Résumé :
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[BDSP. Notice produite par INIST HR0xXCc7. Diffusion soumise à autorisation]. Context Because of the additional costs associated with improving diabetes management, there is interest in whether improved glycemic control leads to reductions in health care costs, and, if so, when such cost savings occur. Objective To determine whether sustained improvements in hemoglobin A1c (HbA1c) levels among diabetic patients are followed by reductions in health care utilization and costs. Design and Setting Historical cohort study conducted in 1992-1997 in a staff-model health maintenance organization (HMO) in western Washington State. Participants All diabetic patients aged 18 years or older who were continuously enrolled between January 1992 and March 1996 and had HbA1c measured at least once per year in 1992-1994 (n=4744). Patients whose HbA1c decreased 1% or more between 1992 and 1993 and sustained the decline through 1994 were considered to be improved (n=732). All others were classified as unimproved (n=4012). Main Outcome Measures Total health care costs, percentage hospitalized, and number of primary care and specialty visits among the improved vs unimproved cohorts in 1992-1997. Results Diabetic patients whose HbA1c measurements improved were similar demographically to those whose levels did not improve but had higher baseline HbA1c measurements (10.0% vs 7.7% ; P<. mean total health care costs were to less each year in the improved cohort for and>
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