{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T21:48:30Z","timestamp":1789595310753,"version":"build-2803163510"},"reference-count":38,"publisher":"American Diabetes Association","issue":"11","license":[{"start":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T00:00:00Z","timestamp":1663113600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To estimate medical costs associated with 17 major diabetes-related complications and treatment procedures among Medicare beneficiaries aged \u226565 years with type 2 diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>Claims data from 100% of Medicare beneficiaries enrolled in fee-for-service plans from 2006 to 2017 were analyzed. Records with type 2 diabetes and complications were identified using ICD-9, ICD-10, and diagnosis-related group codes. The index year was the year when a person was first identified as having diabetes with an inpatient claim or an outpatient claim plus another inpatient\/outpatient claim in the 2 years following the first claim in Medicare. Included individuals were followed from index years until death, discontinuation of plan coverage, or 31 December 2017. Fixed-effects regression was used to estimate the cost in years when the complication event occurred and in subsequent years. The total cost for each complication was calculated for 2017 by multiplying the complication prevalence by the cost estimate. All costs were standardized to 2017 U.S. dollars.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Our study included 10,982,900 beneficiaries with type 2 diabetes. Follow-up ranged from 3 to 10 years. The three costliest complications were kidney failure treated by transplant (occurring year $79,045, subsequent years $17,303), kidney failure treated by dialysis ($54,394, $38,670), and lower-extremity amputation ($38,982, $8,084). Congestive heart failure accounted for the largest share (18%) of total complication costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Costs associated with diabetes complications were substantial. Our cost estimates provide essential information needed for conducting economic evaluation of treatment and programs to prevent and delay diabetes complications in Medicare beneficiaries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc21-2151","type":"journal-article","created":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T09:11:28Z","timestamp":1663146688000},"page":"2570-2576","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":35,"title":["Medical Costs Associated With Diabetes Complications in Medicare Beneficiaries Aged 65 Years or Older With Type 2 Diabetes"],"prefix":"10.2337","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4740-6406","authenticated-orcid":false,"given":"Yu","family":"Wang","sequence":"first","affiliation":[{"name":"1Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8429-6301","authenticated-orcid":false,"given":"Ping","family":"Zhang","sequence":"additional","affiliation":[{"name":"1Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Shao","sequence":"additional","affiliation":[{"name":"1Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA"},{"name":"2Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda J.","family":"Andes","sequence":"additional","affiliation":[{"name":"1Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppina","family":"Imperatore","sequence":"additional","affiliation":[{"name":"1Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2022,9,14]]},"reference":[{"key":"2022110118550151100_B1","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1089\/pop.2011.0053","article-title":"Creating public awareness: state 2025 diabetes forecasts","volume":"15","author":"Rowley","year":"2012","journal-title":"Popul Health Manag"},{"key":"2022110118550151100_B2","doi-asserted-by":"crossref","first-page":"917","DOI":"10.2337\/dci18-0007","article-title":"Economic costs of diabetes in the U.S. in 2017","volume":"41","author":"American Diabetes Association","year":"2018","journal-title":"Diabetes Care"},{"key":"2022110118550151100_B3","volume-title":"Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014","author":"Centers for Disease Control and Prevention","year":"2014"},{"key":"2022110118550151100_B4","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.2337\/diacare.22.10.1660","article-title":"Predicting expenditures for Medicare beneficiaries with diabetes. A prospective cohort study from 1994 to 1996","volume":"22","author":"Krop","year":"1999","journal-title":"Diabetes Care"},{"key":"2022110118550151100_B5","doi-asserted-by":"crossref","first-page":"747","DOI":"10.2337\/diacare.21.5.747","article-title":"Patterns of expenditures and use of services among older adults with diabetes. Implications for the transition to capitated managed care","volume":"21","author":"Krop","year":"1998","journal-title":"Diabetes Care"},{"key":"2022110118550151100_B6","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.amepre.2013.04.017","article-title":"Lifetime direct medical costs of treating type 2 diabetes and diabetic complications","volume":"45","author":"Zhuo","year":"2013","journal-title":"Am J Prev