- Current Status of Diabetes Management in Korea Using National Health Insurance Database.
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Seok Won Park, Dae Jung Kim, Kyung Wan Min, Sei Hyun Baik, Kyung Mook Choi, Ie Byung Park, Jeong Hyun Park, Hyun Shik Son, Chul Woo Ahn, Jee Young Oh, Juneyoung Lee, Choon Hee Chung, Jaiyong Kim, Hwayoung Kim
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Korean Diabetes J. 2007;31(4):362-367. Published online July 1, 2007
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DOI: https://doi.org/10.4093/jkda.2007.31.4.362
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3,143
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- BACKGROUND
The prevalence of diabetes is steadily increasing in Korea. The increase in number of people with diabetes would ultimately result in premature death, poor quality of life, and increasing economic burden. However, in our country, researches regarding on the quality of diabetes management are lacking. This study was conducted in 2005 using National Health Insurance Database to know the current status of diabetes management in Korea. METHODS: We have randomly selected 3,902 subjects out of 2,503,754 subjects who had claims with diagnosis of diabetes between January 2003 to December 2003 by using two staged cluster sampling method. Field survey with review of medical records and telephone survey was conducted with standardized record forms developed by Korean Diabetes Association; Task Force Team For Basic Statistical Study of Korean Diabetes Mellitus. RESULTS: The age of diabetic subjects was 58.1 +/- 12.6 years and the duration of diabetes was 6.2 +/- 5.5 years. Hypertension was present in 54% of diabetic subjects. Among those with hypertension, 59% were controlled with blood pressure below 140/90 mmHg, but only 19% were controlled with blood pressure below 130/80 mmHg. Hyperlipidemia was present in 29% of diabetic subjects. Only 38% of those with hyperlipidemia were controlled with LDL-cholesterol below 100 mg/dL. For glycemic control, only 40% of diabetic subjects achieved the goal of HbA1c less than 7%, which was suggested by ADA. CONCLUSION: We found that only 20~40% of diabetic subjects in Korea achieved the management goal for glucose, blood pressure, and lipids. It seems urgent to develop a quality management program for diabetes subjects in Korea.
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Citations
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- Current Status of the Continuity of Ambulatory Diabetes Care and its Impact on Health Outcomes and Medical Cost in Korea Using National Health Insurance Database.
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Jaiyong Kim, Hyeyoung Kim, Hwayoung Kim, Kyung Wan Min, Seok Won Park, Ie Byung Park, Jeong Hyun Park, Sei Hyun Baik, Hyun Shik Son, Chul Woo Ahn, Jee Young Oh, Sunhee Lee, Juneyoung Lee, Choon Hee Chung, Kyung Mook Choi, Injeoung Choi, Dae Jung Kim
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Korean Diabetes J. 2006;30(5):377-387. Published online September 1, 2006
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DOI: https://doi.org/10.4093/jkda.2006.30.5.377
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2,704
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Abstract
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- BACKGROUND
The continuity of care in chronic diseases, especially in diabetes, was emphasized from many studies. But large scale studies with long-term observation which confirm the impact of continuity of care on health outcomes are rare. This study tried national level 3 year observation to find differences in hospitalization, mortality and medical costs among patient groups with different utilization pattern. METHODS: The 1,088,564 patients with diabetes diagnosis and diabetes drug prescription in 2002, from 20 to 79 years old, and survived until the end of 2004 were included. Annual drug prescription days, number of visited clinics and quarterly continuity of care were measured. Gender, age group, living area, health insurance premium level (as a proxy of the income level), years of first DM diagnosis, five co-morbidities (hypertension, heart disease, stroke, renal disease, admission with DM), hospitalization experience and the type of main attending clinic were adjusted. Hospitalization, mortality and high costs group (top quintile) in 2005 were predicted by multiple logistic regression model. RESULTS: Patients who failed in continuity of care in 2003 and 2004 showed higher hospitalization (OR =1.29), higher mortality (OR =1.75) and they are more likely to be high costs group (OR =1.34) in 2005 than who fulfilled the continuity of care. Patients who have single attending clinic also showed lower hospitalization, lower mortality and lower cost. Completeness in diabetic drug prescription were correlated with lower hospitalization, lower mortality but with higher cost. Possible cost saving from continual care with single attending clinic was estimated at Won 417 billion (Dollar 1 = Won 943.7). Possible expenditure from complete drug prescription was Won 228 billion. So, net saving was Won 139 billion in our study population. CONCLUSION: Continual care and single attending clinic saves patient's life and national costs. Fragmented primary care system in Korea should be reformed for more effective care of chronic diseases. National Health Insurance Database in Korea enables nationwide long-term observation study which overcomes the many limitations found in hospital-based studies and cross-sectional surveys.
