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Event Rates, Hospital Utilization, and Costs Associated with Major Complications of Diabetes: A Multicountry Comparative Analysis
Open accessAbstract
BACKGROUND: Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries. METHODS AND FINDINGS: Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE) study (mean age at entry 66 y). The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies) using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$), which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%-96% across regions) and lowest for nephropathy (15%-26%). The average numbers of days in hospital given at least one admission were greatest for stroke (17-32 d across region) and heart failure (16-31 d) and lowest for nephropathy (12-23 d). Considering regional differences, probabilities of hospitalization were lowest in Asia and highest in Established Market Economies; on the other hand, lengths of stay were highest in Asia and lowest in Established Market Economies. Overall estimated annual hospital costs for patients with none of the specified events or event histories ranged from Int$76 in Asia to Int$296 in Established Market Economies. All complications included in this analysis led to significant increases in hospital costs; coronary events, cerebrovascular events, and heart failure were the most costly, at more than Int$1,800, Int$3,000, and Int$4,000 in Asia, Eastern Europe, and Established Market Economies, respectively. CONCLUSIONS: Major complications of diabetes significantly increase hospital use and costs across various settings and are likely to impose a high economic burden on health care systems.
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“A study has found that the risk of diabetic kidney disease is much higher in Asian countries than in Western countries due to different economic outcomes (100).”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [100]
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“Interestingly, a study has indicated that patients with T2D in Asian countries have a lower risk of coronary diseases than those from eastern Europe or Established Market Economies (100).”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [100]
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Cites
(2001) · RePEc: Research Papers in Economics · Cited by 27,577
Longitudinal data analysis using generalized linear models
LIANG, K.-Y., & ZEGER, S. L. (1986) · Biometrika · doi:10.1093/biomet/73.1.13 · Cited by 18,550
Wild, S., Roglic, G., Green, A., Sicree, R., & King, H. (2004) · Diabetes Care · doi:10.2337/diacare.27.5.1047 · Cited by 15,297
Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes
(2008) · New England Journal of Medicine · doi:10.1056/nejmoa0802987 · Cited by 7,397
Everitt, B. S. (2001) · Psychology Press eBooks · doi:10.4324/9781410605542-11 · Cited by 6,877
Multilevel and Longitudinal Modeling Using Stata
Rabe-Hesketh, S., & Skrondal, A. (2005) · Biometrics · doi:10.1111/j.1541-0420.2006.00588_16.x · Cited by 4,626
Economic Costs of Diabetes in the U.S. in 2002
American Diabetes Association (2003) · Diabetes Care · doi:10.2337/diacare.26.3.917 · Cited by 4,147
Disease control priorities in developing countries
(2006) · Choice Reviews Online · doi:10.5860/choice.44-0343 · Cited by 3,636
(2016) · Human Rights Documents online · doi:10.1163/2210-7975_hrd-9841-2014001 · Cited by 1,579
Lifetime risk for diabetes mellitus in the United States
Narayan, K. M. V. (2003) · JAMA · doi:10.1001/jama.290.14.1884 · Cited by 1,515
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1 of the 33 references couldn’t be matched to a known paper.
