Factors Influencing Intention to Receive Examination of Diabetes Complications

Yi-Lin Hsieh,Fang-Hsin Lee,Chien-Liang Chen,Ming-Fong Chang,Pei-Hsuan Han 한국간호과학회 2016 Asian Nursing Research Vol.10 No.4

Purpose: The purpose of this study was to understand the situation of diabetes patients receiving examinations for diabetes complications and to explore the factors influencing their intention to receive examinations for diabetes complications. Methods: A cross-sectional study was performed that included 251 diabetes patients who visited outpatient clinics in Southern Taiwan. A survey using a self-administered questionnaire was conducted from October 2015 to January 2016. The questionnaire included items on demographic characteristics, perceived susceptibility to diabetes complications, perceived seriousness of diabetes complications, perceived benefits of taking action to receive diabetes complication examinations, perceived barriers to taking action to receive diabetes complication examinations, and the intention to receive diabetes complication examinations. The data were analyzed using regression analysis. Results: The percentage of participants who received fundus, foot, and kidney examinations was 67.7%, 61.4%, and 73.3%, respectively. Every point increase on the perceived barriers to taking action to receive diabetes complication examinations scale increased the intention to receive a foot examination in the following year by 0.91 times (p = .002), and every point increase on the perceived susceptibility to diabetes complications scale increased the intention to receive a kidney examination in the following year by 1.19 times (p = .045). Conclusions: Nurses should shoulder the responsibility to increase patients' intention to receive examination of diabetes complications. The results of this study can be used to promote nurses' care efficacy in preventing diabetes complications. They can also provide medical institutions with information to establish prevention and control policies for diabetes complications.

한국인 제2형 당뇨병환자에서 조기 대혈관 합병증 발생과 관련된 위험 인자

이해리 ( Hae Ri Lee ),유재명 ( Jae Myung Yu ),최문기 ( Moon Gi Choi ),유형준 ( Hyung Joon Yoo ),홍은경 ( Eun Gyoung Hong ) 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.2

