Economic burdens of type 1 diabetes and its complications: A nationwide, longitudinal analysis

To derive the healthcare costs by type 1 diabetes (T1D)-related complications and across time in Asian populations.

T1D patients were identified from Taiwan's National Health Insurance Research Database in 2008-2016 and followed up until death or 12/31/2018. A generalized estimating equation model was adopted to assess the cost impacts of diabetes complications.

Our study included 10,137 patients with a mean follow-up of 9.1 years. Costs increased from 1.13-fold (nephropathy) to 1.79-fold (ischemic heart disease/myocardial infarction [IHD/MI]) in the event/occurrence years and from 1.02-fold (diabetic foot or neuropathy) to 1.71-fold (peripheral vascular disease) in state/subsequent years. Recurrent cardiovascular events increased event-year costs from 1.19-fold (cerebrovascular disease) to 1.84-fold (IHD/MI). Acute complications, including hospitalized hyperglycemia and hypoglycemia, increased costs by 1.26-fold and 1.36-fold, respectively. The top costly subtype complications increased event-year costs by 5.96-fold (kidney transplant) and 1.77-fold (hemorrhagic stroke), while those increased state-year costs by 18.26-fold (kidney transplant) and 3.40-fold (end-stage renal disease). For fatal complications, costs increased by 1.93-fold for cardiovascular disease death and 1.64-fold for other-cause death.

Our findings not only support the parameterization of diabetes economic models to determine cost-effective interventions for T1D but also highlight the importance of early prevention for T1D progression.