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- RJ Rubin, 1994, Health expenditures for people with diabetes mellitus, 1992., J Clin Endocrinol Metab, 78, 809A, 10.1210/jcem.78.4.8157701 · DOI
Cited by
Sorted by citations
Items 101–159 of 159
Fuentes-Merlos, Á., Quesada, J. A., Reina, R., & Orozco‐Beltrán, D. (2022) · Family Medicine and Community Health · doi:10.1136/fmch-2022-001700 · Cited by 8
The Road Not Taken: Transferability Issues in Multinational Trials
Vemer, P., & Mölken, M. R. (2013) · PharmacoEconomics · doi:10.1007/s40273-013-0084-z · Cited by 8
Faktor Risiko Terjadinya Komplikasi Kronis Diabetes Melitus Tipe 2 pada Pra Lansia
Purwandari, C. A. A., Wirjatmadi, B., & Mahmudiono, T. (2022) · Amerta Nutrition · doi:10.20473/amnt.v6i3.2022.262-271 · Cited by 8
Aloumanis, K., Benroubi, M., Sourmeli, S., & Drossinos, V. (2013) · Primary care diabetes · doi:10.1016/j.pcd.2013.04.001 · Cited by 8
Tambo-Lizalde, E., Carrasco, J. M., Mayoral-Blasco, S., Rabanaque, M. J., & Abad-Díez, J. M. (2012) · Revista de Calidad Asistencial · doi:10.1016/j.cali.2012.07.006 · Cited by 8
Puteh, S. E. W., Kamarudin, N. ‘., Hussein, Z. B., Adam, N., & Shahari, M. R. (2024) · BMC Public Health · doi:10.1186/s12889-024-19475-w · Cited by 7
Sibarani, M. H. R., Wijaya, I. P. E. K., Rizka, A., Soewondo, P., Riyadina, W., Rahajeng, E., Sudikno, S., Harbuwono, D. S., & Tahapary, D. L. (2021) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2021.102330 · Cited by 7
Chen, M., Kong, F., Su, B., Wei, X., & Yang, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192113859 · Cited by 7
Ong, S. C., Low, J. Z., & Linden, S. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1195124 · Cited by 6
Nerat, T., & Kos, M. (2013) · Slovenian Journal of Public Health · doi:10.2478/sjph-2013-0018 · Cited by 6
Healthcare burden and factors of type 2 diabetes mellitus with Schizophrenia
Huang, C., Liu, T., Huang, Y.-T., Hsieh, H., Chang, C., Chu, C., Wei, C., & Weng, S. (2021) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-021-01258-8 · Cited by 6
Dynamique des dépenses hospitalières des personnes traitées pour diabète, en France (2007-2008)
Ricci, P., Weill, A., Ricordeau, P., & Allemand, H. (2010) · Pratiques et Organisation des Soins · doi:10.3917/pos.414.0293 · Cited by 6
Regional differences in diabetic patients' pharmacotherapy in Bulgaria.
Valov, V., Doneva, M., Borisova, A. M., Tankova, T. I., Czech, M., Manova, M. M., Savova, A., Peikova, L., & Petrova, G. I. (2014) · PubMed · Cited by 6
Quality of diabetes care in family health facilities in one health district in alexandria.
Fatouh, N. F., & El-Din, M. N. (2009) · PubMed · Cited by 5
Yang, A., & Chen, H. (2020) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-020-01210-1 · Cited by 5
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Wang, N., Chalmers, J. P., Harris, K., Poulter, N. R., Mancia, G., Harrap, S. B., Hamet, P., Grobbee, D. E., Marre, M., & Woodward, M. (2024) · Journal of Hypertension · doi:10.1097/hjh.0000000000003855 · Cited by 4
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Implications of CVD-REAL 2 study for Indian diabetic population
Chawla, R., & Jaggi, S. (2019) · Journal of Diabetology · doi:10.4103/jod.jod_48_18 · Cited by 4
