For patients with type 2 diabetes, lowering blood sugar can be a difficult and expensive endeavor. But a recent study suggests that a 1% reduction in blood sugar sustained over several years leads to substantial cost savings.

The report found that adults who kept their hemoglobin A1 C stable:

• had fewer doctor visits

• were hospitalized less often

• were less likely to visit hospital emergency departments

This translated into a savings of $685 to $950 within 2 years.

"Improvements in glycemic control provide positive reinforcement for the patient's efforts in managing their illness, which may increase self-efficacy and reduce dependency on medical care for diabetes management," according to Dr. Edward H. Wagner, from the University of Washington in Seattle, and colleagues.

Patients with type 2 diabetes do not respond to insulin, the hormone that regulates blood sugar. High hemoglobin A1 C can lead to a number of serious medical complications including:

• heart disease

• kidney failure

• blindness

• amputations

The study of more than 4,700 diabetics aged 18 years and older found that those who sustained a 1% or more decrease in hemoglobin A1 C for more than a year, lowered their average annual healthcare costs. Costs rose for those whose hemoglobin A1 C did not improve, the report indicates.

Those who lowered their hemoglobin A1 C had higher rates of complications such as stroke, heart disease and foot ulcers at the outset, suggesting that their disease was more advanced. This might explain why those who managed to lower their hemoglobin A1 C had slightly higher rates of death after 3 years, the authors note.

The Journal of the American Medical Association 2001;285:182-189