Physiologic insulin resensitization lowers cost in patients with diabetes and kidney disease.

Objective: To examine the effect of physiologic insulin resensitization (PIR) on the cost of treating patients with diabetes and chronic kidney disease (CKD).

Study design: The mean 1-year cost of treating 66 Medicare Advantage patients with diabetes and CKD who were receiving PIR was compared with that of treating 1301 Medicare Advantage patients with diabetes and CKD not receiving PIR. Differences in disease severity were compared using mean risk adjustment factor scores.

Methods: Cost comparisons were made for CKD stages 2, 3a, 3b, 4, and 5. The total cost of treating the PIR patients was then compared with the total costs of treating the same number of non-PIR patients to determine cost differences potentially incurred.

Results: The mean annual cost of treating PIR patients with stage 2 CKD was $11,251 vs $18,058 for the non-PIR group. For patients with stage 3a CKD, the mean PIR cost was $10,974 vs $18,563 for the non-PIR group. For patients with stage 3b CKD, the mean costs were $19,520 and $18,398, respectively. The mean costs for stages 4/5 CKD were $14,042 vs $22,124, respectively. The costs for an equal number of non-PIR patients at each stage were $345,830 higher than the actual costs of the PIR patients. There were no significant differences in the mean risk adjustment factor scores between the 2 groups.

Conclusions: PIR is a possible method of reducing the cost of treating patients with diabetes and CKD. Given the rapidly increasing numbers of patients with diabetes and CKD who are Medicare Advantage beneficiaries, PIR should be considered for use by managed care organizations.