Diabetes In Europe Research Articles

The Costs of Type 2 Diabetes Mellitus in Italy

To estimate the direct, indirect, and intangible costs associated with type 2 diabetes mellitus in Italy in 1998. To evaluate the economic impact of diabetic complications, and to investigate drug treatment patterns and associated costs in patients with type 2 diabetes. The Italian arm of an international study (COsts of Diabetes in Europe--Type 2 [CODE-2], a descriptive, cross-sectional survey) was set up to collect information retrospectively by means of questionnaires from a sample of 1263 patients. Resource use was measured in monetary terms using a set of costs and tariffs. Intangible costs were estimated using the EuroQol questionnaire. The average yearly cost for medical resources for a patient with type 2 diabetes was 2991 Euro, whereas the estimated cost for the whole population with type 2 diabetes was about 5170 million Euro. This corresponds to 6.65% of the total healthcare expenditure (public and private) in Italy. Of direct costs, 29% was spent for the treatment of diabetes and 39% for the treatment of diabetic complications; while the remaining 32% was spent for healthcare not related to diabetes. Quality of life score in patients with type 2 diabetes (EuroQoL overall average score) was 0.68. Type 2 diabetes has a high cost to society. The major cost component is due to the care of diabetic complications, not to the treatment of the illness itself; in particular, drug costs represent a relatively small proportion of such treatment cost.

Identification of Anti-.ALPHA.-Amylase Components from Olive Leaf Extracts

Olive (Olea europaea L.) is recognized as a folk medicine for diabetes in Europe. The inhibitory action of an ethanol extract of olive leaves (OEE) on the activities of human amylases was examined in vitro. OEE inhibited the activities of α-amylases from human saliva and pancreas with IC50 values of 4.0 and 0.02 mg/ml, respectively. Two anti-α-amylase components were purified from a 50% ethanol soluble fraction of OEE using Sephadex LH-20 column chromatography. One was identified as luteolin-7-O-β glucoside and the other as luteolin-4′-O-β glucoside. The 50% ethanol insoluble fraction of OEE was dissolved in 98% ethanol and fractionated using Cosmosil C18-OPN column chromatography. The anti-α-amylase component purified by this chromatography was identified as oleanolic acid. Both luteolin and oleanolic acid have an inhibitory effect on postprandial blood glucose increase in diabetic rats. Olive leaves suppressed the elevation of blood glucose after oral administration of starch in borderline volunteers (fasting blood glucose: 110–140 mg/dl), and thus they may be a useful food supplement for the prevention of diabetes.

Age- and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European cohorts.

To report the age- and sex-specific prevalences of diabetes and impaired glucose regulation (IGR) according to the revised 1999 World Health Organization criteria for diabetes in Europe. A total of 13 studies from nine European countries with 7,680 men and 9,251 women aged 30-89 years were included in the data analysis. In most of the study populations, the age-specific prevalences of diabetes were <10% in subjects younger than 60 years and between 10 and 20% at 60-79 years of age. Mean 2-h plasma glucose (2hPG) concentration increased linearly with age, but fasting plasma glucose (FPG) concentration did not. The increase in the prevalence of undiagnosed diabetes and IGR in the elderly was mainly a result of the large increase in 2hPG rather than FPG. Diabetes and impaired fasting glycemia defined by isolated fasting hyperglycemia was more common in men than in women 30-69 years of age, whereas the prevalence of isolated postload hyperglycemia, particularly impaired glucose tolerance, was higher in women than in men, especially in the elderly (individuals >70 years of age). More than half of the diabetes was undiagnosed in subjects younger than 50 years of age. Most European populations have a moderate to low prevalence of diabetes and IGR. Diabetes and IGR will be underestimated in Europe, particularly in women and in elderly men, if diagnoses are based on fasting glucose determination alone.

