Setting global targets for treating diabetes in lower-income countries, similar to the targets set for HIV/AIDS, would save lives and decrease medical care costs, researchers said.
An analysis of data on over 23,000 patients with diabetes from 67 different countries found that if 80% had their diabetes and associated comorbidities diagnosed, treated, and controlled, it would reduce the disability-adjusted life years (DALYs) lost from diabetes, from 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 in Lancet Global Health.
This 80% global target would increase the median cost for treatment and control from $2,143,500 to $2,192,725 per 1,000 people over 10 years, but the expenses saved from reduced cardiovascular event management would result in an overall incremental cost-effectiveness ratio of $1,362 per DALY averted, the authors noted.
In a statement accompanying the study, Davies said her team had already identified "huge drop-offs" in the care received by people with diabetes in lower- and middle-income countries. Fewer than 10% of these patients are receiving the medical care they need, she added.
"Setting global targets for HIV and AIDS has led to massive improvements in people getting the treatment that they need to save lives and improve health," Davies said. "Our research suggests that similar targets would certainly be useful in improving lives for people with diabetes. We must definitely now achieve scale-up blood pressure and statin medication treatment as part of our ongoing fight against diabetes."
The authors analyzed data for 23,678 patients with diabetes (median age 53, 59.8% women) gathered with nationally representative, cross-sectional surveys that were administered from 2006 to 2018. They used these data to estimate the risk among patients for atherosclerotic cardiovascular disease, heart failure, end-stage renal disease, severe vision loss, and pressure sensation loss associated with diabetes.
They then constructed a microsimulation model to estimate DALYs lost due to diabetes and its comorbidities, as well as the healthcare costs of diagnosis, treatment, and control of blood pressure, dyslipidemia, and glycemia. They used data from meta-analyses to estimate reductions in risk, and they used the WHO OneHealth Tool to estimate costs of medical care if the 80% target was reached.
Davies and colleagues found that blood pressure and cholesterol management were the two most critical strategies for reducing DALYs associated with diabetes in lower-income countries. "In this model-based analysis, the greatest reductions in cardiovascular events were achieved through increased treatment with blood pressure and statin medicines, and increased titration of blood pressure medicines to achieve blood pressure targets," they wrote.
The team noted several limitations to their study. The diagnosis of conditions such as hypertension was based on criteria that are used in epidemiologic studies, but these criteria could over- or under-estimate the numbers that would actually be diagnosed in a clinical setting. In addition, the cross-sectional data might not show systematically underdiagnosed conditions, they said.
The microvascular risk equations used in the study were derived from cohorts and clinical trials based mostly in the U.S., they added. As such, they might not be completely applicable to the patients in the study, although coefficients were used to account for certain ethnicities. The study also did not account for any behavioral changes that patients might make on receiving a diagnosis of hypertension or diabetes.
The study did not simulate targeting a specific LDL cholesterol level for statin treatment, because current practice favors risk-based, rather than target-based, treatment, Davies and colleagues explained. In the future, however, the practice might switch back to a target-based approach that could lead to different costs and outcomes, they added.
"Finally, there are data limitations in cost estimates in that cost estimates are often approximations with widely varying quality and geographic representation, and the actual cost that the health system experiences from reaching a target like 80/80/80 may not be the costs that would be experienced if guidelines were being perfectly adhered to," they wrote.
"While the data utilized here are cross-sectional, efforts to repeat these analyses are underway, and if augmented by cost and disability assessments, may help to enhance our understanding of what targets to set and how to maximize the potential for strategic investments to improve the population health of those with diabetes," they added.
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Disclosures
No funding sources were reported for this study.
No authors disclosed conflicts of interest.
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