Preventing Complications Can Reduce Diabetes Costs
Gannon, Kathi, Drug Topics
The cost of diabetes has skyrocketed, zooming from $20.4 billion in 1987 to nearly $92 billion in 1992, according to a recent study by the American Diabetes Association. That's a pretty sobering thought as Americans observe National Diabetes Month.
But another study--by the National Institute of Diabetes & Digestive & Kidney Disease, which is part of the National Institutes of Health--indicates that preventative measures could reduce diabetes complications, thereby keeping rising costs at bay.
The 10-year trial was conducted at 29 medical centers in the United States and Canada and included more than 1,400 persons with insulin-dependent diabetes. The purpose of the study was to determine if control of blood glucose levels would slow or prevent complications from diabetes, ADA chairman Michael Greene explained to Drug Topics.
Each patient in the Diabetes Control & Complications Trial (DCCT) received one of two types of therapy--standard or intensive. Patients in the standard treatment group took one or two insulin shots per day, tested their blood sugar levels once or twice a day, and visited a member of the health-care team once every three months.
The intensive-treatment group took three or more insulin shots a day or used an insulin pump. This group tested their blood sugar levels a minimum of four times daily. They also received considerable counseling from members of the health-care team on lifestyle issues such as nutrition and exercise.
"The message was clear," Greene said, commenting on the results of the study, which were published in the New England Journal of Medicine on Sept. 30. "More intensive care will minimize or prevent the complications of the disease." The patients in the intensive control group had a 60% reduction in their risk for the development and progression of diabetes complications involving the eyes, kidneys, and nervous system.
"This is a wake-up call for all persons with diabetes to focus their treatment efforts on prevention of long-term complications, not just maintenance,' said James R. Gavin III, M.D., Ph.D., president of the American Diabetes Association.
The message implicit in DCCT hits home with Greene. A diabetes patient himself, he has been following a rigorous approach to treating the disease For quite some time.
"Many people don't go the extra mile because they're in denial about the disease," Greene said. "And many people fight the more diligent schedule; it forces a person to organize his or her life a different way. It's a natural human tendency to resist this change.
"To adopt the more proactive approach, a person has to have vision to say 'If I do the job now, it will pay off in the long run," Greene continued.
Although the pharmacist was not specifically included as a member of the health-care team in DCCT, "the pharmacist is in an ideal position to encourage persons with diabetes to follow preventative methods," Greene said. Because patients with diabetes will return to the drugstore frequently for insulin refills, the R.Ph. may e his patients with diabetes more often than other patients and can play an important educational role in their treatment. "The pharmacist is approachable and in a key position to get the word out."
While DCCT studied only insulin-dependent diabetes, it's important for R.Ph.s to stress prevention to patients with both insulin- and noninsulin-dependent forms of the disease.
ADA thinks that preventative care of diabetes is in lodistep with the proposed health-reform plan. "Diabetes is a classic, chronic disease in which extra effort on the front end can save enormous costs on the back end," said Greene. "And treating diabetes involves a multidisciplinary team--the physician, the pharmacist, and the nurse educator. Diabetes is an attractive model to support the value of preventative education and care," Greene said. And the push for preventative efforts to control diabetes can serve as a model to persons with other chronic disease states. …