Medical costs and health care utilization in Dutch diabetes patients with high levels of diabetes-distress

Aims: Diabetes-distress is prevalent in persons with diabetes. However, studies on the association between diabetes-distress, costs and healthcare utilization are scarce. We aim to explore whether diabetes-distress is related to healthcare utilization and medical costs. Methods: In this cross-sectional study, diabetes patients completed the Problem Areas in Diabetes Short Form (PAID5) and the Patient Health Questionnaire (PHQ9). Healthcare utilization (in number of yearly visits) was measured using the Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness (TiC-P), and extraction from the hospital's medical records. Healthcare costs were calculated using Dutch standard costs. Generalized linear models (Gamma log link) were used to estimate the associations while adjusting for confounders. Results: Diabetes-distress was related to healthcare utilization, mean difference 10, 95 % CI 9 to 14, but not to healthcare costs, mean difference €467, 95 % CI -71 to 1006. When controlling for depressive symptoms, comorbidity, age, ethnicity, socioeconomic status and diabetes duration, diabetes-distress remained associated with healthcare utilization, mean difference 9, 95 % CI 2 to 16. Conclusions: This is the first study to evaluate associations between diabetes-distress and healthcare utilization and costs in diabetes patients. Diabetes-distress was significantly related to an increased amount of healthcare utilization, but not costs.