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Special Issue "Economic Causes and Impacts of Diabetes and Diabetes-Related Conditions"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (15 November 2017)

Special Issue Editors

Guest Editor
Assoc. Prof. Dennis Petrie

Centre for Health Economics, Monash Business School, Monash University, 15 Innovation Walk, Clayton, Melbourne, Australia
Website | E-Mail
Interests: health economics; health inequalities; applied econometrics; economic evaluation; simulation modelling
Guest Editor
Dr. Thomas Lung

Health Economics and Process Evaluation, The George Institute for Global Health, Level 10, 83/117 Missenden Road, Camperdown, New South Wales, Australia
Website | E-Mail
Interests: health economics; economic evaluation; simulation modelling

Special Issue Information

Dear Colleagues,

Diabetes and diabetes-related complications have a substantial burden on healthcare costs, morbidity and premature mortality. In 2015, it was estimated 415 million adults has diabetes worldwide and diabetes-related health expenditure would cost approximately $673 billion, with these numbers projected to increase in the future.

A combination of genetics, lifestyle and environmental factors play a role in determining an individuals’ risk of developing diabetes. In addition economic factors play a role in how individuals manage their diabetes and access to treatments which influence their subsequent risk of developing diabetes-related complications. Poor management of important clinical risk factors, impacting on the incidence of diabetes and diabetes-related complications are also likely to result in increased healthcare costs (both public and private) as well as other economic factors, such as labour force participation and the uptake of private health insurance.

This Special Issue aims at collating innovative papers that improve our understanding of those economic factors (e.g. income, education, lifestyle, employment, environmental, health insurance) that influence both the risk of developing diabetes and the progression and management of an individual’s diabetes. Papers which examine and quantify the impact of diabetes and diabetes-related complications on income, labour force participation, lifestyle, healthcare costs and other economic factors are also welcomed as well as papers which examine socioeconomic inequalities in these outcomes. Submissions are encouraged to cover a broad range of topics, including, without being limited to, the following:

  • Economics
  • Diabetes
  • Type 2 Diabetes
  • Type 1 Diabetes
  • Socioeconomic status
  • Inequalities
  • Diabetes related treatments
  • Diabetes-related complications
  • Longitudinal analysis
  • Labour force participation
  • Healthcare costs
  • Health insurance
  • Morbidity
  • Quality Adjusted Life Years
  • Life expectancy

Assoc. Prof. Dennis Petrie
Dr. Thomas Lung
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (6 papers)

