Summary

Over the period of 1994 to 2007, there has been a shift in the way diabetes is treated. People are more likely to receive combination therapy. And newer, more costly, drugs like the glitazones are being prescribed more often. This increased investment is, of course, justifiable if it can be shown that the long-term clinical outcome for the diabetic has improved.

Introduction

In the year 2000, more than 11 million Americans had diabetes, which is a 4-8 fold increase over the rates in the 1959s. By the year 2050, it is likely that the number of Americans with diabetes will have gone up to 29 million. In 2002, more than one tenth of the US healthcare budget went to diabetes, mostly for treatment of complications. Therefore, glycemic control - which reduces complications - is essential and this is done through a combination of lifestyle measures and medication. New drugs have come onto the market in recent years and these are being taken up, making treatment more complex and more costly.

What was done

Researchers at the University of Chicago and elsewhere charted changes in the management of diabetes in the US between 1994 and 2007. They used the National Disease and Therapeutic Index to analyse the medications prescribed in this time in doctor's office visits for diabetic patients aged 35 and over. They also used the National Prescription Audit to assess medication costs between 2001 and 2007.

What was found

The analysis found that the number of patient visits to treat diabetes between 1994 and 2007 rose from 25 million to 36 million, reflecting the increase in the number of cases. The average number of medications increased to 1.14 to 1.63 per patient treated, The number of visits where only one medication was prescribed decreased from 82 percent to 47 percent - so patients are increasingly likely to be taking more than one drug.

The trend in insulin use was a decrease from 38 percent in 1994 to a low point of 25 percent in 2000 and then an increase to 28 percent. Newer drugs like the glitazones have had an impact. The use of the older sulfonylurea drugs decreased from 67 percent to 34 percent of treatment visits. By 2007, the biguanides and glitazones were prescribed in 54 percent and 28 percent of treatment visits. This has led to increases in costs, from 6.7 billion US dollars in 2001 to 12.5 billion US dollars in 2007.

What this study means

The changes in treatment of diabetes have been significant over the last several years. What is now needed is evidence that the new, and more costly, drugs are more effective in terms of patient outcomes. If complications can be prevented, then naturally the increased cost would be justified.