OBJECTIVES : Heart failure (HF) is a common comorbidity of type 2 diabetes (T2D). Patients with both HF and T2D face increased mortality and greater all-cause healthcare utilization (HCU) and costs, compared to those with only one of the two conditions. However, little is known about how HF contributes to the economic burden of diabetes, given the fact that HF negatively impacts glycemic control. This study aimed to examine and compare diabetes-related HCU and costs in T2D patients with and without HF.

METHODS : This was a retrospective cohort study using Truven Marketscan^® Commercial and Medicare Supplemental Claims data from 2014 to 2016. Adult men and non-pregnant women with T2D and HF were compared with those without HF in diabetes-related HCU and costs, including inpatient visits and length of stay, emergency room (ER) visits, overall outpatient visits, general practitioner visits, specialist visits, and prescription drugs. A 1:1 greedy propensity score matching (PSM) algorithm was performed to adjust for demographic characteristics. Multivariate regression models were built to adjust for comorbidities and baseline HCU.

RESULTS : A total of 864,330 patients met study criteria. After PSM, 22,026 subjects remained in each cohort. The HF cohort had higher proportion of diabetes-related inpatient visits (13.45% vs. 4.13%), ER visits (4.75% vs. 2.11%), outpatient specialist visits (7.35% vs. 6.03%) and more insulin prescriptions (1.61 vs. 0.75) during a 12-month follow-up period, all P < 0.0001. Patients with HF incurred higher per-patient-per-year diabetes-related medical costs ($5,755 vs. $1,831) and prescription costs ($1,657 vs. $1,348). Overall, patients with both T2D and HF spent $4,233 more in managing diabetes annually, compared to those with T2D only.

CONCLUSIONS : Heart failure increased the economic burden of managing T2D. Future studies should explore the impact of HF or other cardiovascular diseases on specific diabetes complications to understand the driving characteristics of this impact.