Worksite-Based Diabetes Disease Management Program

Abstract

Diabetes mellitus (DM) affects approximately 5.9% of Americans and was estimated in 1997 to account for $44 billion in direct and $54 billion in indirect costs. The average annual medical care cost in 1992 for a person with diabetes was $11,157 versus $2,600 for a person without diabetes. The Diabetes Control and Complications Trial (DCCT) demonstrated that good control of diabetes can delay the onset and slow the progression of many diabetic complications and thereby result in avoidance of costs related to such complications. Bank One evaluated a worksite-based patient education program for employees with DM. The goal of the program was to determine if such a program could result in improved DM control. A total of 53 employees initially participated in baseline laboratory fasting and met monthly with a diabetic nurse educator. Thirty-six of these 53 employees (or 68%) participated in baseline, 3-month, and 6-month diabetes laboratory testing. Of these 36 employees, 44% were on oral agents, 39% on insulin, 3% on combination therapy, and 14% on diet alone. Prior to receiving any laboratory results, 47% of these participants rated their level of control as "good" or "very good," 33% rated their level of control as "average," 8% considered it "poor," and 12% were "not sure" of their level of diabetes control. Baseline, 3-month and 6-month mean fasting blood glucose levels were 193.4mg%, 179.2mg%, and 169.7mg%, respectively. Baseline, 3-month, and 6-month mean hemoglobin A1C values were 9.0%, 8.4% (p = 0.006), and 8.5% (p = 0.024), respectively. Medical (inpatient and outpatient) and pharmaceutical charges were available for 22 of the original 53 employees. The average total charges in 1995, 1996, and 1997 were $2,822, $4,457, and $6,826, respectively. A worksite-based diabetes disease education program has been shown to significantly improve control of the disease. This should result in lower direct and indirect healthcare costs, reduced absenteeism and enhanced quality of life over time providing that the intervention takes place at an earlier stage of the disease before the onset of complications.