Fractures are more costly in people with type 1 diabetes
New research from the University of Southern Denmark shows that healthcare costs are higher for people with fractures if they have type 1 diabetes. Greater focus on prevention could help bring these costs down.
It is well established that people with type 1 diabetes are at higher risk of complications when they experience a bone fracture. This is partly due to changes in bone structure, but also because diabetes-related complications – such as nerve damage in the feet – increase the risk of falling.
What has not been studied until now, however, is whether fractures also lead to higher healthcare costs for people with type 1 diabetes. This question has now been investigated by a research team from the University of Southern Denmark, in collaboration with researchers from Steno Diabetes Center North Denmark and ETH Zurich.
Type 1 diabetes
Type 1 diabetes is a chronic, lifelong condition that cannot be cured or prevented. It is an autoimmune disease, meaning the immune system mistakenly attacks the body’s own cells – in this case, the cells that produce insulin.
The exact cause of the disease is unknown. People with type 1 diabetes need to take insulin for the rest of their lives to regulate their blood sugar.
If left untreated, the condition can lead to serious complications such as blindness, kidney failure and nerve damage.
Source: Diabetesforeningen
The researchers matched a group of individuals with type 1 diabetes to a comparable group without diabetes. This made it possible to directly compare healthcare costs between the two groups following a bone fracture.
– We found that costs are generally higher for people with type 1 diabetes when they sustain a fracture. This was the case for all fracture types except hip fractures, says Troels Kristensen, Associate Professor in Health Economics and Policy at DaCHE – Danish Centre for Health Economics, University of Southern Denmark.
– It was somewhat surprising that we saw no cost difference for hip fractures, which are usually the most expensive type.
Even so, people with type 1 diabetes are still five times more likely to suffer a hip fracture and have a higher mortality rate.
A stronger focus on prevention
Although total healthcare costs for hip fractures are similar regardless of diabetes status, all other types of fractures are more costly in people with type 1 diabetes. This is partly due to higher medication use and longer hospital stays.
Placing more emphasis on prevention may help address the issue.
– We need to put greater focus on preventing fractures in people with type 1 diabetes – for example, by making it a standard topic during their annual check-ups. This could help reduce both the health risks and the financial burden, says Annika Vestergaard Kvist. The study formed part of her PhD at the University of Southern Denmark.
About the study
- The researchers drew on data from the Danish National Patient Register to identify patients who had sustained a fracture in the hip, upper arm, forearm, foot or ankle.
- In total, 4,158 people with type 1 diabetes were matched in a 1:4 ratio with individuals without diabetes. The study compared direct healthcare costs during the first year after the fracture between the two groups.
- Fracture types: Hip, upper arm, forearm, foot, and ankle.
Read the study
“Direct healthcare cost of fractures in patients with type 1 diabetes: a population-based cohort study in Denmark” is published in The Journal of Clinical Endocrinology & Metabolism (JCEM). Read the study:
Meet the researcher
Troels Kristensen is associate professor in Health Economics and Politics at DaCHE – Danish Centre for Health Economics, Department of Public Health
Meet the researcher
Annika Vestergaard Kvist is first author of the study. The research was part of her PhD at the University of Southern Denmark. She is now a postdoc and data scientist at Steno Diabetes Center North Denmark, Aalborg University Hospital.