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- Current Status of Diabetic Foot in Korean Patients Using National Health Insurance Database.
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Choon Hee Chung, Dae Jung Kim, Jaiyong Kim, Hyeyoung Kim, Hwayoung Kim, Kyung Wan Min, Seok Won Park, Jeong Hyun Park, Sei Hyun Baik, Hyun Shik Son, Chul Woo Ahn, Jee Young Oh, Sunhee Lee, Juneyoung Lee, Kyung Mook Choi, Injeoung Choi, Ie Byung Park
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Korean Diabetes J. 2006;30(5):372-376. Published online September 1, 2006
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DOI: https://doi.org/10.4093/jkda.2006.30.5.372
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3,044
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- BACKGROUND
Foot ulcer diseases are more prevalent in diabetic patients than that those of non-diabetic patients. Several reports showed the risk of amputation and the medical cost were increased when foot ulcer developed. Therefore, strict glycemic control from the initial period of diabetes is necessary. Since there is no enough epidemiologic data, large scaled studies for medical and economic consequences about diabetic foot ulcer are needed. METHODS: This study was based on health insurance claims submitted to the National Health Insurance Review Agency during the period from December 1994 through December 2002. We investigated the incidence and medical cost of foot disorders in Korean population using the disease-classification codes on the health insurance claim forms. RESULTS: The incidences of foot disorders (per 100,000 of population) were 49.7 for amputations, 99.7 for ulcers, and 1,051 for injuries in diabetic patients, and 4.2 for amputations, 10.3 for ulcers, and 943 for injuries in non-diabetic patients. Relative risk of the incidences of foot amputation, ulcer, and injury in diabetic patients comparing with non-diabetic patients were 11.7, 9.7, and 1.1, respectively. Total medical costs (per capita) of foot amputation, ulcer, and injury in diabetic patients were 2.0, 1.7, and 2.1 times higher, respectively, than those of non-diabetic patients. Mean hospital stay of foot amputation, ulcer, and injury in diabetic patients were 1.6, 1.3, and 1.7 times more, respectively, than those of non-diabetic patients. CONCLUSION: In diabetic patients, the incidences of foot amputation and ulcer are higher than those of non-diabetic patients. To reduce those incidences, we need to early strict glycemic control as well as government based management.
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Citations
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Chong Rye Song, Yong Soon Kim, Jin Hyun Kim
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Ie Byung Park, Jaiyong Kim, Dae Jung Kim, Choon Hee Chung, Jee-Young Oh, Seok Won Park, Juneyoung Lee, Kyung Mook Choi, Kyung Wan Min, Jeong Hyun Park, Hyun Shik Son, Chul Woo Ahn, Hwayoung Kim, Sunhee Lee, Im Bong Lee, Injeoung Choi, Sei Hyun Baik
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Hyojin Jeon, Junhyung Kim, Hyeonjung Yeo, Hoijoon Jeong, Daegu Son, Kihwan Han
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- Current Status of Aspirin User in Korean Diabetic Patients Using Korean Health Insurance Database.
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Ie Byung Park, Dae Jung Kim, Jaiyong Kim, Hyeyoung Kim, Hwayoung Kim, Kyung Wan Min, Seok Won Park, Jeong Hyun Park, Sei Hyun Baik, Hyun Shik Son, Chul Woo Ahn, Jee Young Oh, Sunhee Lee, Juneyoung Lee, Choon Hee Chung, Injeoung Choi, Kyung Mook Choi
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Korean Diabetes J. 2006;30(5):363-371. Published online September 1, 2006
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DOI: https://doi.org/10.4093/jkda.2006.30.5.363
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2,669
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- AIMS: ADA guidelines recommend aspirin for all patients with diabetes who have had a prior CHD events as well as a primary prevention strategy among those with at least one other risk factor. We examined the current status of regular aspirin intake among Korean adults who diagnosed as diabetes. METHODS: This study examined the characteristics of aspirin user in new-onset diabetes over 40 years based on health insurance claims submitted to the Health Insurance Review Agency (HIRA) of Korea during the period from January 2001 through December 2003. New onset diabetes defined as the first health insurance claim of antidiabetic drugs submitted to HIRA for the three months (January to March 2001) that never submitted for previous 6 years. RESULTS: The number of total new-onset diabetic patients was 30,014 in 2001, 29,819 in 2002, and 32,061 in 2003. The incidence rate of diabetes over 40 years for 3 months in 2001, 2002 and 2003 were 0.172%, 0.167% and 0.18. Mean age of women who diagnosed diabetes were significant higher than that of men in 2001 (women 59.2+/-10.6 yrs, men 54.8+/-9.8 yrs), in 2002 (women 59.5+/-10.6 yrs, men 54.6+/-9.3 yrs) and in 2003 (women 59.6+/-10.7 yrs, men 54.7+/-9.9 yrs) (p < 0.001). The number of aspirin user increased from 2,065 (6.9%) in 2001, 2,638 (8.9%) in 2002 and 3,711 (11.6%) in 2003. 