Rucci, P., Avaldi, V. M., Travaglini, C., Ugolini, C., Berti, E., Moro, M. L., & Fantini, M. P. (2019) · PharmacoEconomics - Open · doi:10.1007/s41669-019-0166-8 · Cited by 4
Principales factores asociados al coste de la diabetes mellitus tipo 2: revisión de la literatura
Paz, S., Alsina, D. G.-S., Torres, A., & Lizán, L. (2014) · Avances en Diabetología · doi:10.1016/j.avdiab.2014.02.001 · Cited by 4
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Masconi, K. L., Echouffo-Tcheugui, J. B., Matsha, T. E., Erasmus, R. T., & Kengne, A. P. (2015) · Expert Review of Endocrinology & Metabolism · doi:10.1586/17446651.2015.1015989 · Cited by 3
Epidemiology of Diabetic Ketoacidosis in the Waikato Region of New Zealand: 2000-2019
Chepulis, L. M., Papa, V., Lao, C., Wu, J. C., Riguetto, C. M., McClintock, J. M., & Paul, R. G. (2023) · Journal of Diabetes Research · doi:10.1155/2023/4715783 · Cited by 3
Huang, C., Lin, C., Liu, T., Lin, P., Chu, C., Wang, J., Wei, C., & Weng, S. (2024) · Psychiatric Quarterly · doi:10.1007/s11126-024-10072-z · Cited by 3
Lv, G., Chinaeke, E. E., Jiang, X., Xiong, X., Wu, J., Yuan, J., & Lu, K. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12796-5 · Cited by 4
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Chalmers, J. P., & Woodward, M. (2019) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13894 · Cited by 3
Self-citationEpidemiology of Stroke Patients with Diabetes
Cha, J. (2021) · Stroke revisited · doi:10.1007/978-981-16-5123-6_6 · Cited by 3
Tan, Y. J., Linden, S., & Ong, S. C. (2024) · PLoS ONE · doi:10.1371/journal.pone.0305257 · Cited by 2
Naidoo, L., Butkow, N., Barnard-Ashton, P. M., & Libhaber, E. N. (2019) · Journal of Endocrinology Metabolism and Diabetes of South Africa · doi:10.1080/16089677.2019.1613042 · Cited by 2
Abbade, E. B. (2019) · Medicina (Ribeirão Preto) · doi:10.11606/issn.2176-7262.v52i3p201-211 · Cited by 2
Brown-Podgorski, B. L., de Groot, M., Shi, Y., & Vest, J. R. (2021) · Population Health Management · doi:10.1089/pop.2020.0216 · Cited by 2
Tan, Y. J., Low, J. Z., & Ong, S. C. (2024) · Clinical Therapeutics · doi:10.1016/j.clinthera.2024.08.008 · Cited by 2
Zoysa, W. D., Weerarathna, T. P., Darshana, I. L. A. N., Egodage, U. K., Jayasekara, P., Sujanitha, V., Silva, S., Mettananda, C. D., Pathirage, M., Ramadasa, U., et al. (2025) · BMC Endocrine Disorders · doi:10.1186/s12902-025-01994-1 · Cited by 2
Nath, D. C., & Bhattacharjee, A. (2011) · Pakistan Journal of Statistics and Operation Research · doi:10.18187/pjsor.v7i2-sp.305 · Cited by 1
Zaman, M., Patel, A. A., Chalmers, J. P., Woodward, M., Clarke, P., Li, Q., & Zoungas, S. (2013) · Diabetic Medicine · doi:10.1111/dme.12181 · Cited by 1
Self-citationThe Evolving Face of Heart Failure Associated with Elevated Cardio-Metabolic Risk Factors
Dutt, C., Chauthaiwale, V. M., Mohanan, A., Chandra, K. P., Zambad, S. P., Gupta, R. K., & Parikh, S. (2012) · InTech eBooks · doi:10.5772/28065
Bloomgarden, Z. T. (2012) · Journal of Diabetes · doi:10.1111/j.1753-0407.2012.00228.x
Ipingbemi, A. E., Erhun, W. O., Awogbemi, J. K., & Ipingbemi, E. (2014)
Carrondo, M. C. (2014) · JOURNAL OF HEALTH SCIENCE
Diagnosis of admitted diabetic patients in a Tertiary Care Hospital in Pakistan.
