One-Hour Postload Plasma Glucose in Middle Age and Medicare Expenditures in Older Age Among Nondiabetic Men and Women: The Chicago Heart Association Detection Project in Industry

• Published in: Diabetes care Vol. 28; no. 5; pp. 1057 - 1062
• Main Authors: Liu, Kiang, Dyer, Alan R, Vu, Thanh-Huyen, Pirzada, Amber, Manheim, Larry M, Manning, Willard G, Ashraf, Muhammad S, Garside, Daniel B, Daviglus, Martha L
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.05.2005
• Subjects: Adult; adulthood; Aged; Aged, 80 and over; Biological and medical sciences; Blood Glucose; blood serum; body mass index; Cardiovascular disease; Care and treatment; Cerebrovascular Disorders - economics; Cerebrovascular Disorders - epidemiology; Chicago - epidemiology; cholesterol; coronary disease; Cost Savings; Databases, Factual; Diabetes; Diabetes Mellitus; Diabetes. Impaired glucose tolerance; education; electrocardiography; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Evaluation; Female; Glucose; Glycemic index; health care costs; Health care expenditures; Health Expenditures - statistics & numerical data; heart; Humans; Hyperglycemia - economics; Hyperglycemia - epidemiology; industry; Male; Medical care, Cost of; Medical sciences; Medicare; Medicare - economics; men; Middle age; Middle Aged; nationalities and ethnic groups; Older people; Postprandial Period; smoking (habit); systolic blood pressure; women; Chicago; United States; Human; Health insurance; Middle age; Health economy; Expenditure; Cardiovascular disease; Glucose tolerance test; Circulatory system; Glucose; Glycemia; Public health
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.28.5.1057

OBJECTIVE:--To examine associations in nondiabetic individuals of 1-h postload plasma glucose measured in young adulthood and middle age with subsequent Medicare expenditures for cardiovascular disease (CVD), diabetes, cancer, and all health care at age 65 years or older using data from the Chicago Heart Association Detection Project in Industry (CHA). RESEARCH DESIGN AND METHODS--Medicare data (1984-2000) were linked with CHA baseline records (1967-1973) for 8,580 men and 6,723 women ages 33-64 years who were free of coronary heart disease, diabetes, and major electrocardiogram (ECG) abnormalities and who were Medicare eligible (65+ years) for at least 2 years. Participants were classified based on 1-h postload plasma glucose levels <120, 120-199, or [>/=]200 mg/dl. RESULTS:--With adjustment for baseline age, cigarette smoking, serum cholesterol, systolic blood pressure, BMI, ethnicity, education, and minor ECG abnormalities, the average annual and cumulative Medicare, total, and diabetes- and CVD-related charges were significantly higher with higher baseline plasma glucose in women, while only diabetes-related charges were significantly higher in men. For example, in women, multivariate-adjusted CVD-related cumulative charges were, respectively, $14,260, $18,909, and $21,183 for the three postload plasma glucose categories (P value for trend = 0.035). CONCLUSIONS:--These findings suggest that maintaining low glucose levels early in life has the potential to reduce health care costs in older age.