Showing papers by "Ping Zhang published in 2015"
TL;DR: In women with a history of GDM in the DPP/Diabetes Prevention Program Outcomes Study, both lifestyle and metformin were highly effective in reducing progression to diabetes during a 10-year follow-up period.
Abstract: Context: Gestational diabetes (GDM) confers a high risk of type 2 diabetes In the Diabetes Prevention Program (DPP), intensive lifestyle (ILS) and metformin prevented or delayed diabetes in women with a history of GDM Objective: The objective of the study was to evaluate the impact of ILS and metformin intervention over 10 years in women with and without a history of GDM in the DPP/Diabetes Prevention Program Outcomes Study Design: This was a randomized controlled clinical trial with an observational follow-up Setting: The study was conducted at 27 clinical centers Participants: Three hundred fifty women with a history of GDM and 1416 women with previous live births but no history of GDM participated in the study The participants had an elevated body mass index and fasting glucose and impaired glucose tolerance at study entry Interventions: Interventions included placebo, ILS, or metformin Outcomes Measure: Outcomes measure was diabetes mellitus Results: Over 10 years, women with a history of GDM
307 citations
TL;DR: This systematic economic review for the Community Preventive Services Task Force was done to estimate the cost associated with diet and physical activity promotion programs and the cost-effectiveness and costbenefit ratios of these programs.
Abstract: This systematic review for the CPSTF examined evidence from 28 studies about the cost and cost-effectiveness of combined diet and physical activity promotion programs for persons at increased risk ...
116 citations
TL;DR: In the past 2 decades, managing diabetes has become more expensive, mostly due to the higher spending on drugs.
Abstract: OBJECTIVE Diabetes care has changed substantially in the past 2 decades. We examined the change in medical spending and use related to diabetes between 1987 and 2011. RESEARCH DESIGN AND METHODS Using the 1987 National Medical Expenditure Survey and the Medical Expenditure Panel Surveys in 2000–2001 and 2010–2011, we compared per person medical expenditures and uses among adults ≥18 years of age with and without diabetes at the three time points. Types of medical services included inpatient care, emergency room (ER) visits, outpatient visits, prescription drugs, and others. We also examined the changes in unit cost, defined by the expenditure per encounter for medical services. RESULTS The excess medical spending attributed to diabetes was $2,588 (95% CI, $2,265 to $3,104), $4,205 ($3,746 to $4,920), and $5,378 ($5,129 to $5,688) per person, respectively, in 1987, 2000–2001, and 2010–2011. Of the $2790 increase, prescription medication accounted for 55%; inpatient visits accounted for 24%; outpatient visits accounted for 15%; and ER visits and other medical spending accounted for 6%. The growth in prescription medication spending was due to the increase in both the volume of use and unit cost; whereas, the increase in outpatient expenditure was almost entirely driven by more visits. In contrast, the increase in inpatient and ER expenditures was caused by the rise of unit costs. CONCLUSIONS In the past 2 decades, managing diabetes has become more expensive, mostly due to the higher spending on drugs. Further studies are needed to assess the cost-effectiveness of increased spending on drugs.
65 citations
TL;DR: Diabetes is associated with a substantially increased risk of death in Chinese adults, especially from CVD, almost half of which is due to stroke.
Abstract: OBJECTIVE Despite its growing prevalence in China, the extent to which diabetes leads to excess cardiovascular disease (CVD) mortality and all-cause mortality is unclear. RESEARCH DESIGN AND METHODS We compared death rates and causes of death among 630 people with newly diagnosed diabetes (NDD) and 519 with normal glucose tolerance (NGT) who, in 1986, were identified as a result of screening 110,660 adults aged 25–74 years for diabetes in Da Qing, China. RESULTS During 23 years of follow-up, 338 (56.5%) participants with NDD and 100 (20.3%) with NGT died. CVD was the predominant cause of death in those with diabetes (47.5% in men and 49.7% in women), almost half of which was due to stroke (52.3% in men and 42.3% in women). The age-standardized incidence of all-cause death was three times as high in those with NDD as in those with NGT with incidences (per 1,000 person-years) of 36.9 (95% CI 31.5–42.3) vs. 13.3 (10.2–16.5) in men ( P P CONCLUSIONS Diabetes is associated with a substantially increased risk of death in Chinese adults, especially from CVD, almost half of which is due to stroke.
65 citations
TL;DR: The partial meal replacement plan consumed by Intensive Lifestyle Intervention participants was related to superior diet quality and had a significantly lower fat and cholesterol intake and greater fiber intake than Diabetes Support and Education participants at 12 months.
27 citations
TL;DR: The results indicate that policy-makers should carefully balance the benefit and cost of the program while considering using a population-based approach to screen for diabetes, and significant uncertainty was demonstrated in sensitivity analysis.
Abstract: The cost-effectiveness of screening for type 2 diabetes mellitus (DM2) in developing countries remains unknown. The Brazilian government conducted a nationwide population screening program for type 2 diabetes mellitus (BNDSP) in which 22 million capillary glucose tests were performed in individuals aged 40 years and older. The objective of this study was to evaluate the life-time cost-effectiveness of a national population-based screening program for DM2 conducted in Brazil. We used a Markov-based cost-effectiveness model to simulate the long-term costs and benefits of screening for DM2, compared to no screening program. The analysis was conducted from a public health care system perspective. Sensitivity analyses were conducted to examine the robustness of results to key model parameters. Brazilian National diabetes screening program will yield a large health benefit and higher costs. Compared with no screening, screen detection of undiagnosed diabetes resulted in US$ 31,147 per QALY gained. Results from sensitivity analyses found that screening targeted at hypertensive individuals would cost US$ 22,695/QALY. When benefits from early glycemic control on cardiovascular outcomes were considered, the cost per QALY gained would reduce significantly. In the base case analysis, not considering the intangible benefit of transferring diabetes management to primary care nor the benefit of using statin to treat eligible diabetic patients, CE ratios were not cost-effective considering thresholds proposed by the World Health Organization. However, significant uncertainty was demonstrated in sensitivity analysis. Our results indicate that policy-makers should carefully balance the benefit and cost of the program while considering using a population-based approach to screen for diabetes.
17 citations
TL;DR: If the effectiveness of the intervention is similar to lifestyle interventions tested in other settings and costs per session equal the current reimbursement rate, intensive behavioral therapy for obesity offers good value, however, intervention effectiveness and the pattern of implementation and utilization strongly influence cost effectiveness.
15 citations
TL;DR: The average person with diabetes spent a total of $13,700 on health care in 2012 and the per capita and total health care expenditures attributed to diabetes have been increasing and are expected to increase through the near future.
Abstract: Diabetes is one of the most costly chronic diseases in the United States. More than one in ten U.S. health care dollars spent in 2012 was attributed to diabetes (American Diabetes Association, 2013) and as much as one-third of Medicare’s budget for beneficiary care was incurred for those with diabetes (Centers for Medicare and Medicaid, 2005). The average person with diabetes spent a total of $13,700 on health care in 2012 and the per capita and total health care expenditures attributed to diabetes have been increasing and are expected to increase through the near future (American Diabetes Association, 2013; Zhuo et al., 2015).
6 citations