Costs of long-term complications in type 2 diabetes patients in Germany. Results of the CODE-2 Study

In the German arm of CODE-2((R)) (Costs of Diabetes in Europe - Type 2), medical, demographic and economic data were collected retrospectively for a period of 1 year on the basis of medical files of 809 patients by personal interviews with 135 primary care physicians. The results were extrapolated to the German diabetes type 2 population. The influence of micro- and macrovascular complications on total costs was analyzed. Costs of three major complications (ulcer, amputation, and stroke/PRIND) were determined. Here, comorbidities with other major complications were excluded. About half of the patients with diabetes type 2 had severe diabetes-related comorbidity, 56.2% showing more than one. For patients with macro- or microvascular complications, the costs increase 2.5 up to 4.1 times in comparison to the average health-insured patient. Costs for patients with ulcer of the lower extremities added to a mean total of EURO 7,537.- (DM 14,742.-) in the year of complication occurring. For patients undergoing amputation, mean annual costs of EURO 10,796.- (DM 21,115.-) arose. In diabetes patients suffering from a stroke, costs in the respective year summed up to EURO 7,147.- (DM 13,987.-). Amputations therefore led to a more than sixfold increase in costs, ulcer and stroke to a more than fourfold increase compared to diabetes patients without complications. This analysis demonstrates the huge financial expenditure for managing specific diabetes-related complications and long-term effects. In order to reduce total costs, the focus should turn to early prevention of complications. Targeted intervention studies will have to prove that an initial increase in treatment costs due to preventive measures can be more than compensated by savings occurring from prevention of complications.

Bootstrap Confidence Intervals for Costs-of-Illness of Type 2 Diabetes Mellitus in Germany

Objective The Costs of Diabetes in Europe–Type 2 study (CODE-2 ®, SmithKline Beecham plc) measures costs of managing patients with type 2 diabetes mellitus in Germany. The aim of this analysis was to assess the uncertainty of these estimates. Design and Setting The German study arm was based on a sample of 809 patients with type 2 diabetes registered in general practices. Information on socioeconomic data, medical resource use, and clinical data was collected retrospectively for 1998. Patients and Participants Patients were grouped in five strata based on their complication status, because of the high impact of complications on costs. To obtain higher credibility of resulting estimates, rare complication groups were overrepresented. To be representative, results were weighted using real prevalence data on complications from a prestudy. Main Outcome Measures and Results Within each stratum, results were calculated as arithmetic mean except for demographic data, where the median was applied as input for weighted averages. Because the degree of precision of calculated estimates was not accessible analytically, 95% confidence intervals (CIs) were computed via bootstrapping of 10,000 independent bootstrap samples for each of the calculated estimates. All costs are given for the payers’ perspective in German Deutsche Mark (DM). Costs per patient and year for ambulatory care were DM 775 with 95% CI (721–835), for hospitalizations DM 2771 (2242–3342), for drug treatment DM 1496 (1399–1598), and for rehabilitation DM 120 (70–177). The indirect cost was DM 372 (144–645). From the perspective of the sickness funds, cost per patient and year was DM 5539 (5184–5894). Mean HbA1c status was 7.51% (7.37–7.66) with the majority of patients not achieving glycemic control below 6.5%. Conclusion Bootstrap CIs are remarkably narrow. Combining a weighted stratification with bootstrap estimation is an appropriate method for analyzing the weighted average of highly variable and skewed parameters such as costs of diabetes.

Evaluation of risk factors for development of complications in Type II diabetes in Europe.

