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    <recommendedItem id="20100101_19_132"
                     title="Economic Burden of Diabetes Tops $200B"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/17950?impressionId=1265798763042"
                     
      &lt;p&gt;Medical costs and reduced work productivity associated with diabetes cost the U.S. $218 billion in 2007, researchers said.&lt;/p&gt;
&lt;p&gt;The annual average cost per patient was $9,975 for diagnosed diabetes and $2,864 for undiagnosed disease, according to Timothy M. Dall of the Lewin Group in Falls Church, Va., and colleagues.&lt;/p&gt;
&lt;p&gt;&quot;The burden of diabetes to society is even higher when one considers intangible costs from reduced quality of life,&quot; the researchers wrote online in &lt;em&gt;Health Affairs&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;The sobering statistics presented in this paper underscore the urgency to better understand the cost-mitigation potential of prevention and treatment strategies.&quot;&lt;/p&gt;
&lt;p&gt;Dall and his colleagues, working with funding from Novo Nordisk, developed the estimates from a proprietary economic model based on medical literature, government statistics, and insurance claims data.&lt;/p&gt;
&lt;p&gt;Results from the National Health Interview Survey, corrected with claims data, indicate that about one million Americans had type 1 diabetes and 16.5 million had type 2 diabetes in 2007.&lt;/p&gt;
&lt;p&gt;The economic model indicated that the per-patient economic burden was $14,856 for type 1 diabetes and $9,677 for type 2 disease.&lt;/p&gt;
&lt;p&gt;National Health and Nutrition Examination Survey findings indicate that some 57 million individuals had &quot;prediabetes,&quot; and another 6.3 million Americans had diabetes but have not been formally diagnosed.&lt;/p&gt;
&lt;p&gt;Their average costs were $443 for prediabetes (medical costs only) and $2,864 for undiagnosed diabetes, Dall and colleagues estimated.&lt;/p&gt;
&lt;p&gt;Compared to those with no diagnosis, people with known diabetes accounted for vastly more use of various services, including outpatient care, emergency visits, and hospitalization.&lt;/p&gt;
&lt;p&gt;For example, ambulatory visits for neurological symptoms were nearly eight times as common among among type 1 diabetics as among nondiabetics, and five times as common among those with type 2 diabetes.&lt;/p&gt;
&lt;p&gt;Inpatient days for cardiovascular problems were increased more than six-fold for both types of diabetes, and emergency visits for such problems were about three times as common.&lt;/p&gt;
&lt;p&gt;Undiagnosed diabetes had smaller but still detectable consequences for medical expenses. Compared with people with no history of diabetes, undiagnosed diabetics had 70% more outpatient visits and more than twice as many hospital inpatient days for cardiovascular complaints.&lt;/p&gt;
&lt;p&gt;Overall, the bill for medical services associated with diabetes was $153 billion, according to Dall and colleagues  --  about 7% of the total national healthcare expenditure.&lt;/p&gt;
&lt;p&gt;The researchers put the loss of work productivity at $65 billion, including absenteeism, reduced productivity while at work, disability, and premature death.&lt;/p&gt;
&lt;p&gt;Some of the data underlying the estimate came from National Health Interview Survey data on missed workdays and disability rates, reports in the literature, and CDC estimates of diabetes-related mortality.&lt;/p&gt;
&lt;p&gt;Dall and colleagues noted that patients and their families bear much of the burden in the form of out-of-pocket expenses and reduced earnings  --  not to mention the impaired quality of life and other intangibles.&lt;/p&gt;
&lt;p&gt;But everyone else shares the costs as well, they argued.&lt;/p&gt;
&lt;p&gt;&quot;This diabetes burden represents a hidden &apos;tax&apos; in the form of higher health insurance premiums and reduced disposable income,&quot; Dall and colleagues wrote.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_82"
                     title="Appointment with the Pharmacist May Be Beneficial (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/PracticeManagement/tb/17873?impressionId=1265798763042"
                     
      When pharmacists take a more active role in patient care, disease outcomes are improved  --  particularly for diabetes patients, a new study shows.&lt;br&gt;
&lt;br&gt;Diabetics who had an intensive consultation with a pharmacist regarding their medications, as well as subsequent follow-up, saw significant improvements in hemoglobin A1c and fasting plasma glucose, Erin Slazak, PharmD, of the University at Buffalo, and colleagues reported online in the &lt;em&gt;Journal of the American Pharmacists Association&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The pilot study was small, with only 50 patients, and it lacked a control group, but Slazak said she and colleagues collected the data &quot;because we wanted to show that we were having a positive effect on patient outcomes at the primary care level.&quot;&lt;br&gt;