배경: 대혈관 합병증은 당뇨병환자의 주요 사망 원인으로 미세혈관 합병증과는 달리 유병기간과 비례하지 않는다. 그러나 한국인에서 당뇨병성 대혈관 합병증 발생까지의 당뇨병의 평균 유병기간이나 합병증 발생과 관련된 예측 인자들에 대한 연구는 아직 많이 부족한 실정이다. 따라서 저자들은 제2형 당뇨병에서 대혈관 합병증 발생까지의 평균 유병기간과 대혈관 합병증 발생에 영향을 미치는 요인들, 특히 조기합병증 발생에 관여하는 위험요소들을 조사하고자 하였다. 방법: 대혈관 합병증이 처음 발생하여 입원한 121명의 환자와 대혈관 합병증의 과거력이 없는 115명의 제2형 당뇨병 입원환자를 대상으로 하여 임상적 특성을 후향적으로 조사, 분석하였다. 대혈관 합병증 발생까지의 당뇨병 이환 기간을 5년을 기준으로 조기발생군(54명)과 후기발생군(67명)으로 나누어 비교 분석하였다. 또한 대혈관 합병증 발생군을 성별에 따라 나누어 추가 분석을 시행하였다. 결과: 대혈관 합병증 발생까지의 평균 당뇨병 유병기간은 8.7±7.8년, 평균 연령은 61세, 남녀 각 63명, 58명이었다. 대혈관 합병증 발생군과 대조군과의 비교에서 평균 나이(61.0±11.8 vs. 56.0±14.6세, P=0.004), 수축기와 이완기 혈압 모두 대혈관 합병증 발생군에서 높았고(133.6±20.7/79.8±12.3 vs. 121.8±17.7/76.3±9.6 mm Hg, P<0.05), 흡연력이 있는 환자의 비율이 높았다(42.1 vs. 20.0%, P<0.001). 그러나 당화혈색소는 대조군에서 대혈관 합병증 발생군에 비해 더 높았고(9.5±2.4 vs. 8.2±1.8%, P<0.001), 미세혈관 합병증 동반율도 유의하게 더 높았다. 대혈관 합병증 조기발생군의 평균 연령이 후기발생군보다 더 적었으며(58.2±12.8 vs. 63.4±10.4세, P=0.015), 흡연력은 더 많았다(53.7 vs. 32.8%, P=0.021). 대혈관 합병증 발생군에서 성별에 따른 분석 결과, 남성에서 여성보다 합병증 발생 연령이 보다 적었고(57.5±10.3 vs. 64.9±12.2세, P<0.001), 당뇨병의 가족력이 남성에서 더 많았으며 흡연력은 남성에서 77.8%로 여성의 3.4%에 비해 매우 높았다. 결론: 본 연구를 통하여 제2형 당뇨병에서 대혈관 합병증발생에 고령, 고혈압, 그리고 흡연력이 중요한 위험 인자임을 알 수 있었고 대혈관 합병증 위험도는 미세혈관 합병증 발생 이전부터 높아져 있었다. 특히 흡연력은 한국인 남성 제2형 당뇨병환자에서 대혈관 합병증 조기 발생에 관여하는 중요한 예측 인자로 생각된다. 또한 추가 분석 결과를 미루어볼 때, 같은 당뇨병의 유병기간을 가졌다 하더라도 60세 미만의 상대적으로 젊은 나이의 당뇨병환자들이 고령의 환자들보다 대혈관 합병증 조기 발생 위험도가 상대적으로 높은 것으로 여겨지며, 대혈관 합병증 발생과 관련하여 성별에 따라 연령, 당뇨병의 가족력, 고혈압, 흡연력과 같은 몇 가지 위험 요소들의 차이점이 발견되었다. 이러한 결과들은 제2형 당뇨병환자에서 대혈관 합병증 발생 예방에 효과적으로 이용될 수 있을 것으로 생각된다. Background: The average duration of diabetes and predictive factors of macrovascular complications in Korean diabetic patients remain to be elucidated. This study examines the average duration of diabetes up to the onset of macrovascular complications and clinically important factors of early development of these complications in Korean type 2 diabetic patients. Methods: Clinical characteristics in type 2 diabetics with (n=121) and without macrovascular complications (n=115) were analyzed. In addition, early onset (≤5 years, n=54) and late onset groups (>5 years, n= 67) were compared, as were the clinical characteristics between male and female patients in the macrovascular complications group. Results: The average duration of diabetes was 8.7±7.8 years in the macrovascular complications group. Average age, systolic and diastolic blood pressures and smoking history were all higher in the macrovascular complications group than the control group. However, HbA1c levels and prevalence of microvascular complications were higher in the controls. Average age was lower in the early onset group and many more patients of that group had a smoking history. In the analysis based on sex, marcrovascular complications developed earlier in male patients. In addition, the prevalence of family history of diabetes was higher in males and 77.8% of male patients had a smoking history (female: 3.4%). Conclusion: Our study confirms that older age, high blood pressure and smoking history are major risk factors for the development of macrovascular complications. Moreover, a smoking history in males can be both risk and predictive factors for earlier development of macrovascular complications in Korean type 2 diabetic patients. We also found that several clinical characteristics including age, family history of diabetes, hypertension and smoking history, vary between the sexes, and these findings can provide useful indices for the prevention of macrovascular complications. (Korean Diabetes J 33:134-142, 2009)

당뇨병환자의 만성합병증 예방행위실천에 영향을 미치는 요인

김순구 대한당뇨병학회 2008 Diabetes and Metabolism Journal Vol.32 No.1

Background: The prevalence of diabetes is steadily increasing in Korea. The increase of people with diabetes will ultimately result in taking a turn for the worse, not only affecting the health of the people, but there will be an increase of social finances. This study was aimed at investigating the factors influencing adherence to preventive behavior on chronic complications of Diabetes Mellitus. Methods: Data was collected by questionnaires from 332 diabetic patients who were visited out-patient clinics, with 323 finally selected for the study. The data was analyzed by the SPSS program. Results: The level of knowledge on chronic complications of Diabetes Mellitus was 18.02 points space(maximum 24 points). The level of hardiness was 119.80 points(maximum 240 points). The level of adherence to preventive behavior on chronic complications of Diabetes Mellitus was 49.11 points(maximum 75 points). The score of knowledge and hardiness showed a significant correlation with adherence to preventive behavior on chronic complications of Diabetes Mellitus. The significant predictors influencing adherence to preventive behavior were treatment, knowledge of Diabetes Mellitus, and hardiness. Conclusion: This study suggests that treatment, knowledge, and hardiness are significant influencing factors on adherence to preventive behavior on chronic complications of Diabetes Mellitus. The results of this study will contribute to developing a program for people with diabetes. (J Kor Diabetes Assoc 32:77~82, 2008)

Associations between diabetes self-management and microvascular complications in patients with type 2 diabetes

Fatemeh Mehravar,Mohammad Ali Mansournia,Kourosh Holakouie-Naieni,Ensie Nasli-Esfahani,Nasrin Mansournia,Amir Almasi-Hashiani 한국역학회 2016 Epidemiology and Health Vol.38 No.-

