Relationship of hemoglobin A(1c), age of diabetes diagnosis, and ethnicity to clinical outcomes and medical costs in a computer-simulated cohort of persons with type 2 diabetes

Objective: To project the impact of maintaining long-term glycemic control (ie, a sustained reduction in glycosylated hemoglobin (hemoglobin A(1c) [HbA(1c)]) on the lifetime incidence and direct medical costs of complications in persons with type 2 diabetes. Study design, patients, and methods: Computer simulation of hypothetical patient cohorts using a published model developed by the National Institutes of Health. Results: Across all HbA(1c) levels, Hispanics had the highest and whites had the lowest complication rates. With lower maintained HbA(1c), the absolute decrease in complication rates was greatest and the reduction in direct medical expenditures was highest among Hispanics (18% vs 15% for blacks and 12% for whites). Complication rates and costs were most dramatically reduced when lower levels of HbA(1c) were maintained among persons with a younger age at diagnosis. Conclusions: Maintaining long-term glycemic control reduces complication rates and costs for medical care for all ethnic groups regardless of age at diagnosis. Relatively greater benefit is achieved by interventions targeting Hispanics and younger, newly diagnosed persons.