The Cost of Diabetes in Europe-Type II study is the first large coordinated attempt to measure the current standard of care and determine the costs of managing patients with Type II (non-insulin-dependent) diabetes mellitus. The study evaluated glycaemic control, blood lipid levels and blood pressure, all of which are risk factors for complications. Records of these clinical characteristics were collected from over 7000 patients during the 6-month study period. The mean HbAlc value for the entire study population was 7.5%, ranging from 7.0% in Sweden to 7.8% in the United Kingdom. Only 31% of individuals achieved good glycaemic control (HbAlc≤=6.5%) according to current European guidelines. Only 64% of the total study population were tested for HbAlc values at least once within the 6-month study period (ranging from 49% in Spain to 71% in the UK), although HbAlc testing every 3 months is recommended for all patients, by European Diabetes Policy Group guidelines. The majority of patients had borderline total cholesterol values, with a mean value of 5.7 mmol/1. Overall, 21% of patients were classified as having low risk cholesterol levels (<4.8 mmol/1). Good triglyceride levels (<1.7 mmol/1) were achieved by 47% of the total study population. During the study period, 81 % of patients had their blood pressure measured, with 35% and 53.3% of the patients reaching the recommended targets for systolic and diastolic blood pressure, respectively. This study showed that a high proportion of patients with risk factors for diabetes-related complications are not adequately controlled. Improvements in disease management and monitoring are therefore required to ensure that guideline targets are met, thus reducing the long-term complications of Type II diabetes.

Assessing the impact of complications on the costs of Type II diabetes.

'The Cost of Diabetes in Europe-Type II (CODE-2) study' provides the first coordinated attempt to assess the total costs of managing people with Type II (non-insulin-dependent) diabetes mellitus in Europe. Type II diabetes is associated with a number of serious long-term complications, which are a major cause of morbidity, hospitalisation and mortality in diabetic patients. Patients were divided into four broad categories defining their complication status in terms of no complications, one or more microvascular complications, one or more macrovascular complications or one or more of each microvascular and macrovascular complication. The prevalence of complications and associated costs were assessed retrospectively for 6 months. In total, 72% of patients in the CODE-2 study had at least one complication, with 19% having microvascular only, 10% having macrovascular only and 24% of the total having both microvascular and macrovascular complications. Of patients with microvascular complications, 28% had neuropathy, 20% renal damage, 20% retinopathy and 6.5% required treatment for eye complications. Among the patients with macrovascular complications, 18% had peripheral vascular disease, 17% angina, 12% heart failure and 9% had myocardial infarction. Percutaneous transluminal coronary angioplasty, coronary artery bypass graft or stroke occurred in 3%, 4% and 5% of the patients, respectively. In patients with both microvascular and macrovascular complications, the total cost of management was increased by up to 250% compared to those without complications. Complications have a substantial impact on the costs of managing Type II diabetes. This study has confirmed that the prevention of diabetic complications will not only benefit patients, but potentially reduce overall healthcare expenditure.

Revealing the cost of Type II diabetes in Europe.

'The Cost of Diabetes in Europe-Type II study' is the first coordinated attempt to measure total healthcare costs of Type II (non-insulin-dependent) diabetes mellitus in Europe. The study evaluated more than 7000 patients with Type II diabetes in eight countries - Belgium, France, Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom. A bottom-up, prevalence-based design was used, which optimised the collection of data at the national level while maintaining maximum international comparability. Effort was made to ensure consistency in terms of data specification, data collection tools and methods, sampling design, and the analysis and reporting of results. Results are reported for individual countries and in aggregate for the total study population. The total direct medical costs of Type II diabetes in the eight European countries was estimated at EUR 29 billion a year (1999 values). The estimated average yearly cost per patient was EUR 2834 a year. Of these costs, hospitalisations accounted for the greatest proportion (55%, range 30-65%) totalling EUR 15.9 billion for the eight countries. During the 6-month evaluation period, 13% of the Type II diabetic patients were hospitalised, with an average of 23 days in hospital projected annually. In contrast, drug costs for managing Type II diabetes were relatively low, with antidiabetic drugs and insulin accounting for only 7% of the total healthcare costs for Type II diabetes. Type II diabetes mellitus is a common disease and the prevalence is expected to increase considerably in the future, especially in developing countries. Current comprehensive economic data on the costs of diabetes are required for policy decisions to optimise resource allocation and to evaluate different approaches for disease management.

Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes.

To estimate the health-related quality of life (HRQOL) and treatment satisfaction for patients with type 2 diabetes in the Netherlands and to examine which patient characteristics are associated with quality of life and treatment satisfaction. For a sample of 1,348 type 2 diabetes patients, recruited by 29 general practitioners, we collected data regarding HRQOL. This study was performed as part of a larger European study (Cost of Diabetes in Europe - Type 2 [CODE-2]). We used a generic instrument (Euroqol 5D) to measure HRQOL. Treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire. Patients without complications had an HRQOL (0.74) only slightly lower than similarly aged persons in the general population. Insulin therapy, obesity, and complications were associated with a lower HRQOL, independent of age and sex. Although higher fasting blood glucose and HbA1c levels were negatively associated with HRQOL, these factors were not significant after adjustment for other factors using multivariate analysis. Overall treatment satisfaction was very high. Younger patients, patients using insulin, and patients with higher HbA1c levels were less satisfied with the treatment than other patients. Obesity and the presence of complications are important determinants of HRQOL in patients with type 2 diabetes.

Complications, co-morbidity, and blood glucose control in type 2 diabetes mellitus patients in Germany--results from the CODE-2 study.

In this study, prevalence and incidence of complications as well as co-morbidity in type 2 diabetes patients in Germany were evaluated as part of a cost-of-illness study (CODE-2(TM), Costs of Diabetes in Europe - Type 2)In a pre-study, 197 general practitioners and diabetes specialists all over Germany provided data on the complication status of 2701 randomly selected patients with type 2 diabetes. The patients were grouped into five mutually exclusive strata. This pre-study was performed to generate a general overview on complication status to select proper patients for the main study. The main study was performed on stratified samples derived from the pre-study. Irrespective of the real prevalence of the five strata, an equal number of 160 were randomly selected from each stratum. Thus, rare complications were also covered in the study. Data from 809 patients were collected retrospectively on the basis of medical files during interviews with the physician. To achieve representative estimates of absolute prevalence and incidence of diabetes-related complications in Germany, results were weighted using frequencies of the strata. Severe complications were diagnosed in 50% of these patients. Prevalences were: 10.56% myocardial infarction, 6.66% stroke, 3.97% foot ulcer, 2.30% amputations and 1.34% blindness. Overall incidences in the diabetes population were estimated at 0.78% myocardial infarction, 1.28% stroke and 0.80% amputations. 23% of the diabetes patients suffered from 2 or more complications. The complication status became considerably worse with increasing time since the diagnosis of diabetes. The mean HbA1c level was 7.51% (i.e. 122% of the upper limit of the respective normal ranges). The presence of complications and co-morbidity in type 2 diabetes patients was a frequent finding. This underlines the importance of complications in diabetes patients and the necessity to increase any means of prevention in order to relieve the personal and economic burden of type 2 diabetes.

Pioglitazone the answer to managing type 2 diabetes in Europe?

Pioglitazone the answer to managing type 2 diabetes in Europe?

Correlations between the incidence of childhood-onset type I diabetes in Europe and HLA genotypes.

