Ercilia M Olivera

Costs of Temporary and Permanent Disability Induced by Diabetes

Objective To evaluate the indirect costs of diabetes and show their relationship to the chronic complications of diabetes. Research Design and Methods The cost of temporary and permanent disability for diabetic patients was studied in a group of La Plata University employees and in a second group at the government institutions of the Buenos Aires Province during 3 consecutive yr (1984–1986). Results Absences due to temporary disability were similar for the diabetic group without chronic complications and an age-and sex-matched nondiabetic control group. Conversely, diabetic patients with chronic complications had major increases in absences compared with the control subjects. Diabetes mellitus was the third leading cause of permanent disability mainly due to macrovascular and retinal lesions. This disability resulted in an average of 11 yr of work production loss per patient. Conclusions These results suggest that diabetic individuals without complications incur few additional costs compared with nondiabetic individuals. However, once complications appear, the indirect costs are very high, suggesting that secondary preventions of the diabetic complications might be an optimal approach for reducing the health-care burden of diabetes.

Characteristics, clinical course, and in-hospital mortality of non-insulin-dependent diabetic and nondiabetic patients with acute myocardial infarction in Argentina.

The characteristics and clinical course of 1040 cases of acute myocardial infarction (AMI) among non-insulin-dependent diabetics (146) and nondiabetics (894) were compared. Patients with non-insulin-dependent diabetes mellitus (NIDDM) historically showed a greater percentage of AMI, angina, and risk factors than nondiabetic patients. Although the degree of left-ventricular function upon admission (according to the Killip and Kimball scores) was similar in both the diabetic and nondiabetic groups, the prevalence of hypertension and hypercholesterolemia was significantly higher in the NIDDM patients. All told, NIDDM cases were 1.73 [relative risk (RR)] times more likely to die of AMI than nondiabetic patients. The age factor and the presence of shock of any type also significantly increased the case-fatality rate. Diabetic patients showed signs of successful reperfusion less often than control subjects, an event that was closely associated with their case-fatality rate. In the NIDDM group, both the age and gender factor as well as a history of either casual or in-hospital clinical events such as cardiogenic shock, reinfarction, unsuccessful reperfusion, and incidence of anterior AMI along with either pain or previous angina were clear prognosticators of poor outcome from AMI. In the nondiabetic group, cardiogenic shock and hypertension were indicators of poor prognosis. These results would suggest that an improvement in the incidence of successful reperfusion in NIDDM patients, particularly in the face of clinical indicators of poor AMI prognosis, could decrease the high AMI mortality currently observed in these patients.