Type 2 diabetes treatment: How cost effective is intensified multifactorial treatment?

Diabetes
type 2 diabetes treatment

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Researchers conducted a cost-analysis of intensified multifactorial treatment compared to conventional type 2 diabetes treatment.

Patients with type 2 diabetes have higher chances of undergoing damage to the eyes, kidneys, nerves, legs, and brain. All these complications are life-threatening and fatal, which eventually affects the mortality rate in diabetic patients. However, most of these complications can be prevented by careful screening and use of multifactorial therapies for type 2 diabetes treatment.

In 1993, a team of researchers started the Steno-2 Study to find out whether a targeted, multifactorial treatment has an impact on the mortality rate of type 2 diabetes from any cause. This study included 160 Danish patients with type 2 diabetes and an average age of 55 years. They randomly divided the patients into two groups: one group of 80 patients received the conventional multifactorial treatment, based on the recommendations given by the Danish Medical Association, and the second group of 80 patients received the intensified multifactorial treatment.

The intensified multifactorial treatment group received treatment for all adjustable risk factors like blood glucose, blood pressure, total cholesterol, triglycerides. The target levels for these were lower than those for the conventional treatment group. The treatment keenly focused on the use of multiple medicines to act on various disease pathways as well as improved health through nutrition, exercise, and cessation of smoking. The findings of this study were published in a press release by the American Diabetes Association’s convention in June 2018.

They followed-up on the patients over 21 years. The intensified treatment group showed almost a 50% reduction in diabetes-related damage to the heart, brain, and legs after receiving treatment for 7.8 years, as compared to the conventional treatment group. All the 160 patients were then followed-up observationally for an average period of 5.5 years, where all the participants received the intensified treatment.

At 13.3 years of follow-up, the group that was originally assigned the intensified treatment showed a 50% reduction in mortality and at 21.2 years, they showed 7.9 years of increased lifespan. This increased lifespan was matched by the amount of time these patients spent without any heart disease incidents.

Researchers also found that there was no difference in the direct medical costs between the intensified treatment group and the conventional treatment group over a follow-up period of 21.2 years. However, they do note that while the intensified, multifactorial treatment may lead to an initial increase in costs, the investment in this type 2 diabetes treatment is worth the health benefits and increased longevity for the patients.

In the press release published by the American Diabetes Association, lead author Joachim Gaede said, “investing in early-intensified intervention…will pay for itself over time due to a reduced cost of complications incurred by patients.” The total costs in the intensified group were 13$ million, whereas the total costs in conventional treatment were $12.3 million.

The researchers concluded that after an average follow-up of 21.2 years, there were no significant differences in total costs or cost per patient with intensified multifactorial treatment for 7.8 years when compared with conventional multifactorial treatment. Moreover, there was a gain in lifespan and achievement of health benefits in type 2 diabetes patients undergoing intensified, multifactorial treatment as compared to conventional treatment.

Written by Pratibha Duggal

Reference: American Diabetes Association. (2018). Intense Multifactorial Treatment for Type 2 Diabetes Shown to be Cost Effective. [online] Available at: http://www.diabetes.org/newsroom/press-releases/2018/intense-multifactorial-treatment-for-type-2-diabetes-shown-to-be-cost-effective.html [Accessed 12 Sep. 2018].

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