Med"},{"key":"2022110118550151100_B7","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1007\/s00125-014-3369-7","article-title":"Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes","volume":"57","author":"Zoungas","year":"2014","journal-title":"Diabetologia"},{"key":"2022110118550151100_B8","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jdiacomp.2012.02.004","article-title":"Stratifying healthcare costs using the diabetes complication severity index","volume":"26","author":"Wu","year":"2012","journal-title":"J Diabetes Complications"},{"key":"2022110118550151100_B9","doi-asserted-by":"crossref","first-page":"107735","DOI":"10.1016\/j.jdiacomp.2020.107735","article-title":"Estimating costs of diabetes complications in people &lt;65 years in the U.S. using panel data","volume":"34","author":"Yang","year":"2020","journal-title":"J Diabetes Complications"},{"key":"2022110118550151100_B10","article-title":"Medicare Administrative Data User Guide","author":"Chronic Conditions Warehouse","year":"2019"},{"key":"2022110118550151100_B11","doi-asserted-by":"crossref","first-page":"961","DOI":"10.15585\/mmwr.mm6843a2","article-title":"Diabetes prevalence and incidence among Medicare beneficiaries\u2014United States, 2001\u20132015","volume":"68","author":"Andes","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2022110118550151100_B12","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/1471-2288-9-62","article-title":"Optimal strategy to identify incidence of diagnostic of diabetes using administrative data","volume":"9","author":"Asghari","year":"2009","journal-title":"BMC Med Res Methodol"},{"key":"2022110118550151100_B13","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1111\/pedi.12152","article-title":"Use of administrative and electronic health record data for development of automated algorithms for childhood diabetes case ascertainment and type classification: the SEARCH for Diabetes in Youth Study","volume":"15","author":"Zhong","year":"2014","journal-title":"Pediatr Diabetes"},{"key":"2022110118550151100_B14","unstructured":"U.S. Department of Veterans Affairs\n          . Measuring costs for cost-effectiveness analysis. Accessed 8 February 2022. Available from https:\/\/www.herc.research.va.gov\/include\/page.asp?id=measure-costs-cea"},{"key":"2022110118550151100_B15","first-page":"2","article-title":"Panel data: fixed and random effects","volume":"7","author":"Schmidheiny","year":"2011","journal-title":"Short Guide Microeconometrics"},{"key":"2022110118550151100_B16","doi-asserted-by":"crossref","first-page":"2300","DOI":"10.2337\/diacare.26.8.2300","article-title":"The direct medical cost of type 2 diabetes","volume":"26","author":"Brandle","year":"2003","journal-title":"Diabetes Care"},{"key":"2022110118550151100_B17","first-page":"421","article-title":"Medical costs associated with type 2 diabetes complications and comorbidities","volume":"19","author":"Li","year":"2013","journal-title":"Am J Manag Care"},{"key":"2022110118550151100_B18","first-page":"176","article-title":"Direct medical costs of complications of diabetes in the United States: estimates for event-year and annual state costs (USD 2012)","volume":"17","author":"Ward","year":"2014","journal-title":"J Med Eng Technol"},{"key":"2022110118550151100_B19","doi-asserted-by":"crossref","first-page":"971","DOI":"10.2337\/dc17-1763","article-title":"Health care costs associated with incident complications in patients with type 2 diabetes in Germany","volume":"41","author":"K\u00e4hm","year":"2018","journal-title":"Diabetes Care"},{"key":"2022110118550151100_B20","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1185\/030079905X65349","article-title":"Review of the cost of diabetes complications in Australia, Canada, France, Germany, Italy and Spain","volume":"21","author":"Ray","year":"2005","journal-title":"Curr Med Res Opin"},{"key":"2022110118550151100_B21","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1046\/j.1464-5491.2003.00972.x","article-title":"The impact of diabetes-related complications on healthcare costs: results from the United Kingdom Prospective Diabetes Study (UKPDS study no. 65)","volume":"20","author":"Clarke","year":"2003","journal-title":"Diabet Med"},{"key":"2022110118550151100_B22","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1111\/j.1524-4733.2007.00228.x","article-title":"Estimating the cost of complications of diabetes in Australia using administrative health-care data","volume":"11","author":"Clarke","year":"2008","journal-title":"Value Health"},{"key":"2022110118550151100_B23","doi-asserted-by":"crossref","first-page":"e1000236","DOI":"10.1371\/journal.pmed.1000236","article-title":"Event rates, hospital utilization, and costs associated with major complications of diabetes: a multicountry comparative analysis","volume":"7","author":"Clarke","year":"2010","journal-title":"PLoS Med"},{"key":"2022110118550151100_B24","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.2337\/dc20-0072","article-title":"Health care costs associated with macrovascular, microvascular, and metabolic complications of type 2 diabetes across time: estimates from a population-based cohort of more than 0.8 million individuals with up to 15 years of