&lt;br&gt;Adding a pharmacist to a patient&apos;s healthcare management team is not a new idea. Prior studies  --  including the Asheville Project and the Diabetes Ten City Challenge  --  have shown it improves disease outcomes and cost-effectiveness.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;&quot;There is an increasing body of evidence to support that pharmacists provide an effective and unique role in a collaborative disease management model,&quot; said Toni Fera, PharmD, of HealthMapRx and the lead investigator of the Diabetes Ten City Challenge.&lt;/p&gt;
&lt;p&gt;&quot;Medication adherence is critical to the management of chronic diseases, and pharmacists are uniquely trained to help patients understand why they need to take their medications,&quot; Fera said. &quot;And it helps them overcome barriers that prevent patients from taking their medications appropriately.&quot;&lt;/p&gt;
&lt;p&gt;Fera said there&apos;s &quot;growing momentum&quot; to include pharmacists in patient care. Medicare Part D plans, for example, allow pharmacists to provide medication therapy management services, which include a review of medications and proper use.&lt;/p&gt;
&lt;p&gt;Some state-level programs exist, such as the one run by Slazak and colleagues.&lt;/p&gt;
&lt;p&gt;Slazak said patients receive a one-hour consultation in which they bring in all their medication bottles  --  prescription and nonprescription  --  and have a thorough history taken. Pharmacists explain why each medication is relevant to treatment, and discuss necessary diet and lifestyle changes.&lt;/p&gt;
&lt;p&gt;&quot;We make sure the patient leaves with a solid understanding of why they&apos;re taking the medications they&apos;re taking,&quot; Slazak said.&lt;/p&gt;
&lt;p&gt;She and colleagues will then make recommendations to the patient&apos;s physician regarding medications (in New York state, pharmacists don&apos;t have prescribing power, but in some states they can adjust medications as necessary, without consulting the patient&apos;s doctor).&lt;/p&gt;
&lt;p&gt;They&apos;ll also follow up with the patient, either over the phone or in person, on a monthly or weekly basis, depending on the patient.&lt;/p&gt;
&lt;p&gt;In their study, Slazak and colleagues found significant reductions in hemoglobin A1c and fasting plasma glucose after both six months and one year, compared with baseline (A1c -1.1%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001 and fasting plasma glucose -39 mg/dL, &lt;em&gt;P&lt;/em&gt;=0.003; and A1c -1.1%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001 and fasting plasma glucose -35 mg/dL, &lt;em&gt;P&lt;/em&gt;=0.005, respectively).&lt;/p&gt;
&lt;p&gt;There were no significant decreases in other metabolic parameters, including blood pressure and cholesterol.&lt;/p&gt;
&lt;p&gt;&quot;There are a lot of possible reasons for that, mostly because we&apos;re focused on diabetes,&quot; Slazak said. &quot;And our program was fairly new at the time, so we weren&apos;t working as closely with the providers as we are now.&quot;&lt;/p&gt;
&lt;p&gt;She said the relationship between pharmacists and primary care providers is key to this type of collaboration. While physicians may have heeded 50% of pharmacists&apos; recommendations at the beginning of the study, Slazak said, they now heed more than 90%.&lt;/p&gt;
&lt;p&gt;The program also tended to reduce costs. Geometric mean costs tended to decrease versus baseline at six-month (&amp;#8211;$84; &lt;em&gt;P&lt;/em&gt;=0.785) and 12-month (&amp;#8211;$216; &lt;em&gt;P&lt;/em&gt;=0.414) assessments, despite nominal increases in diabetes and total medication costs. None of the changes was statistically significant.&lt;/p&gt;
&lt;p&gt;The researchers have since matched the 50 patients in this study, which was conducted between 2006 and 2007, with 50 controls, for a more complete report, but the data has not yet been published.&lt;/p&gt;
&lt;p&gt;While programs like this one have been appearing around the country, Fera said remaining challenges included determining how to incorporate the pharmacist into the existing healthcare system and how to coordinate care and sharing of information among providers.&lt;/p&gt;
&lt;p&gt;&quot;It really hinges on having the pharmacist prove a cost-benefit ratio to a physician group or third-party payer,&quot; Slazak said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;A co-author reported relationships with Bayer, Cadence, Cubist, Forest, Optimer, Ortho-McNeil, Schering-Plough, and Wyeth.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_183"
                     title="Variant Gene Linked to Diabetes Is Carried by 38% of People"
                     score="-0.005"
                     href="