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Research

Open AccessArticle Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study
Int. J. Environ. Res. Public Health 2018, 15(1), 89; doi:10.3390/ijerph15010089
Received: 22 November 2017 / Revised: 31 December 2017 / Accepted: 1 January 2018 / Published: 8 January 2018
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Abstract
The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of
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The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance. Full article
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Open AccessArticle Diabetic Ketoacidosis Severity at Diagnosis and Glycaemic Control in the First Year of Childhood Onset Type 1 Diabetes—A Longitudinal Cohort Study
Int. J. Environ. Res. Public Health 2018, 15(1), 26; doi:10.3390/ijerph15010026
Received: 19 October 2017 / Revised: 15 December 2017 / Accepted: 18 December 2017 / Published: 25 December 2017
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Abstract
It is unclear whether diabetic ketoacidosis (DKA) severity at diagnosis affects the natural history of type 1 diabetes (T1D). We analysed associations between DKA severity at diagnosis and glycaemic control during the first year post-diagnosis. We followed 341 children with T1D, <19 years
[...] Read more.
It is unclear whether diabetic ketoacidosis (DKA) severity at diagnosis affects the natural history of type 1 diabetes (T1D). We analysed associations between DKA severity at diagnosis and glycaemic control during the first year post-diagnosis. We followed 341 children with T1D, <19 years (64% non-white) attending paediatric diabetes clinics in East London. Data were extracted from routine medical registers. Subjects were categorized with normal, mild, moderate, or severe DKA. Linear mixed-effects modelling was used to assess differences in longitudinal HbA1c trajectories (glycaemic control) during 12 months post-diagnosis (1288 HbA1c data-points) based on DKA, adjusting for sex, age, ethnicity, SES (Socioeconomic Status) and treatment type. Females (OR 1.6, 95% CI 1.1–2.4) and younger age, 0–6 vs. 13–18 years (OR 2.9, 95% CI 1.5–5.6) had increased risk for DKA at diagnosis. Moderate or severe DKA was associated with higher HbA1c at diagnosis (adjusted estimates 8 mmol/mol, 2–14, and 10 mmol/mol, 4–15, respectively, compared to normal DKA). Differences in HbA1c trajectories by DKA were no longer apparent at six months post-diagnosis. All subjects experienced a steep decrease in HbA1c during the first three months followed by a gradual increase. While, DKA severity was not associated with glycaemic control at 12 months post-diagnosis, age at diagnosis, ethnicity, gender, and treatment type were significantly associated. For example, Black and mixed ethnicity children had increased risk for poor glycaemic control compared to White children (adjusted RRR 5.4, 95% CI 1.7–17.3 and RRR 2.5, 95% CI 1.2–6.0, respectively). DKA severity at diagnosis is associated with higher initial HbA1c but not glycaemic control from six months post-diagnosis. Age at diagnosis, ethnicity, gender, and insulin pump are associated with glycaemic control at one year post-diagnosis. Full article
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Open AccessArticle Price and Availability of Sugar-Free, Sugar-Reduced and Low Glycemic Index Cereal Products in Northwestern México
Int. J. Environ. Res. Public Health 2017, 14(12), 1591; doi:10.3390/ijerph14121591
Received: 28 October 2017 / Revised: 16 December 2017 / Accepted: 16 December 2017 / Published: 18 December 2017
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Abstract
Sugar-free (SF), sugar-reduced (SR), or low-glycemic-index (low GI) cereal products could be helpful for the dietary treatment of disorders related to glucose homeostasis. However, access and economic aspects are barriers that could hamper their consumption. Thus, the availability and price of such cereal
[...] Read more.
Sugar-free (SF), sugar-reduced (SR), or low-glycemic-index (low GI) cereal products could be helpful for the dietary treatment of disorders related to glucose homeostasis. However, access and economic aspects are barriers that could hamper their consumption. Thus, the availability and price of such cereal products were evaluated in Northwestern México. The products were categorized in 10 groups. The data were collected in five cities by store visitation (from November 2015 to April 2016). The availability in specialized stores and supermarkets was expressed as availability rates based on the total number of products. The price of the SF, SR, and low GI products were compared with their conventional counterparts. Availability rates were higher in supermarkets than in specialized stores by product numbers (14.29% versus 3.76%, respectively; p < 0.001) and by product categories (53.57% versus 26.92%, respectively; p < 0.001). Five categories of products labeled as SF, SR, and low GI (oats, cookies and crackers, flours, snacks, and tostadas/totopos) had higher prices than their conventional counterparts (p < 0.05). In conclusion, in Northwestern Mexico, the availability of SF, SR, and low GI cereal-based foods is relatively low, and these foods are more expensive than their conventional counterparts. Full article
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Open AccessArticle Associations of Fasting Blood Glucose with Influencing Factors in Northeast China: A Quantile Regression Analysis
Int. J. Environ. Res. Public Health 2017, 14(11), 1368; doi:10.3390/ijerph14111368
Received: 18 August 2017 / Revised: 7 November 2017 / Accepted: 8 November 2017 / Published: 10 November 2017
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Abstract
Background: Diabetes mellitus (DM) has become a major public health problem in China. Although a number of researchers have investigated DM risk factors, little is known about the associations between values of fasting blood glucose (FBG) and influencing factors. This study aims
