A new study published in the October 27 issue of Archives of Internal Medicine finds that more adults with type 2 diabetes are receiving progressively more complex and expensive arrays of treatments.

Type 2 diabetes – a metabolic disorder where the body becomes unable to control blood sugar levels – affected more than 11 million Americans in 2000. “By 2050, the number of Americans with diabetes is expected to soar to 29 million, a prevalence of 7 percent,” write G. Caleb Alexander, M.D., M.S. (University of Chicago Hospitals) and colleagues. “The annual economic burden of diabetes is estimated at $132 billion and increasing. In 2002, more than one-tenth of U.S. health care expenditures were attributable to diabetes.” Physicians have been prescribing more medications and combining drugs from different therapeutic classes, factors that come with increasing costs as they become more prevalent and more complex.

The researchers collected diabetes prescription information and costs from national databases in order to evaluate the national trends. The data consisted of prescription data from U.S. patients with type 2 diabetes who were age 35 and older. The patients all visited a physician’s office between 1994 and 2007, and information was available about medication costs from 2001 to 2007.

A summary of some of the researchers’ findings on diabetes care between 1994 and 2007 is presented below:

  • The number of yearly patient visits to treat diabetes increased by 11 million
  • Diabetes patients received on average 1.14 medication prescriptions in 19994 and 1.63 in 2007
  • In 1994, 82% of visits resulted in only one drug prescription (when treatment was given) compared to 47% in 2007.
  • Insulin use for type 2 diabetes patients was at 38% in 1994, 25% in 2000, and 28% in 2007
  • The frequency of prescribing sulfonylurea drugs went from 67% to 34% of treatment visits
  • The frequency of prescribing new drugs such as biguanides and glitazones incresed to 54% and 28% of treatment visits, respectively

Much of the increase in the average cost per prescription was attributed to the increasing use of glitazones and other new forms of insulin and new classes of drugs. Glitazone increased in price from $56 in 2001 to $76 in 2007. Similarly, overall medication expenditures for those with diabetes increased from $6.7 billion in 2001 to $12.5 billion in 2007.

“We document large shifts in patterns of diabetes treatment and pharmaceutical expenditures across treatment classes,” conclude Alexander and colleagues. “Whether increased treatment costs are balanced by improved outcomes associated with these changes cannot be evaluated in the absence of data comparing effectiveness and cost-effectiveness across treatment classes. Our findings suggest the importance of generating new comparative data and coupling this information with clinical and formulary guidelines that contribute to constraining costs, maximizing glycemic control and minimizing diabetes-related morbidity and mortality.”

National Trends in Treatment of Type 2 Diabetes Mellitus, 1994-2007
G. Caleb Alexander, MD, MS; Niraj L. Sehgal, MD, MPH; Rachael M. Moloney, BA; Randall S. Stafford, MD, PhD
Archives of Internal Medicine (2008); 168[19]: pp. 2088-2094.
Click Here to View Abstract

More information on diabetes is available in our What is diabetes? section.

Written by: Peter M Crosta