OBJECTIVES: Diabetes treatment is a substantial economic burden, with high lifetime costs for patients. The objective of this study was to examine the comorbidities, complications, and surgical procedures associated with type 2 diabetes that impact the high cost of the disease.

METHODS: Prospectively collected inpatient and emergency department (ED) electronic health record data (Cerner Health Facts®) from >700 US hospitals between 2009 and 2016 was retrospectively analyzed. Patients were required to be ≥18 years old and have ICD-9/10 coding for type 2 diabetes. Patient-based data for Elixhauser comorbidities, and visits associated with ICD-9/10 diagnosis codes for complications and procedure codes for surgeries were examined.

RESULTS: Compared to all hospital patients, type 2 diabetes patients were significantly more likely to suffer from comorbidities such as hypertension (42.4% of type 2 diabetes patients vs. 16.5% of all patients for inpatient; 36.0% vs. 7.1% for ED; p<0.001), obesity (15.8% vs. 5.3% inpatient; 9.8% vs. 1.8% ED; p<0.001), and renal failure (12.7% vs. 3.4% inpatient; 6.8% vs. 0.9% ED; p<0.001). Similarly, a significantly higher percentage of diabetes patient visits were associated with disease complications, including coronary artery disease (36.4% vs. 11.4% inpatient; 11.8% vs. 1.6% ED; p<0.001), neuropathy (10.1% vs. 1.3% inpatient; 2.1% vs. 0.1% ED; p<0.001), nephropathy (7.0% vs. 0.9% inpatient; 0.9% vs. <0.1% ED; p<0.001) and retinopathy (2.9% vs. 0.4% inpatient; 0.5% vs. <0.1% ED; p<0.001). Additionally, diabetes inpatients were more likely to undergo cardiovascular procedures, such as angioplasty (3.0% vs. <0.1%; p<0.001), vascular/ arterial stents (2.2% vs. 1.1%; p<0.001), percutaneous coronary intervention (1.9% vs. 0.2%; p<0.001), coronary-artery by-pass grafting (1.0% vs. <0.1%; p=0.004), and valve procedures (0.3% vs. 0.2%, p<0.001).

CONCLUSIONS: This analysis provides insights into potentially relevant clinical factors that may contribute to the economic burden of type 2 diabetes across both the inpatient and ED care settings.