephropathy over an 8-year period. They found that costs increased by 37% following progression from normoalbuminuria to microalbuminuria (defined as 30–299 mg/g) and 41% following progression from microalbuminuria to macroalbuminuria …