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Background: Diabetes mellitus (DM) has become a major public health problem in China. Although a number of researchers have investigated DM risk factors, little is known about the associations between values of fasting blood glucose (FBG) and influencing factors. This study aims to explore these associations by the quantile regression (QR) model. Methods: A cross-sectional survey based on a sample of 23,050 adults aged 18 to 79 years was conducted in Jilin in 2012, and some subjects were excluded due to missing values with respect to necessary variables or having glycemic control, in accordance with the purposes of this study. Finally, in total 14,698 people were included in this study. QR was performed to identify the factors influencing the level of FBG in different quantiles of FBG. Results: The distribution of FBG status was different between males and females (χ2 = 175.30, p < 0.001). The QR model provided more detailed views on the associations of FBG with different factors and revealed apparent quantile-related patterns separately for different factors. Body mass index (BMI) was positively associated with the low and middle quantiles of FBG. Waist circumference (WC) had a positive association with the high quantiles of FBG. Conclusions: FBG had a positive association with BMI in normal FBG, and a positive association with WC in high FBG. Diet and alcohol intake were associated with FBG in normal FBG. FBG was more likely to be elevated in the elderly, female workers, and people with family history of DM. Full article
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Open AccessArticle Variation in Point-of-Care Testing of HbA1c in Diabetes Care in General Practice
Int. J. Environ. Res. Public Health 2017, 14(11), 1363; doi:10.3390/ijerph14111363
Received: 24 August 2017 / Revised: 8 November 2017 / Accepted: 8 November 2017 / Published: 9 November 2017
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Abstract
Background: Point-of-care testing (POCT) of HbA1c may result in improved diabetic control, better patient outcomes, and enhanced clinical efficiency with fewer patient visits and subsequent reductions in costs. In 2008, the Danish regulators created a framework agreement regarding a new fee-for-service fee for
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Background: Point-of-care testing (POCT) of HbA1c may result in improved diabetic control, better patient outcomes, and enhanced clinical efficiency with fewer patient visits and subsequent reductions in costs. In 2008, the Danish regulators created a framework agreement regarding a new fee-for-service fee for the remuneration of POCT of HbA1c in general practice. According to secondary research, only the Capital Region of Denmark has allowed GPs to use this new incentive for POCT. The aim of this study is to use patient data to characterize patients with diabetes who have received POCT of HbA1c and analyze the variation in the use of POCT of HbA1c among patients with diabetes in Danish general practice. Methods: We use register data from the Danish Drug Register, the Danish Health Service Register and the National Patient Register from the year 2011 to define a population of 44,981 patients with diabetes (type 1 and type 2 but not patients with gestational diabetes) from the Capital Region. The POCT fee is used to measure the amount of POCT of HbA1c among patients with diabetes. Next, we apply descriptive statistics and multilevel logistic regression to analyze variation in the prevalence of POCT at the patient and clinic level. We include patient characteristics such as gender, age, socioeconomic markers, health care utilization, case mix markers, and municipality classifications. Results: The proportion of patients who received POCT was 14.1% and the proportion of clinics which were “POCT clinics” was 26.9%. There were variations in the use of POCT across clinics and patients. A part of the described variation can be explained by patient characteristics. Male gender, age differences (older age), short education, and other ethnicity imply significantly higher odds for POCT. High patient costs in general practice and other parts of primary care also imply higher odds for POCT. In contrast, high patient costs for drugs and/or morbidity in terms of the Charlson Comorbidity index mean lower odds for POCT. The frequency of patients with diabetes per 1000 patients was larger in POCT clinics than Non-POCT clinics. A total of 22.5% of the unexplained variability was related to GP clinics. Conclusions: This study demonstrates variation in the use of POCT which can be explained by patient characteristics such as demographic, socioeconomic, and case mix markers. However, it appears relevant to reassess the system for POCT. Further studies are warranted in order to assess the impacts of POCT of HbA1c on health care outcomes. Full article
Open AccessArticle Early Onset of Type 1 Diabetes and Educational Field at Upper Secondary and University Level: Is Own Experience an Asset for a Health Care Career?
Int. J. Environ. Res. Public Health 2017, 14(7), 712; doi:10.3390/ijerph14070712
Received: 14 May 2017 / Revised: 16 June 2017 / Accepted: 26 June 2017 / Published: 30 June 2017
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Abstract
Ill health in early life has a significant negative impact on school grades, grade repetition, educational level, and labor market outcomes. However, less is known about qualitative socio-economic consequences of a health shock in childhood or adolescence. We investigate the relationship between onset
[...] Read more.
Ill health in early life has a significant negative impact on school grades, grade repetition, educational level, and labor market outcomes. However, less is known about qualitative socio-economic consequences of a health shock in childhood or adolescence. We investigate the relationship between onset of type 1 diabetes up to age 15 and the probability of choosing and completing a health-oriented path at upper secondary and university level of education. We analyze the Swedish Childhood Diabetes Register, the National Educational Register, and other population registers in Sweden for 2756 people with type 1 diabetes and 10,020 matched population controls. Educational decisions are modeled as unsorted series of binary choices to assess the choice of educational field as a potential mechanism linking early life health to adult outcomes. The analyses reject the hypothesis of no systematic differences in choice of educational field between people with and without type 1 diabetes at both levels. The results are robust to selection on ability proxies and across sensitivity analysis. We conclude that the observed pro health-oriented educational choices among people with type 1 diabetes in our data are consistent with disease onset in childhood and adolescence having qualitative impact on life-course choices. Full article
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