gms | German Medical Science

Objectives: The prevalence of diabetes in Germany is steadily rising, with diabetes-related costs already exceeding 37 billion euros annually. Musculoskeletal complications account for a main proportion of these costs. Prediabetes, a precursor to diabetes, further increases the risk of musculoskeletal complications and associated costs. This study aimed to assess the cost difference between G-DRG reimbursement and real hospital costs for diabetic, prediabetic, and nondiabetic inpatients at a Level 1 Trauma Center, alongside their clinical outcomes.

Methods: All inpatients at the Level 1 Trauma Center were consecutively included in the study (Ethical vote: 454/2021BO2) in October and November 2021. Anamneses and HbA1C levels were used to identify pre-/diabetics. All patient-related data (department, length of hospital stay, complications, reimbursements (aG-DRG, nursing service reimbursements, total G-DRG), and real hospital costs) were extracted from the hospital management system. The mean values, standard deviation, and significance testing (analysis of variance (ANOVA) test) were performed using the GraphPad Prism software version 8.0.1.

Results and conclusion: Data from 1,186 patients were analyzed in this study. A total of 36.2% (N=429) were pre-diabetics and 17.3% (N=205) were diabetics. Every fourth diabetic patient was newly diagnosed due to increased HbA1C levels. Prediabetics (27%) and diabetics (42%) have higher complication rates than nondiabetics (25%). Prediabetics stayed on average 1.58 days (+ 26.8%) and diabetics 4.73 days (+ 80.2%) longer in the hospital than nondiabetics. The total G-DRG reimbursement could not compensate for the real hospital costs of prediabetics and diabetics – resulting in an underfunding of -42,389.41 euro, and -224,174.10 euro, respectively. This deficit could not be compensated by the nondiabetics as the number of prediabetics and diabetics was unexpectedly high.

In this consecutive study cohort more than half of inpatients at the Level 1 Trauma Center had prediabetes or diabetes. The unexpectedly high percentage of pre-/diabetics, supports the establishment of a routine HbA1C screening for all inpatients. Pre-/diabetics developed more complications, resulting in significantly longer hospital stays. Moreover, these groups were underfunded in the updated G-DRG system. The Level 1 Trauma Center, which treats around 9,500 inpatients a year, is running into a deficit of more than half a million euros a year due to these underfunded groups.