Setting global diabetes goals could save lives


Setting global goals for diabetes treatment in low-income countries, similar to the goals set for HIV / AIDS, would save lives and lower health care costs, the researchers said.

An analysis of data on more than 23,000 diabetic patients from 67 different countries found that if 80% had their diabetes and associated comorbidities diagnosed, treated and controlled, it would reduce the disability-corrected life years (DALY) lost to cause of diabetes, with a median of 1,109 to 1,029 DALYs per 1,000 people over 10 years, reported Justine Davies, MD, of the University of Birmingham in England, and colleagues from Lancet Global Health.

This 80% global target would increase the median cost of treatment and control from $ 2,143,500 to $ 2,192,725 per 1,000 people over 10 years, but the expense saved through reduced management of cardiovascular events would translate into a report. Overall incremental cost-effectiveness of $ 1,362 per DALY avoided, the authors note.

In a statement accompanying the study, Davies said his team had already identified “huge drops” in the care received by people with diabetes in low- and middle-income countries. Less than 10% of these patients receive the medical care they need, she added.

“Setting global targets for HIV and AIDS has dramatically improved the number of people receiving the treatment they need to save lives and improve their health,” Davies said. “Our research suggests that similar goals would certainly be helpful in improving the lives of people with diabetes. We must now certainly achieve increased blood pressure and statin therapy as part of our continued fight against diabetes.”

The authors analyzed data from 23,678 diabetic patients (median age 53, 59.8% female) collected in nationally representative cross-sectional surveys that were conducted from 2006 to 2018. They used these data. data to estimate the risk of atherosclerotic cardiovascular disease in patients. heart failure, end stage renal disease, severe vision loss, and loss of pressure sensation associated with diabetes.

They then built a microsimulation model to estimate DALYs lost due to diabetes and its comorbidities, as well as the healthcare costs of diagnosing, treating, and controlling blood pressure, dyslipidemia, and blood sugar. They used the meta-analysis data to estimate the risk reductions, and they used the WHO’s OneHealth tool to estimate the costs of medical care if the 80% target was met.

Davies and his colleagues found that managing blood pressure and cholesterol were the two most critical strategies for reducing DALYs associated with diabetes in low-income countries. “In this model-based analysis, the largest reductions in cardiovascular events were obtained through increased treatment with blood pressure drugs and statins, and increased titration of blood pressure drugs to achieve goals. blood pressure, ”they wrote.

The team noted several limitations to their study. The diagnosis of conditions such as hypertension was based on criteria used in epidemiological studies, but these criteria could overestimate or underestimate the numbers that would actually be diagnosed in a clinical setting. Additionally, cross-sectional data might not show consistently underdiagnosed conditions, they said.

The microvascular risk equations used in the study are derived from cohorts and clinical trials based primarily in the United States, they added. As such, they might not be fully applicable to the patients in the study, although coefficients were used to account for certain ethnicities. The study also ignored behavioral changes patients might make when diagnosed with hypertension or diabetes.

The study did not simulate targeting a specific LDL cholesterol level for statin therapy because current practice favors risk-based treatment over target, Davies and colleagues explained. In the future, however, the practice could revert to a goal-based approach which could lead to different costs and outcomes, they added.

“Finally, there are data limitations in cost estimates as cost estimates are often approximations with highly variable quality and geographic representation, and the actual cost the health system incurs in meeting a target. like 80/80/80 may not be the costs that would be experienced if the guidelines were fully followed, ”they wrote.

“Although the data used here is cross-sectional, efforts to repeat these analyzes are ongoing and, if complemented by cost and disability assessments, can help improve our understanding of what goals to set and how to achieve. maximize the potential for strategic investments to improve the health of the population of people with diabetes, ”they added.

  • Jeff Minerd is a freelance medical and science writer based in Rochester, NY.

Disclosures

No sources of funding were reported for this study.

No author has disclosed any conflicts of interest.

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