OBJECTIVES: Diabetes is a major public health problem that is approaching epidemic proportions globally. Diabetes self-management can reduce complications and mortality in type 2 diabetic patients. The purpose of this study was to examine associations between diabetes self-management and microvascular complications in patients with type 2 diabetes. METHODS: In this cross-sectional study, 562 Iranian patients older than 30 years of age with type 2 diabetes who received treatment at the Diabetes Research Center of the Endocrinology and Metabolism Research Institute of the Tehran University of Medical Sciences were identified. The participants were enrolled and completed questionnaires between January and April 2014. Patients’ diabetes self-management was assessed as an independent variable by using the Diabetes Self-Management Questionnaire translated into Persian. The outcomes were the microvascular complications of diabetes (retinopathy, nephropathy, and neuropathy), identified from the clinical records of each patient. A multiple logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between diabetes self-management and the microvascular complications of type 2 diabetes, adjusting for potential confounders. RESULTS: After adjusting for potential confounders, a significant association was found between the diabetes self-management sum scale and neuropathy (adjusted OR, 0.64; 95% CI, 0.45 to 0.92, p=0.01). Additionally, weak evidence was found of an association between the sum scale score of diabetes self-management and nephropathy (adjusted OR, 0.71; 95% CI, 0.47 to 1.05, p=0.09). CONCLUSIONS: Among patients with type 2 diabetes, a lower diabetes self-management score was associated with higher rates of nephropathy and neuropathy.

Associations Between the Continuity of Ambulatory Care of Adult Diabetes Patients in Korea and the Incidence of Macrovascular Complications

Young-Hoon Gong,윤석준,김동우 대한예방의학회 2015 Journal of Preventive Medicine and Public Health Vol.48 No.4

Objectives: The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea. Methods: This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited. Results: Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance. Conclusions: Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.

1형 당뇨병 환자에서 미세혈관 합병증의 발생 빈도와 위험 인자

권아름,이슬,채현욱,김덕희,김호성 대한소아내분비학회 2012 Annals of Pediatirc Endocrinology & Metabolism Vol.17 No.1

Purpose: We observed the frequencies of microvascular complications and their related factors in patients with type 1 diabetes. Methods: Two hundred seventy one patients (111 males and 160 females, mean age 21.9 ± 5.8 years) with type 1 diabetes were included. Subjects were all at least 10 years old and had diabetes for at least two years. Three types of microvascular complications (diabetic nephropathy, retinopathy, and neuropathy) were evaluated, and their frequencies and risk factors were analyzed. Results: The overall prevalence of microvascular disease was 83/271 (30.6%). Microalbuminuria had developed in 39 patients (14.4%), persistent microalbuminuria in 31patients (11.4%), and proteinuria in 12 (4.4%). Diabetic retinopathy had developed in 35patients (12.9%) and neuropathy in 39 patients (13.7%). The mean HbA1c for 10 years was significantly higher in the patients with microvascular complications (10.5 ± 2.8%vs. 8.4 ± 1.4%). The rate of intensive management in the non-complication group was higher than in the microvascular complication group. The incidence of microalbuminuria was greater in males than females, but there were no gender differences in either diabetic retinopathy or neuropathy. Puberty and the duration of diabetes may be associated with microvascular complications. Conclusion: The incidence of microvascular complications in type 1 diabetes is declining. Sex, puberty, and the duration of diabetes as well as prolonged hyperglycemia are all related to microvascular complications. Therefore, intensive insulin management and regular screening for microvascular complications should be performed in patients who have either entered into puberty or have had diabetes for more than 5 years. 목적: 본 연구에서는 1형 당뇨병 환자를 대상으로 미세혈관 합병증의 발생 빈도와 이와 관련된 인자들을 알아보고자한다. 방법: 연세대학교 세브란스 병원에서 1형 당뇨병으로 진단받는 환자들 중, 만 10세가 넘고 당뇨병 유병기간이 적어도2년이 넘는, 총 271명의 1형 당뇨병 환자(남자 111명, 여자 160명, 평균 나이 21.9±5.8세)를 대상으로 당뇨병성 신증, 망막병증, 신경병증의 세가지 미세혈관 합병증을 조사하고, 이와 관련된 인자들을 분석하였다. 결과: 미세혈관 합병증은 전체 271명 중 83명(30.6%)에서 발생하였다. 미세알부민뇨는 39명(14.4%)에서, 지속성 미세알부민뇨는 31명(11.4%)에서 발생하였으며, 단백뇨는 12명(4.4%)에서 발생하였다. 또한, 당뇨병성 망막병증은 35명(12.9%)의 환자에서, 신경병증은 39명(13.7%)의 환자에서 발생하였다. 10년 동안의 평균 당화혈색소는 미세혈관합병증이 있는 군에서 합병증이 없는 군 보다 더 높았다(10.5±2.8% vs. 8.4±1.4%). 또한 인슐린 치료법 중 적극적치료법의 비율은 미세혈관 합병증이 없는 군에서 미세혈관 합병증이 있는 군보다 더 높았다. 미세알부민뇨는 여자보다남자에서 더 많이 발생하였으나, 당뇨병성 망막병증이나 신경병증에서는 성별의 차이를 보이지 않았다. 또한, 사춘기및 당뇨병의 유병기간도 미세혈관 합병증의 위험인자로 생각된다. 결론: 1형 당뇨병 환자에서 미세혈관 합병증의 발생률은 점차적으로 낮아지고 있다. 하지만, 지속적인 고혈당뿐만 아니라 성별, 사춘기, 당뇨병의 유병기간도 미세혈관 합병증 발생과 연관된 위험인자이기 때문에, 적극적 인슐린 치료법을 통해 철저히 혈당을 관리하고, 사춘기 연령이거나 당뇨병의 유병기간이 5년이 넘는 환자에서는 미세혈관 합병증에대한 정기적인 선별검사가 필요하다.

