Changes in Direct Medical Cost and Medications for Managing Diabetes in Beijing, China, 2016 to 2018: Electronic Insurance Data Analysis

The article by Lixin Guo et.al. is an important contribution to evaluation temporal changes in the costs and drugs used for Chinese patients with diabetes. This study is a large-scale retrospective study, which aims to analyze the changes of treatment cost, medication and prescription of diabetic patients in Beijing from 2016 to 2018. In this research, the baseline information of all patients, including age, sex, complications, complications, medical expenses, etc. were extracted, and the personal privacy information was desensitized. The main end-point indicators include the number of outpatient drugs, disease diagnosis, estimated annual outpatient drug costs and commonly used prescription drugs. The medical expenditure of patients with diabetes is less, and the complexity of treatment is also gradually decreasing, which confirms the success of rational treatment options and medical insurance policy for patients with diabetes in Beijing, China.
There were many strengths worthy of mentioning in the study. First, this research is the first cost analysis of the medical management of diabetes since the implementation of Chinese medical insurance. It is a timely feedback and reminder for us to find the changes in treatment costs and trends in medications prescribed in recent years. The second strength is its enough large sample size fostering confidence in the results. As an observational, retrospective, multi-center study, it was conducted by the team of Guo et al. with a huge workload and included millions of diabetes patients enrolled in Beijing’s medical insurance (897,385 patients in 2016; 959,509 patients in 2017; and 996,142 patients in 2018). Therefore, the analysis can be comprehensive, and the evaluated result can be more useful and persuasive. The third strength is that country-specific characteristics in glycaemia management was discussed. Because of differences in race, blood glucose, and dietary patterns between Chinese and Western populations, the use of acarbose and premixed insulin are more frequently and suitable for Chinese patients with diabetes, especially for patients with postprandial hyperglycemia. It is very important to have Chinese experience in the management of diabetes to appropriately face diabetes in local people. The forth strength is that Studies have estimated the cost-effectiveness of some commonly diabetic complications and comorbidities. Indirect costs of diabetes-related cardiovascular diseases or secondary infections, however, have not been measured in most previous studies, whereas diabetic complications are thought to be one of the key factors in determining both quality of life and health care costs. The decrease in complexity and costs of drug regimens prescribed is partly attributable to early detection and treatment of more patients, and the reduction of complications and comorbidities.
It is encouraging that there is a significant reduction in the number of diabetes medications used and a more rational approach to optimizing metabolic targets. For aged patients with diabetes, the reduction in multiple medication plays a key role in safety and controlling the risk of hypoglycemia. In terms of adults patients with diabetes, these changes make their lives more convenience and improve compliance. Additionally, more and more evidence show that diabetic comorbidities and complications seriously increase the mean number of medications and associated costs. It is gradually known that we should pay more attention on early detection and controlling in diabetic comorbidities and complications.
Further research on this subject could explore medical cost and medications for managing diabetes in rural areas. Although Beijing is a representative city of China, it was only generated from a single city’s database. As the saying in this article, the proportion of the population with diabetes receiving medical treatment is lower in rural areas; and the proportion of reimbursement over the medical expenses with new rural cooperative medical system is also different from Beijing Medical Insurance. This treatment and cost analysis of diabetes of capital city is comprehensive, and it is hoped that there may be lessons from this experience for Chinese and worldwide areas.