follow-up","volume":"43","author":"Chen","year":"2020","journal-title":"Diabetes Care"},{"key":"2022110118550151100_B25","doi-asserted-by":"crossref","first-page":"81","DOI":"10.2165\/00019053-200927010-00008","article-title":"Estimating the cost of diabetes mellitus-related events from inpatient admissions in Sweden using administrative hospitalization data","volume":"27","author":"Gerdtham","year":"2009","journal-title":"PharmacoEconomics"},{"key":"2022110118550151100_B26","doi-asserted-by":"crossref","first-page":"651","DOI":"10.2337\/dc13-2176","article-title":"Burden of diabetic foot ulcers for Medicare and private insurers","volume":"37","author":"Rice","year":"2014","journal-title":"Diabetes Care"},{"key":"2022110118550151100_B27","doi-asserted-by":"crossref","first-page":"245","DOI":"10.2337\/ds18-0033","article-title":"Diabetes management in the elderly","volume":"31","author":"Leung","year":"2018","journal-title":"Diabetes Spectr"},{"key":"2022110118550151100_B28","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.2337\/dci20-0017","article-title":"Cost-effectiveness of interventions to manage diabetes: has the evidence changed since 2008?","volume":"43","author":"Siegel","year":"2020","journal-title":"Diabetes Care"},{"key":"2022110118550151100_B29","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1136\/bmj.320.7246.1373","article-title":"Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41)","volume":"320","author":"Gray","year":"2000","journal-title":"BMJ"},{"key":"2022110118550151100_B30","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s12933-016-0363-z","article-title":"Cost-effectiveness of screening strategies to detect heart failure in patients with type 2 diabetes","volume":"15","author":"van Giessen","year":"2016","journal-title":"Cardiovasc Diabetol"},{"key":"2022110118550151100_B31","doi-asserted-by":"crossref","first-page":"10","DOI":"10.2165\/00003495-199000394-00004","article-title":"Role of the kidney in congestive heart failure. Relationship of cardiac index to kidney function","volume":"39","author":"Ljungman","year":"1990","journal-title":"Drugs"},{"key":"2022110118550151100_B32","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1097\/00041552-200403000-00004","article-title":"The association between congestive heart failure and chronic renal disease","volume":"13","author":"Silverberg","year":"2004","journal-title":"Curr Opin Nephrol Hypertens"},{"key":"2022110118550151100_B33","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s10157-008-0074-1","article-title":"The correction of anemia in patients with the combination of chronic kidney disease and congestive heart failure may prevent progression of both conditions","volume":"13","author":"Silverberg","year":"2009","journal-title":"Clin Exp Nephrol"},{"key":"2022110118550151100_B34","doi-asserted-by":"crossref","first-page":"i","DOI":"10.3310\/hta15440","article-title":"The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation","volume":"15","author":"Pavey","year":"2011","journal-title":"Health Technol Assess"},{"key":"2022110118550151100_B35","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1097\/HJR.0b013e32832d193b","article-title":"The impact of acute myocardial infarction and stroke on health care costs in patients with type 2 diabetes in Sweden","volume":"16","author":"Ringborg","year":"2009","journal-title":"Eur J Cardiovasc Prev Rehabil"},{"key":"2022110118550151100_B36","doi-asserted-by":"crossref","first-page":"A6","DOI":"10.1053\/j.ajkd.2019.09.003","article-title":"US Renal Data System 2019 annual data report: epidemiology of kidney disease in the United States","volume":"75","author":"Saran","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"2022110118550151100_B37","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1186\/s12913-018-3148-0","article-title":"Identifying diabetes cases from administrative data: a population-based validation study","volume":"18","author":"Lipscombe","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"2022110118550151100_B38","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/S0895-4356(98)00161-9","article-title":"The use of automated data to identify complications and comorbidities of diabetes: a validation study","volume":"52","author":"Newton","year":"1999","journal-title":"J Clin Epidemiol"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/45\/11\/2570\/690195\/dc212151.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/45\/11\/2570\/690195\/dc212151.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,1]],"date-time":"2022-11-01T14:57:17Z","timestamp":1667314637000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/45\/11\/2570\/147597\/Medical-Costs-Associated-With-Diabetes"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,14]]},"references-count":38,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,9,14]]},"published-print":{"date-parts":[[2022,11,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc21-2151","relation":{"has-preprint":[{"id-type":"doi","id":"10.2337\/figshare.20611344.v1","asserted-by":"object"},{"id-type":"doi","id":"10.2337\/figshare.20611344","asserted-by":"object"}]},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,14]]}}}