According to recent estimates, diabetes affects nearly 29 million people in the United States, putting these individuals at risk for other chronic conditions, such as cardiovascular disease, stroke, and other conditions. Diabetes ranked as the seventh-leading cause of death in the U.S. in 2009 and 2010, and costs for managing the disease are nearly $245 billion each year. Studies indicate that patients with diabetes have medical expenditures that are about 2.3 times higher than those without the disease.
Considering the growing epidemic of diabetes, the U.S. Department of Health and Human Services has set one of its Healthy People 2020 goals to reduce the burden of the disease. In a recent data brief from the CDC’s National Center for Health Statistics, Jill Jacobsen Ashman, PhD, and colleagues set out to examine trends for visits to office-based physicians by patients with diabetes from 2005 through 2010. The data brief also described age differences in the utilization of healthcare by patients with the disease in 2010. All estimates were made using data from the 2005–2010 National Ambulatory Medical Care Survey.
According to the data brief, the overall number of visits by patients with diabetes increased by 20%, rising from 94.4 million in 2005 to 113.3 million in 2010 (Figure 1). “Visits by patients with diabetes represented about 11% of all office-based physician visits in 2010,” adds Dr. Ashman. From 2005 to 2010, the number of visits by patients with diabetes increased across all age groups except for those younger than 25, with the largest percentage increase (34%) occurring among individuals aged 25 to 44.
Researchers also found that the volume of visits was much higher for older age groups. People aged 65 and older had 53.7 million visits in 2010, compared with 2.6 million visits that occurred among patients under the age of 25. The overall rate of physician office visits by patients with diabetes was not statistically different from 2005 to 2010 for all age groups, but the rate of these visits increased with advancing age in both 2005 and 2010. The highest visit rate in 2010 among patients with diabetes was for those aged 65 and older, with 1,380 visits per 1,000 persons. The lowest visit rate was for those under the age of 25, with 20 visits per 1,000 persons.
The data brief noted that more than 80% of visits by patients with diabetes were by those making multiple trips to the sampled doctor in the past year. Regardless of age, 55% of visits by patients with diabetes were made by those who visited their physician’s office four or more times in the past year.
Other Conditions Common
Overall, about 87% of office-based physician visits made by patients with diabetes were for those with multiple chronic conditions. “The number of chronic conditions increased with advancing patient age,” Dr. Ashman says. The study showed that 18% of visits made by patients with diabetes aged 25 to 44 were by those with four or more chronic conditions. The corresponding percentages for those aged 45 to 64 and for those aged 65 and older were 36% and 35%, respectively, representing a substantial increase. Diabetes was reported as the only chronic condition for 49% of visits made by patients under the age of 25, but it was the only chronic condition for just 10% of the visits made by patients aged 65 and older.
According to Dr. Ashman, medications were prescribed or continued at the majority of office-based physician visits by patients with diabetes. “The number of medications prescribed or continued increased as patients got older,” she says. Visits by older patients were more likely to include five or more drugs being prescribed or continued than visits by younger patients (Figure 2). The report noted that five or more drugs were prescribed or continued at 38% of the visits by patients with diabetes aged 25 to 44, with this rate increasing to 60% of visits for patients aged 65 and older.
More to Come
“Diabetes is not the only health concern for the majority of patients who have it,” says Dr. Ashman. “A significant number of visits are being made by patients who have additional chronic conditions. Regardless of age, patients with diabetes continue to extensively use healthcare resources and are making frequent trips to the doctor, often receiving multiple prescriptions. It’s important to continue to examine these trends given the changes in standards of care that may influence office-based physician visits.”
Ashman JJ, Talwalkar A, Taylor SA. Age differences in visits to office-based physicians by patients with diabetes: United States, 2010. NCHS Data Brief. 2014;161:1-8. Available at: http://www.cdc.gov/nchs/data/databriefs/db161.htm.
CDC. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services. 2014.
Kochanek KD, Xu J, Murphy SL, et al. Deaths: final data for 2009. National vital statistics reports; vol 60 no 3. Hyattsville, MD: National Center for Health Statistics. 2011.
American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36:1033-1046.