Abstract
Aims/hypothesis
‘The Cost of Diabetes in Europe-Type II (CODE-2) study’ provides the first coordinated attempt to assess the total costs of managing people with Type II (non-insulin-dependent) diabetes mellitus in Europe. Type II diabetes is associated with a number of serious long-term complications, which are a major cause of morbidity, hospitalisation and mortality in diabetic patients.
Methods
Patients were divided into four broad categories defining their complication status in terms of no complications, one or more microvascular complications, one or more macrovascular complications or one or more of each microvascular and macrovascular complication. The prevalence of complications and associated costs were assessed retrospectively for 6 months.
Results
In total, 72% of patients in the CODE-2 study had at least one complication, with 19% having microvascular only, 10% having macrovascular only and 24% of the total having both microvascular and macrovascular complications. Of patients with microvascular complications, 28% had neuropathy, 20% renal damage, 20% retinopathy and 6.5% required treatment for eye complications. Among the patients with macrovascular complications, 18% had peripheral vascular disease, 17% angina, 12% heart failure and 9% had myocardial infarction. Percutaneous transluminal coronary angioplasty, coronary artery bypass graft or stroke occurred in 3%, 4% and 5% of the patients, respectively. In patients with both microvascular and macrovascular complications, the total cost of management was increased by up to 250% compared to those without complications. Conclusion/interpretation. Complications have a substantial impact on the costs of managing Type II diabetes. This study has confirmed that the prevention of diabetic complications will not only benefit patients, but potentially reduce overall healthcare expenditure.
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Abbreviations
- CODE-2:
-
Cost of diabetes in Europe-Type 2
- ADA:
-
American Diabetes Association
- MI:
-
myocardial infarction
- HRQoL:
-
health related quality of life
- PVD:
-
peripheral vascular disease
- PTCA:
-
percutaneous transluminal coronary angioplasty
- CABG:
-
coronary artery bypass graft
- TIA:
-
transient iscaemic attack.
References
Reaven GM (1988) Banting lecture. Role of insulin resistance in human disease. Diabetes 37:1595–1607
Reaven GM, Hollenbeck CB, Chen Y-Di (1989) Relationship between glucose tolerance, insulin secretion and insulin action in non-obese individuals with varying degrees of glucose tolerance. Diabetologia 32:52–55
Cowie CC, Eberhardt MS (eds) (1996) Diabetes 1996: Vital Statistics. American Diabetes Association, Alexandria
American Diabetes Association (1997) Diabetes Facts and Figures. American Diabetes Association, Alexandria
Hanefeld M, Schmechel H, Schwanebeck U, Lindner J, The DIS Group (1997) Predictors of coronary heart disease and death in NIDDM: The diabetes Intervention Study Experience. Diabetologia 40:S123–S124
Lehto S, Ronnemaa T, Pyorala K, Laasko M (2000): Cardiovascular risk factors clustering with endogenous hy-perinsulinaemia predict death from coronary heart disease in patients with Type II diabetes. Diabetologia 43:148–155
Bruno G, Merletti F, Boffetta P et al. (1999) Impact of glycaemic control, hypertension and insulin treatment on general and cause-specific mortality: an Italian population-based cohort of Type II (non-insulin-dependent) diabetes mellitus. Diabetologia 42:297–301
Cunha-Vaz J (1998) Lowering the risk of visual impairment and blindness. Diabet Med 15:47–50
Ritz E (1999) Nephropathy in Type 2 diabetes. J Intern Med 245:111–126
Ward JD (1995b) The cost of diabetic foot problems. Pharmacoeconomics 8:55–57
Huse DM, Oster G, Killen AR, Lacey MJ, Colditz GA (1989) The economic costs of non-insulin-dependent diabetes mellitus. JAMA 262:2708–2713
Susman JL, Helseth LD (1997) Reducing the complications of type II diabetes: a patient-centered approach. Am Fam Physician 56:471–480
O’Brien JA, Shomphe LA, Kavanagh PL, Raggio G, Caro JJ (1998) Direct medical costs of complications resulting from Type 2 diabetes in the U.S. Diabetes Care 21:1122–1128
Brown JB, Pedula KL, Bakst AW (1999) The progressive cost of complications in Type 2 diabetes mellitus. Arch Intern Med 159:1873–1880
MacLeod KM, Tooke JE (1995) Direct and indirect costs of cardiovascular and cerebrovascular complications of Type II diabetes. Pharmacoeconomics 8:46–51
Smith TL, Melfi CA, Kesterson JA, Sandmann BJ, Kotsanos JG (1999) Direct medical charges associated with myocardial infarction in patients with and without diabetes. Med Care 37:AS4–AS11
Jönsson B (2000) Revealing the cost of Type II diabetes in Europe. Diabetologia Supplement (this issue)
Koopmanschap M (2000) Coping with Type II diabetes: the patient perspective. Diabetologia Supplement (this issue)
Javitt JC (1995) Cost savings associated with detection and treatment of diabetic eye disease. Pharmacoeconomics 8:33–39
Ward JD (1995a) The cost of diabetic neuropathy. Pharmaoeconomics 8:52–54
Borch-Johnsen K (1995) The costs of nephropathy in Type II diabetes. Pharmacoeconomics 8:40–45
Fuller JH, Elford J, Goldblatt P, Adelstein AM (1983) Diabetes mortality: new light on an underestimated public health problem. Diabetologia 24:336–341
Head J, Fuller JH (1990) International variations in mortality among diabetic patients: the WHO Multinational Study of Vascular Disease in Diabetics. Diabetologia 33:477–481
European Study Group (1999) A desktop guide to Type 2 diabetes mellitus. European Diabetes Policy Group 1999. Diabet Med 16:716–730
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The authors wrote on behalf of the CODE-2 advisory board
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Williams, R., Van Gaal, L. & Lucioni, C. Assessing the impact of complications on the costs of Type II diabetes. Diabetologia 45 (Suppl 1), S13–S17 (2002). https://doi.org/10.1007/s00125-002-0859-9
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DOI: https://doi.org/10.1007/s00125-002-0859-9