개인의 사회경제적 수준과 지역의 사회경제적 수준의 상호작용이 제2형 당뇨 환자에서 당뇨합병증 발생 및 당뇨와 관련된 입원에 미치는 영향: 2002-2013년 국민건강보험공단 표본 코호트 자료를 활용하여

장지은 ( Jieun Jang ),주영준 ( Yeong Jun Ju ),이두웅 ( Doo Woong Lee ),이상아 ( Sang Ah Lee ),오소연 ( Sarah Soyeon Oh ),최동우 ( Dong-woo Choi ),이현지 ( Hyeon Ji Lee ),신재용 ( Jaeyong Shin ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.1

Background: In this study, we aimed to investigate the interaction effects of individual socioeconomic status and regional deprivation on the onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients. Methods: Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 50,954 patients newly diagnosed with type 2 diabetes from 2004 to 2012 and aged 30 years or above were included. We classified patients into six groups according to individual income level and neighborhood deprivation: ‘high in advantaged,’ ‘high in disadvantaged,’ ‘middle in advantaged,’ ‘middle in disadvantaged,’ ‘low in advantaged,’ and ‘low in disadvantaged.’ We calculated hazard ratios (HR) of onset of diabetes complication and diabetes-related hospitalization using the Cox proportional hazard model, with the reference group as diabetes patients with high income in advantaged regions. Results: In terms of the interaction effects of individual income level and regional socioeconomic level, even with the same low individual income level, the group with a high regional socioeconomic level (low in advantaged) showed low HRs for the onset of diabetes complication (HR, 1.04; 95% confidence interval [CI], 1.00-1.08) compared to the ‘low in disadvantaged’ group (HR, 1.10; 95% CI, 1.05-1.16). In addition, the ‘high in advantaged’ group showed slightly higher HRs for the onset of diabetes complication (HR, 1.06; 95% CI, 1.00-1.11) compared to the ‘low in advantaged’ and it appeared to be associated with slight mitigation of the risk of diabetes complication. For the low-income level, the patients in disadvantaged regions showed the highest HRs for diabetes-related hospitalization (HR, 1.29; 95% CI, 1.19-1.41) compared to the other groups. Conclusion: Although we need to perform further investigations to reveal the mechanisms that led to our results, interaction effects individual socioeconomic status and regional deprivation might be associated with on onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.

Associations Between the Continuity of Ambulatory Care of Adult Diabetes Patients in Korea and the Incidence of Macrovascular Complications

Gong, Young-Hoon,Yoon, Seok-Jun,Seo, Hyeyoung,Kim, Dongwoo The Korean Society for Preventive Medicine 2015 Journal of Preventive Medicine and Public Health Vol.48 No.4

Objectives: The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea. Methods: This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited. Results: Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance. Conclusions: Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.