30.5% of new-onset diabetics in 2001 had hypertension, 12.4% of them had hypercholesterolemia, 11.8% of them had cerebral infarct, 2.6% of them had cerebral hemorrhage, 3.8% of them had coronary heart disease and, but, 55.6% of them had not any CVD. Logistic regression analysis using aspirin use as a dependent variable showed that the number of aspirin use in patients with hypertension, hypercholesterolemia, cerebral infarct and coronary heart disease was higher than in patients without those (hypertension [OR], 3.89 (95% CI, 3.52~4.31); hypercholesterolemia [OR], 2.16 (95% CI, 1.90~2.46; cerebral infarct [OR], 2.05 (95% CI, 1.82~2.30); coronary heart disease [OR], 9.41 (95% CI, 8.20~10.80), respectively). Coronary heart disease was the most important associated factor of aspirin use. CONCLUSIONS: We found significant underuse of aspirin therapy among our population compared with that of America. Major efforts are needed to increase aspirin use in diabetic patients.
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Citations
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- Current Status of Diabetic End-Stage Renal Disease Using Korean Health Insurance Database.
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Dae Jung Kim, Jaiyong Kim, Hyeyoung Kim, Kyung Wan Min, Seok Won Park, Ie Byung Park, Jeong Hyun Park, Sei Hyun Baik, Hyun Shik Son, Chul Woo Ahn, Jee Young Oh, Sunhee Lee, Juneyoung Lee, Choon Hee Chung, Kyung Mook Choi, Injeoung Choi, Hwayoung Kim
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Korean Diabetes J. 2006;30(5):355-362. Published online September 1, 2006
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DOI: https://doi.org/10.4093/jkda.2006.30.5.355
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Abstract
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- BACKGROUND
Diabetes is becoming one of the main causes of end-stage renal disease (ESRD) worldwide. We studied the prevalence and incidence of end-stage renal disease (ESRD) in the Korean population based on health insurance claims submitted to the Health Insurance Review Agency. We also investigated the proportion of medications taken by the ESRD patients, and frequency of hospital admission or visits, and medical expenses between ESRD patients with and without diabetes. METHODS: This study was based on health insurance claims submitted to the Health Insurance Review Agency during the period from January 2001 through December 2003. Using the disease-classification codes on the health insurance claim forms, those who were diagnosed with chronic renal disease (N18 or N19) and received dialysis-related treatment (Z49), treatment with a kidney dialysis machine (Z99.2), or kidney transplantation (Z94.0) were defined as ESRD patients. Among the ESRD patients, those who were diagnosed with diabetes (E10-E14) and/or took anti-diabetic drugs were defined as ESRD patients with diabetes. RESULTS: The ESRD patients totaled 33,870 in 2001, 37,894 in 2002, and 41,167 (858.3 per million population) in 2003. ESRD patients with diabetes increased to 56.7% in 2003. The number of ESRD patients in whom renal replacement therapy was initiated was 8,134 in 2002 and 8,322 (173.5 per million population) in 2003. ESRD patients with diabetes used more anti-hypertensive drugs (1.2 times as many), lipid-lowering drugs (1.6 times), and anti-platelet agents (1.8 times) than did ESRD patients without diabetes. In 2003, 66.5% of the ESRD patients with diabetes were hospitalized, which was 1.6 times the hospital admissions of ESRD patients without diabetes. ESRD patients with diabetes also had hospital stays that were 1.6 times longer per patient and inpatient service expenses that were 1.6times greater per patient, compared with those reported for ESRD patients without diabetes. CONCLUSION: The incidence of ESRD accompanied by diabetes has risen rapidly. Given the burden of medical treatment costs placed on ESRD patients with diabetes, more aggressive interventions should be implemented to prevent diabetes and renal complications among patients with diabetes.
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Citations
Citations to this article as recorded by - Health-Related Quality of Life Based on Comorbidities Among Patients with End-Stage Renal Disease
Jieun Cha, Dallong Han
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