Siddiqui, R. P., Rukhsana, N., Sahar, N., & Fahim, M. F. (2020) · The Professional Medical Journal · doi:10.29309/tpmj/2020.27.05.3690
Meireles, E., Fernandes, T., Santos, M., Eiras, A., Teixeira, M. A., & Pereira, M. T. (2020) · Galicia Clínica · doi:10.22546/58/1994
Wang, C., Xie, Z., Huang, X., Wang, Z., Shangguan, H., & Wang, S. (2020) · doi:10.21203/rs.3.rs-42382/v1
Cardiovascular risk prevention in clinical medicine: current guidelines in Asia
Lee, H., & Park, J. B. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-91391-1.00032-7
Ranathunga, I., Naveenkumar, J. P., Athukorala, T. G., Sumanatilleke, M., & Somasundaram, N. P. (2022) · Endocrine Abstracts · doi:10.1530/endoabs.81.ep539
Hill‐Briggs, F., Fitzpatrick, S. L., Schumann, K. P., & Golden, S. H. (2014) · Springer eBooks · doi:10.1007/978-0-387-09817-3_17
The Reference Model for Disease Progression
Barhak, J. (2012) · Proceedings of the Python in Science Conferences · doi:10.25080/majora-54c7f2c8-007
Ranathunga, I., Naveenkumar, J. P., Athukorala, T. G., Sumanatilleke, M., & Somasundaram, N. (2022) · Research Square · doi:10.21203/rs.3.rs-1937616/v1
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แผ่วัฒนากุล, เ. (2022) · Ramathibodi Medical Journal · doi:10.33165/rmj.2022.45.4.258675
Statistical Study of Diabetes and Diabetic Foot Problems in Afiya Hospital, Huon
Mansour, N. A. A., -, A. M. S. M., & -, H. R. (2024) · International Journal For Multidisciplinary Research · doi:10.36948/ijfmr.2024.v06i06.33824
Chepulis, L. M., van Zyl, N., Moorhouse, S., Koshy, S., Keenan, R., Lao, C., Mullins, H., Kenealy, T. W., Paul, R. G., & Crocket, H. R. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-13277-5
Puteh, S. E. B. W., Kamarudin, N. ‘., Hussein, Z. B., Adam, N., & Shahari, M. R. (2024) · Figshare · doi:10.6084/m9.figshare.26754184
Puteh, S. E. B. W., Kamarudin, N. ‘., Hussein, Z. B., Adam, N., & Shahari, M. R. (2024) · Figshare · doi:10.6084/m9.figshare.26754190
Puteh, S. E. B. W., Kamarudin, N. ‘., Hussein, Z. B., Adam, N., & Shahari, M. R. (2024) · Figshare · doi:10.6084/m9.figshare.26754181
Puteh, S. E. B. W., Kamarudin, N. ‘., Hussein, Z. B., Adam, N., & Shahari, M. R. (2024) · Figshare · doi:10.6084/m9.figshare.26754187
Asiamah-Asare, B. K. Y., Randall, S. M., Mnatzaganian, G., Varhol, R., Lee, C., Chai, K. E. K., Boyd, J., Shakya, S., Gao, L., Robinson, S., et al. (2026) · Value in Health Regional Issues · doi:10.1016/j.vhri.2026.101615
Shamim, M. A., Tiwari, K., Shukla, R., Swami, M. K., Srivastav, S., Meena, S., Chaturvedy, M., Panda, S., John, D., Shamim, M. A., et al. (2026) · MethodsX · doi:10.1016/j.mex.2026.103953
Metadata
- Authors
- Clarke, P. M., Glasziou, P., Patel, A., Chalmers, J., Woodward, M., Harrap, S. B., Salomon, J. A., & on behalf of the ADVANCE Collaborative Group
- Affiliations
- The University of Sydney (AU)
- University of Oxford (GB)
- The University of Melbourne (AU)
- Harvard University (US)
- Corresponding author
- Clarke, Philip M.
- ORCID
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2010-02-23
- Volume
- 7
- Issue
- 2
- Pages
- e1000236
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC2826379
- OpenAlex
- W2015835669
- Cited by
- 159
- References
- 33
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 11 · 2023: 4 · 2022: 15 · 2021: 8 · 2020: 15 · 2019: 12 · 2018: 7 · 2017: 6 · 2016: 16 · 2015: 9 · 2014: 14 · 2013: 12 · 2012: 10
- FWCI
- 25.66
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- University of Sydney
- Servier
- Medical Research Council
- National Health and Medical Research Council (211086, 358395, 571122)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, diabetes complications, hospital utilization, hospital costs, length of hospital stay, hospitalization rates, coronary disease, cerebrovascular disease, heart failure, peripheral vascular disease, diabetic nephropathy, international dollars, regional cost comparison, economic burden of diabetes, ADVANCE study, cost calculator, low- and middle-income countries, high-income countries, Asia, Eastern Europe
- MeSH terms
- Aged, Diabetes Mellitus, Type 2, Health Expenditures, Female, Hospitalization, Humans, Male, Middle Aged, Cost of Illness
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