Related Experiment Video
Updated: Aug 6, 2026
12:08
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Health-care charges generated by patients with diabetes
D S Bell1, J E Kudlow, M Tidwell
1School of Medicine and Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Summary
Diabetologists provide cost-effective care for diabetes mellitus patients, generating only 3% of total health-care charges. However, low reimbursement rates threaten the practice of this vital subspecialty.
Area of Science:
- Endocrinology
- Health Economics
- Diabetes Care
Background:
- Diabetes mellitus management involves significant healthcare expenditures.
- The cost-effectiveness of subspecialty care in diabetes is crucial for resource allocation.
- Understanding the financial contribution of diabetologists to overall patient costs is essential.
Purpose of the Study:
- To assess the proportion of total healthcare charges attributable to diabetologist care for patients with diabetes mellitus.
- To evaluate the cost-effectiveness of endocrinologist-diabetologist services within a fee-for-service model.
- To identify financial challenges faced by the diabetology subspecialty due to reimbursement structures.
Main Methods:
- Random selection of 50 patients (25 older than 65, 25 younger) receiving primary care from a single diabetologist between 1990-1995.
- Analysis of institutional healthcare bills from multiple medical center billing offices.
- Calculation of charges generated by endocrinology relative to other medical and surgical specialties.
Main Results:
- For every dollar billed by endocrinology, the hospital billed $25.90, other specialties $2.70, surgery $1.10, radiology $0.70, and pathology $0.60.
- Endocrinologist-diabetologist charges constitute approximately 3% of total patient care costs.
- Despite cost-effectiveness, low reimbursement poses a threat to diabetology practice.
Conclusions:
- Endocrinologist-diabetologists deliver the most cost-effective medical service for diabetes mellitus patients.
- The current reimbursement structure for diabetology is financially unsustainable.
- Urgent review of reimbursement policies is needed to preserve subspecialty diabetes care.
Related Concept Videos
01:22Diabetes Mellitus: Overview and Type I Subtype
Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
01:22Diabetes Mellitus: Type 2 and Gestational
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
01:20Pathophysiology of Diabetes
Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. The four categories of diabetes are type 1 diabetes, type 2 diabetes, other specific types of diabetes, and gestational diabetes.
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility, suggesting a...
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility, suggesting a...
01:15Diabetes: Symptoms, Diagnosis, and Complications
For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is based on...
01:22Complications of Diabetes Mellitus
Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia due to insulin deficiency, resistance, or both. Prolonged hyperglycemia disrupts metabolic homeostasis and leads to acute and chronic complications.Acute ComplicationsAcute complications result from sudden metabolic imbalance.Diabetic ketoacidosis (DKA) mainly appears in type 1 diabetes but may also develop in type 2 diabetes, particularly under extreme stress. It arises from severe insulin deficiency,...
01:29Hyperglycemia
Hyperglycemia is an abnormally high blood glucose level. It is diagnosed by fasting glucose ≥126 mg/dL, 2-hour oral glucose tolerance test (or OGTT) ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%. However, HbA1c results may be unreliable in certain conditions, such as anemia or hemoglobinopathies, and the diagnosis should be confirmed unless classic symptoms are present. Postprandial hyperglycemia is typically considered significant when glucose levels exceed 180 mg/dL two...