[ Cover image: Healthcare costs ofdiabetes.
Credit: Steve Pervical/Science PhotoLibrary. ]
In this month’s Diabetic Medicine we publish the costs of diabetes to the National Health Service (NHS) in the UK (Hex and colleagues, page 855). The report, commissioned by Diabetes UK, the Juvenile Diabetes Federation and Sanofi, should act as a wake-up call to commissioners of diabetes services and those providing services to diabetes, whether in primary care or acute hospital trusts. People living with diabetes account for approximately 4.5% of the UK population, and the costs of diabetes according to the report are estimated at 10% of the total NHS budget, rising to 17% in 2035. The study looked at annual patient care costs for both types of diabetes, with Type 2 diabetes at £21.8bn (direct costs £8.8bn and indirect £13bn) being, as expected, higher than that of Type 1 diabetes at £1.9bn (direct £1bn and indirect £0.9bn). Eighty per cent of these costs are accounted for by the costs of the complications associated with diabetes.
Whilst, it is important to ensure the most cost-effective medications are prescribed, using evidence-based guidelines, it is equally important to treat the person living with diabetes as an individual and to incorporate personalized care plans. Diabetes is a chronic disease and the use of some generic medications that are more likely to lead to side effects may have a disastrous effect on long-term concordance with medications that are important to prevent the complications of diabetes. An important balance therefore needs to be struck when considering guidelines for diabetes care that needs an element of flexibility for the individual, whilst not bankrupting the NHS. However, the biggest impact on the future health budget would be to slow down the diabetes epidemic by implementing prevention strategies in those at highest risk of diabetes and to aggressively treat those with diabetes to prevent complications, especially those with a recent onset of disease. This will require seamless care for all those delivering diabetes services and the breaking down of artificial barriers (financial, administrative and otherwise), especially between primary, secondary and tertiary care.