Reducing the costs of diabetes in Europe: Preventing complications is the key

Brussels, Belgium, Tuesday 28 September 1999: The first pan-European study to evaluate the overall cost of individuals with type 2 diabetes reveals that urgent action is needed to reduce the devastating long-term complications of the disease, if costs are to be kept under control.

"We are facing a potential crisis," warned Professor Massimo Massi-Benedetti, President of the International Diabetes Federation, European region, "the key to improving the quality of life of people with type 2 diabetes and to reducing future costs is to address the long-term complications of the disease."

Initial results from the CODE-2* (Costs of Diabetes in Europe--Type 2) study were presented today at a press briefing at the annual meeting of the European Association for the Study of Diabetes (EASD) in Brussels:

• The total cost of more than 10 million individuals with type 2 diabetes in the countries studied was 29 billion Euros, which represents up to 7.4% or an average of 5% of the total healthcare expenditure in each country.
• The overall cost to the healthcare system of an individual with type 2 diabetes is on average over 1.5 times higher than the general population.
• Individuals with type 2 diabetes who have either small blood vessel complications, such as nerve damage or kidney problems, or large blood vessel complications, such as coronary heart disease, are twice as expensive to treat as individuals with no evidence of complications.
• The presence of both types of complications increases costs by 3.5 times.
• Hospitalisation costs, which include the treatment of long-term complications such as heart disease, account for 30-65% of the overall costs of patients with the disease--the largest proportion of costs.
• Oral anti-diabetes medicines, which are the first line of type 2 diabetes treatment with medication, account for a relatively lower proportion of overall costs--only 2.7% of the total costs.
• Other drugs, including insulin (needed in the later stages of the disease, after oral treatments have failed) as well as drugs to treat the long-term complications of the disease, account for 18%-39% of total costs. The remainder of the costs are for "ambulatory care", which includes visits to GPs, specialists and other healthcare practitioners, test procedures and accident and emergency care.

Type 2 diabetes represents approximately 90% of diabetes cases1 but, unlike type 1, or so-called "juvenile" diabetes, it develops later in life and starts with mild symptoms, which can sometimes go undetected. It is only in the later stages of the disease that individuals may need regular insulin injections. Satisfactory blood glucose control can sometimes be achieved using diet and exercise or traditional oral anti-diabetic medicines, such as sulfonylureas.

However, damage to the circulatory system still occurs, and many individuals with type 2 diabetes face progressive small blood vessel (microvascular) complications, including eye disease, kidney problems leading to dialysis, and nerve damage which can sometimes result in amputation. Large blood vessel (macrovascular) complications are even more common, and individuals with type 2 diabetes have more than double the risk of dying from conditions associated with cardiovascular disease, such as angina, heart attack and stroke. The CODE-2* results demonstrate the profound effect that these macrovascular complications have on healthcare costs.

New oral treatments, the thiazolidinediones (also known as glitazones), may hold the key to reducing these costs. The thiazolidinediones reduce insulin resistance--the failure of cells in the body to respond correctly to insulin. Insulin resistance is believed to be one of the fundamental defects in type 2 diabetes.

Notes to Editors

The CODE-2* study began in 1998. Since then, data has been collected for more than 7,000 patients in eight European countries, using patient and practitioner surveys. All survey data was captured on a sophisticated internet technology platform in an effort to ensure a high level of data quality and consistency. The study measures all direct medical costs of type 2 diabetes patients, as well as quality of life and lost productivity due to illness and early retirement.

The CODE-2* study investigated the costs associated with type 2 diabetes patients in eight European countries: Belgium, France, Germany, Italy, the Netherlands, Spain, Sweden and the UK.

CODE-2* is supported by an educational grant from SmithKline Beecham plc.

For further information about type 2 diabetes, insulin resistance, current therapies, the CODE-2* study methodology and more details about the results, please see the following fact sheets:

• Results of CODE-2* "in brief"
• "Background and methodology of CODE-2*"
• "Type 2 diabetes made simple"
• "Insulin resistance explained"
• "Current therapies for type 2 diabetes"

1. American Diabetes Association. Economic Consequences of Diabetes Mellitus in the U.S. in 1997. Diabetes Care 1998; 21:296-309.
2. Kobayashi M. Effects of Current Therapeutic Interventions on Insulin Resistance. Diabetes, Obesity and Metabolism 1999; 1: (Supplement 1):S32-S40.
3. Balkau B & Eschwège E. Insulin resistance: An Independent Risk Factor for Cardiovascular Disease. Diabetes, Obesity and Metabolism 1999; 1: (Supplement 1):S23-S31.
4. 4. Reasner CA. Promising New Approaches. Diabetes, Obesity and Metabolism 1999; 1: (Supplement 1):S41-S48.
5. Groop LC. Insulin resistance: The Fundamental Trigger of Type 2 Diabetes. Diabetes, Obesity and Metabolism 1999; 1: (Supplement 1):S1-S7.
6. Saltiel AR & Olefsky JM. Thiazolidinediones in the Treatment of Insulin Resistance and Type II Diabetes. Diabetes 1996; 45:1661-1669.

The data from the CODE-2* study are for general information only.