OBJECTIVES: Approximately ¾ of adults with type 1 diabetes mellitus (T1DM) do not meet glycemic goals and therefore are at risk of developing diabetes-related complications. Understanding the specific economic burden of diabetes-related complications is important for US payers when making treatment coverage decisions. The objective of this study was to estimate the incidence and costs of diabetes-related events among adults T1DM over a 3-year follow-up period from a U.S. payor perspective.

METHODS: A Markov model using monthly cycles was used to estimate the occurrence of 12 diabetes-related events (myocardial infarction [MI], angina, cardiovascular [CV] death, severe hypoglycemia [SH], diabetic ketoacidosis [DKA], stroke, heart failure, microalbuminuria, macroalbuminuria, end-stage renal disease [ESRD], retinopathy, and neuropathy) over a 3-year follow-up period in a hypothetical payor population of 10,000 adults with T1DM. For each event, an annual event risk and risk of fatality in an adult T1DM population was established based on published sources. An average insulin-optimized A1C level of 7.6% and mean age of 46 years was assumed for this hypothetical population. Costs of each event were derived from published literature and inflation adjusted to 2018 values.

RESULTS: Based on this hypothetical T1DM population, a US payor would expect to observe the following mutually exclusive events within the first year of follow-up, in descending order: SH (1,043), DKA (482), retinopathy (358), neuropathy (329), angina (316), MI (247), microalbuminuria (151), stroke (101), CV death (53), other-cause death (32), and heart failure (31). Management of these events in a T1DM population will cost a payor on average $5,166 per patient and $52 million in the first year and up to $15,673 and $157 million, cumulatively, over 3 years.

CONCLUSIONS: Diabetes-related complications are common in adult patients with T1DM and contribute significantly to the overall healthcare expenditures in this population.