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. 2013 Aug 13;8(8):e70567.
doi: 10.1371/journal.pone.0070567. eCollection 2013.

Direct Diabetes-Related Costs in Young Patients With Early-Onset, Long-Lasting Type 1 Diabetes

Free PMC article

Direct Diabetes-Related Costs in Young Patients With Early-Onset, Long-Lasting Type 1 Diabetes

Christina Bächle et al. PLoS One. .
Free PMC article


Objective: To estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany.

Research design and methods: Data of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0-4 years of age within the years 1993-1999 were included (mean age 13.9 (SD 2.2) years, mean diabetes duration 10.9 (SD 1.9) years, as of 31.12.2007). Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV). Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance). Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors.

Results: Mean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943-4,881). Costs for glucose self-monitoring were the main cost category (28.5%), followed by costs for continuous subcutaneous insulin infusion (25.0%), diabetes-related hospitalizations (22.1%) and insulin (18.4%). Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs.

Conclusions: Main cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group.

Conflict of interest statement

Competing Interests: The DPV initiative is supported by a research grant from Novo Nordisk Germany. The grant supports the establishment and the further development of the DPV database. The authors' analysis was not financially supported by Novo Nordisk and is independent of any commercial funders. This fact does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

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    1. Tao B, Pietropaolo M, Atkinson M, Schatz D, Taylor D (2010) Estimating the cost of type 1 diabetes in the U.S.: a propensity score matching method. PLoS One 5 7: e11501 doi:10.1371/journal.pone.0011501 - DOI - PMC - PubMed
    1. Köster I, von Ferber L, Ihle P, Schubert I, Hauner H (2006) The cost burden of diabetes mellitus: the evidence from Germany–the CoDiM study. Diabetologia 49 7: 1498–1504 doi:10.1007/s00125-006-0277-5 - DOI - PubMed
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Grant support

This study was supported by the Competence Network Diabetes Mellitus by the German Federal Ministry of Education and Research (; FKZ 01GI0802, 01GI1109A, 01GI0859, 01GI1106). The German Diabetes Center is institutionally funded by the German Ministry of Health and the Ministry of Innovation, Sciences and Research of the Federal State of North Rhine-Westphalia. The DPV initiative is supported by the European Foundation for the Study of Diabetes (EFSD), the Dr. Bürger-Büsing Foundation, and by a research grant of Novo Nordisk Germany. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.