VIENNA – Urinary tract infections are relatively common and can be quite expensive among patients with newly diagnosed diabetes.
In a large patient database, the infection rate was about 128/1,000 patients, Shengsheng Yu, Ph.D., said at the annual meeting of the European Association for the Study of Diabetes. While only about 4% of these patients were hospitalized, their treatment costs hovered around $3,407 in Germany, where the study was conducted.
These data were extracted from a large German patient claims database, said Dr. Yu of Merck Sharp & Dohme, Whitehouse Station, N.J. The cohort comprised 530,918 patients who had type 2 diabetes during the study years of 2010-2012. Of these, 64,332 had incident disease.
Patients with newly diagnosed diabetes were significantly younger than was the diabetes-prevalent population (70 vs. 73 years), and had a significantly lower than the Charlson comorbidity index (5.4 vs. 7.3 years). Their diabetes was also less severe when measured by the adapted Diabetes Complication Severity Index (1.5 vs. 2.4).
During the study period, roughly 20% of patients had at least 1 urinary tract infection (UTI); 6% had two or more.
UTIs were twice as common in women. Prevalence also grew with advancing age in both sexes. Among those with newly diagnosed diabetes, women developed their UTI significantly more quickly than did men. By the end of the study, 20% of those women had developed one, compared with 10% of the men.
A multivariate analysis determined the risk factors associated with UTIs. These included having had a previous UTI (odds ratio, 3.5), female gender (OR, 1.7), higher Charlson comorbidity status (OR, 1.5), and age (OR, 1.4 for those older than 79 years).
Hemoglobin A1c levels were also a significant independent predictor of UTI, with an odds ratio of 1.5 for levels of 9.5%-10%, compared with 7%-7.5%.
In an analysis of the development of a first UTI after diagnosis, all of those predictive factors remained significant.
The investigators also examined costs associated with inpatient and outpatient treatment. Total costs included antibiotics and the cost of either ambulatory, outpatient, or in-hospital care.
The majority were treated by a physicians as an outpatient, with a median cost of 86 euros (US$111). About 46,500 received a prescription only, at a median cost of 22 euros (US$25). The smallest number (3,445) required hospitalization – a very expensive experience – with a mean cost of 2,627 euros (US$3,407).
During the discussion period, the issue of infection validation was a concern. Many physicians treat on symptoms only, or on a single urinalysis that might show a small amount of blood or protein. The number of culture-proven UTIs is much less, it was suggested.
Dr. Yu admitted that this is a common occurrence and could be affecting the validity of her conclusions somewhat.
She is an employee of Merck.
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