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8/15/2000

Tight Glucose Control Comes At a Cost

Katherine M. Bennett

Tight control of blood glucose in patients with type 2 diabetes decreases the costs of managing complications from the disease and postpones onset of the first complication but increases treatment costs, British researchers found.

But the money saved by avoiding complications, such as amputation, largely offsets the costs. 

Reporting in the May 20 issue of BMJ, the researchers said that tight glucose control—aimed at keeping the fasting plasma glucose concentration below 108 mg/dL with insulin or a sulfonylurea—increased the average cost for treating a patient by 695 pounds, or about $1050, compared with conventional management, mainly through diet. In the end, however, tight glucose control cut the average cost for managing complications by 957 pounds, or about $1,450. 

The additional cost of intensive diabetes management for each patient dropped by about one third when the researchers adjusted the number of nurse and physician visits to the rates typical of routine care in the community. 

Compared with patients who received conventional diabetes management, patients whose glucose levels were tightly controlled gained an estimated 1.14 years without disease-related complications. 

This economic evaluation used data from a controlled clinical trial of the effect of intensive treatment for type 2 diabetes. The trial, conducted in the 23 centers forming the UK Prospective Diabetes Study Group, involved 3,867 adults with newly diagnosed type 2 diabetes. 

Participants were randomized to receive conventional or intensive management. Half the patients were followed for at least 10 years, enabling the researchers to use clinical data, instead of predicted rates, on the development of complications in order to estimate the long-term implications of type 2 diabetes on health resources and study the economics of improved glucose control. 

According to the researchers, their findings suggest "that intensive management of patients with type 2 diabetes is a feasible and economically supportable option." 

To view the article, go to www.bmj.com/cgi/reprint/320/7246/1373.pdf.