The American Diabetes Association (ADA) recommends glycemic management goals for older diabetes patients take into account the complexity of complications. Little information is available on how cost-effectiveness (CE) of glycemic control goals relates to a patient’s level of complications. We examined the CE of intensive glycemic control (A1c <7.5%) compared to standard treatment (A1c <8.5%) among adults aged 65 y with type 2 diabetes having various complications. 2011-2016 National Health and Nutrition Examination Survey data were used to generate nationally representative samples with various complications. The CDC-RTI diabetes simulation model was used to project the long-term health and cost consequences of intensive/standard glycemic control. The CE of the intensive glycemic control was measured in costs (2017 USD) per quality adjusted life year (QALY). Based on a $50,000/QALY threshold, intensive glycemic control was only marginally cost effective for patients with no complications or any microvascular complication (excluding renal failure) but was not cost-effective for patients with one or more macrovascular complications. Current ADA standards recommend intensive glycemic control among older adults with fewer than 3 complications. From a CE perspective, our results only support the intervention among those with no complications or only microvascular complication.


H. Shao: None. D.B. Rolka: None. E.W. Gregg: None. P. Zhang: None.

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