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Dr. Elizabeth Robertson, Director of Research at Diabetes UK, Evaluates the Costs of Remitting Type 2 Diabetes
Type 2 diabetes is the epidemic of our time. In the United Kingdom, 3.8 million people live with a diagnosis of diabetes; 90% of them living with type 2, and another million thinking they have not been diagnosed yet, it is fair to say that we have a crisis on our hands. Diabetes costs the NHS about £ 10 billion every year, with much of the money spent on treating the devastating complications of the disease, such as cardiovascular disease, vision loss and amputations.
That said, the management of type 2 diabetes has improved dramatically in recent years. Especially since the well-known prospective study on diabetes in the UK has emphasized the need to control blood pressure and blood sugar to reduce the risk of diabetes complications (1). Although drugs are available to help manage type 2 diabetes, only 65% of Britons can achieve their blood glucose goals (2).
Type 2 diabetes remission offers an alternative approach, with people who have previously been diagnosed with type 2 diabetes reaching blood glucose levels within the limits needed to reduce the risk of complications, without the need for anti-diabetic medications. Bariatric surgery has been shown to induce remission in 30-60% of cases, with reports of remission up to 15 years (3,4). However, surgery to achieve remission without surgery is absolutely necessary.
To explore the potential for remission of type 2 diabetes through lifestyle changes, Diabetes UK funded DiRECT, the Diabetes in Remission clinical trial. Led by Professors Mike Lean and Roy Taylor of the University of Glasgow and the University of Newcastle, this trial involves 298 people with type 2 diabetes and is testing a low-calorie weight management program delivered by a general practitioner's office.
The program consists of three parts: 12 to 20 weeks of replacement meals to support significant weight loss, support from a nurse or dietitian to introduce healthy foods into the diet and long-term support to maintain weight loss. DiRECT results over one year showed that 46% of participants were in remission, with two-year data allowing a better understanding of this approach to remission (5).
The results led to a global shift in the conversation around type 2 diabetes; Remission may be possible with weight management in a significant number of people with type 2 diabetes. The prospect of reducing medications and the risk of costly complications – both for the individual and for services health – for millions of people around the world is an invitation.
Of course, questions remain as to the feasibility of such an approach, and in particular the costs that result.
We do not have all the answers yet, but the economic badysis of health performed in 2018 for the first year of DiRECT, published in the Lancet Diabetes & Endocrinology, is an important first step (6).
The badysis suggests that setting up a type 2 diabetes remission program within the NHS could cost £ 1,067 per participant the first year. The Glasgow team in charge of the badysis took into account the training costs of health professionals, diet, clinical examinations, complementary literature and current health care – primary and community care, hospitalizations and medications for type 2 diabetes or high blood pressure.
Taking into account the 46% remission rate observed 12 months after the start of DiRECT, the team estimated that each case of remission would cost £ 2,564. The latest comprehensive badysis conducted in 2010 indicated that the cost of managing type 2 diabetes was, coincidentally, rising to £ 2,564 – rising to £ 2,801 with current inflation .
The latter figure also includes the costs of treating serious complications and covers all stages of type 2 diabetes throughout life, but it raises an important issue as to the relative cost of achieving remission.
As a relatively inexpensive treatment option, compared to the management of type 2 diabetes and likely to reduce the risk of diabetes complications, a long-term remission could result in significant savings for the NHS. It is of course too early to know for sure; further research on the long-term impact of remission on complication rates is absolutely necessary, as are more in-depth badessments of the health economics involved. But these data will emerge, both from the continuation of the DiRECT study and from the recently announced and committed remission pilot programs by the NHS in England and Scotland (7,8).
While understanding the economic implications is vital, we must not forget the impact of remission on a much more personal level, allowing individuals – and their families – to live healthier lives. because of the complexity of the condition and society more broadly. As such, we have a responsibility to make remission an option for those who can benefit now, while continuing to seek better outcomes through new health care research and innovation for all. those affected or at risk.
References
1 UKPDS Group (1998) Lancet 352: 837-53.
2 National Diabetes Audit 2017-2018, Abridged Report on Treatment Processes and Treatment Goals.
3 delegates of the 2nd Summit on Diabetes Surgery (2016) Diabetes Care 39 (6): 861-877.
4 Cummings DE et al. (2016) Diabetologia 59 (5): 945-953.
Lean et al. (2017) Lancet 391 (10120): 541-51.
6 Xin Y et al. (2018) Lancet Diabetes Endocrinol Epub doi: 10.1016 / S2213-8587 (18) 30346-2.
7 NHS England (2019) The long-term plan of the NHS.
8 NHS Scotland (2018) A healthier future: a framework for prevention, early detection and intervention for type 2 diabetes.
Dr. Elizabeth Robertson
Director of Research
Diabetes United Kingdom
Tel: +44 (0) 20 7424 1001
www.diabetes.org.uk
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