현성당뇨병와 임신당뇨병의 모성 및 주산기 합병증의 비교 연구

김상훈 ( Sang Hun Kim ),김평식 ( Pyeong Sik Kim ),육진성 ( Jin Sung Yuk ),오선옥 ( Sun Ok Oh ),박철홍 ( Chul Hong Park ),홍서유 ( Seo Yoo Hong ),이진용 ( Jin Yong Lee ),신정환 ( Jung Hwan Shin ),서용수 ( Yong Soo Seo ) 대한주산의학회 2004 Perinatology Vol.15 No.3

목적 : 현성당뇨병 산모와 임신당뇨병 산모의 모성 합병증과 신생아 합병증을 평가하고 비교하고자 하였다. 방법 : 2001년 1월부터 2002년 12월까지 을지병원 산부인과에서 당뇨가 합병된 65명 산모의 임상기록을 토대로 후향적 조사 분석 하였다. 결과 : 모성 합병증의 경우 현성당뇨병 산모에서는 자간전증 15.4%, 조기산통 15.4%,가 발생하였으며, 임신당뇨병 산모에서는 자간전증 9.6%, 조기산통 3.8%, 회음부 4도열상 1.9%, 태반조기박리 1.9%, 심근병증 1.9%, 양수과다증 1.9%가 발생하였다. 신생아 합병증은 현성당뇨병 산모에서 저혈당증 38.5%, 신생아 호흡 곤란증 15.4%가 발생하였고 임신당뇨병 산모에서는 저혈당증 25%, 고빌리루빈혈증 9.6%, 견갑난산 1.9%가 발생하였다. 치료를 받은 경우 모성합병증과 신생아 합병증은 두 군에서 통계적으로 유의한 차이가 없었다. 임신당뇨병 산모군에서는 치료를 받지 않은 군이 치료를 받은 군에 비해 모성 합병증 및 신생아 합병증이 유의하게 높게 발생하였다. 결론 : 현성당뇨병과 임신당뇨병 산모에서 조기 발견과 치료가 이루어진다면 모성 및 신생아 합병증의 발생은 별다른 차이가 없었다. 따라서 당뇨가 합병된 임신에서는 조기발견과 치료가 중요하다. Objectives : The purpose of this study is to evaluate and compare the maternal and neonatal complications of the overt diabetes with that of gestational diabetes. Method : The medical records of 65 pregnant patients complicated by diabetes mellitus at Eulji medical center from January, 2001 to December, 2002 were reviewed retrospectively. Thirteen patients of them were diagnosed as a overt diabetes and the others were diagnosed as a gestational diabetes. Results : Maternal complications were that preeclampsia in 15.4% and preterm labor in 15.4% in overt diabetes patients and preeclampsia in 9.6%, fourth degree laceration in 1.9%, preterm labor in 3.8%, placenta abruption in 1.9%, cardiomyopathy in 1.9% and polyhydroamnios in 1.9% in gestational diabetes patients. Neonatal complications were that hypoglycemia in 38.5% and respiratory distress syndrome in 15.4% in overt diabetes patients and hypoglycemia in 25%, hyperbilirubinemia in 9.6% and shoulder dystocia in 1.9% in gestational diabetes patients. There were no statistic differences in maternal and neonatal complications in two groups when management had done. And in gestational diabetes group, maternal and neonatal complications were significantly higher in no management group than management group regardless of management types. Conclusion : If early detection and management were done in overt and gestational diabetes, there were no difference in maternal and neonatal complications. Regardless of types of diabetes, early detection and management were important.

Direct Medical Costs for Patients with Type 2 Diabetes and Related Complications: A Prospective Cohort Study Based on the Korean National Diabetes Program

Kim, Tae Ho,Chun, Ki Hong,Kim, Hae Jin,Han, Seung Jin,Kim, Dae Jung,Kwak, Jiyeong,Kim, Young Seol,Woo, Jeong Taek,Park, Yongsoo,Nam, Moonsuk,Baik, Sei Hyun,Ahn, Kyu Jeung,Lee, Kwan Woo The Korean Academy of Medical Sciences 2012 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.27 No.8

<P>We analyzed the direct medical costs for Korean patients with type 2 diabetes according to the type of complications and the number of microvascular complications. We analyzed costs for type 2 diabetes and associated complications in 3,125 patients. These data were obtained from the Korean National Diabetes Program (KNDP), a large, ongoing, prospective cohort study that began in 2005. The cost data were prospectively collected, using an electronic database, for the KNDP cohort at six hospitals. The costs were analyzed according to complications for 1 yr from enrollment in the study. Among 3,125 patients, 918 patients had no vascular complications; 1,883 had microvascular complications only; 51 had macrovascular complications only; and 273 had both complications. The annual direct medical costs for a patient with only macrovascular, only microvascular, or both macrovascular and microvascular complications were 2.7, 1.5, and 2.0 times higher than the medical costs of patients without complications. Annual direct medical costs per patient increased with the number of microvascular complications in patients without macrovascular complications. The economic costs for type 2 diabetes are attributable largely to the management of microvascular and macrovascular complications. Proper management of diabetes and prevention of related complications are important for reducing medical costs.</P>