medwireNews: Health policies that focus on the individualized management of glycemic control in adults with type 2 diabetes may reduce costs and increase quality of life (QoL) compared with a uniform approach of intensive control for all individuals, according to a US study.
Using a Markov model including data from 569 adults aged older than 30 years, the researchers found that an individualized strategy of glycemic control cost US$ 13,547 (€ 11,478) less per person over a lifetime than a uniform approach that targeted a glycated hemoglobin (HbA1c) level of less than 7.0%, with lifetime costs of $ 105,307 (€ 89,227) versus $ 118,854 (€ 100,705).
This was mainly due to lower medication costs, which were $ 34,521 (€ 29,250) with the individualized approach and $ 48,763 (€ 41,317) with the uniform approach, giving a difference of $ 14,242 (€ 12,067).
“Across the remaining life of the U.S. diabetes population, the lifetime cost savings ($13,547 [€ 11,478] per person) would total $234 billion [€ 198 bn],” write Neda Laiteerapong (University of Chicago, Illinois, USA) and colleagues in the Annals of Internal Medicine.
Adults managed with the individualized strategy had less medication use and fewer hypoglycemic events than those managed conventionally, which translated into a slightly higher number of quality-adjusted life–years (QALYs) compared with uniform intensive control, at 16.68 versus 16.58 QALYs, respectively. Although there was a small decrease in remaining life expectancy with individualized management, at 20.63 versus 20.73 years, the researchers considered this to be “more than offset” by the improvement in QoL.
“The prospect of reducing costs by using fewer medications (–0.6 per person per year) and not substantially worsening patient outcomes is appealing, especially given that many patients prefer to avoid diabetes medications if they can do so safely,” say the researchers.
Under the individualized strategy, patients were moved from very intensive to less intensive glycemic control targets as they developed complications and aged. Patients with HbA1c values above target had medications added sequentially, with only one medication class – selected on the basis of ADA/EASD guidelines – added each year. When the HbA1c level was more than 1% below target, the last medication added was removed in the following year.
The researchers highlight that further studies are now required to confirm the risks and benefits of the individualized strategy, and to understand how the effects of glycemic control vary over the course of type 2 diabetes.
By Catherine Booth
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