There are large variations in the incidence of Type I (insulin-dependent) diabetes mellitus within Europe, ranging from 3.2 cases per 100,000 person-years in the Republic of Macedonia to more than 40 new cases per 100,000 person-years in Finland. This variation could be caused by differences in the distribution of genetic susceptibility markers, by differences in the distribution of environmental disease determinants or by a combination of both. To assess how much genes contribute to this variation, we correlated the level of incidence of Type I diabetes with the prevalence in the general population of genetic susceptibility and protective markers encoded by the human leukocyte antigen (HLA)-DQ loci. Positive association was found for the combined group of genotypes associated with Type I diabetes risk (p < 0.001). The whole positive effect was, however, accounted for by the HLA-DQ2/ DQ8 (DQA1*0501-DQB1*0201/DQA1*0301-DQB1*0302) and HLA-DQ4/DQ8 (DQA1*0401-DQB1*0402/DQA*0301-DQB1*0302) genotypes (p < 0.001 and p < 0.004, respectively). No correlation was found between incidence of Type I diabetes and population prevalence of genotypes not encoding for aspartate on position 57 on the HLA-DQbeta chain. It was not possible to detect any negative correlation between Type I diabetes incidence and the prevalence of HLA-genotypes conferring protection against Type I diabetes in a population (HLA-DQA1*0102-DQB1*0602/X). The results suggest that a substantial part of the transnational variation in the incidence of childhood-onset Type I diabetes in Europe is explained by variations between populations in the distribution of particular DQ genotypes which confer a high risk of Type I diabetes in the general population.

Geographical variation of presentation at diagnosis of type I diabetes in children: the EURODIAB study. European and Dibetes.

We aimed to describe the frequency and degree of diabetic ketoacidosis in children across Europe at the time of diagnosis of Type I (insulin-dependent) diabetes mellitus and to determine if factors such as age and geographical region contribute to the risk of diabetic ketoacidosis. The study was part of the EURODIAB project. A total of 24 centres, covering a population at risk of more than 15 million children below 15 years of age, recruited 1,260 children at the time of clinical diagnosis. Polyuria, by far the most frequent symptom, was observed in 96% of the children. In only 25% of the children was the duration of symptoms less than 2 weeks and this proportion was larger in the under 5 year age-group (37 vs 22%; p < 0. 001). Of the 11 centres that recorded diabetic ketoacidosis status, the overall proportion with diabetic ketoacidosis (pH < 7.3) was 40% (95%-CI: 36-44%) in at least 90 % of cases. After stratification by centre, the odds ratio for diabetic ketoacidosis in the under 5 age-group was 1.02 (95%-CI:0.69-1.49) relative to the older children. There was significant variation between the 11 centres in the frequency of diabetic ketoacidosis which ranged from 26 to 67% (p = 0.002). An inverse correlation between the frequency of diabetic ketoacidosis and the background incidence rate was found in these centres (Spearman's rank correlation, rs = -0.715;p = 0.012). Rising standards of medical information and greater awareness concurrent with an overall increase in incidence could have resulted in changes in the clinical presentation at onset of Type I childhood diabetes in Europe.

Trends in the incidence of childhood-onset diabetes in Europe 1989-1998.

To study the epidemiology of childhood-onset (Type I) insulin-dependent diabetes mellitus in Europe, the EURODIAB collaborative group in 1988 established prospective, geographically-defined registers of all children diagnosed with Type I diabetes under 15 years of age. This report is based on 24,423 children, registered by 36 centres, with complete participation during the period 1989-1998 and representing most European countries with a population coverage of approximately 20 million children. Multiple sources of ascertainment were used to validate the level of ascertainment. Trends in Type I diabetes incidence during the period were analysed using Poisson regression with the results from the 36 centres pooled into nine regions. The standardised average annual incidence rate of Type I diabetes varied more than tenfold between centres. Overall, the annual increase in incidence was 3.2% (95%-CI: 2.7%, 3.7%), being highest for children in the 0-4-year age-group 4.8% (3.8%, 5.9%) and lowest for children in the 10-14-year age group 2.1 % (1.4%, 2.8%). However, the absolute increases in Type I diabetes were roughly similar in the three age-groups of 0-4, 5-9 and 10-14 years. Central Eastern Europe showed the highest increase whereas Sardinia and Northern Europe (except Finland) showed no evidence of an increase. For all age-groups relatively fewer cases had disease onset during the summer months, especially the 10-14-year age-group. The extremely large range of incidence rates within Europe has been confirmed. The incidence rate is generally increasing but is more pronounced in some regions than in others. Seasonality at disease onset is apparent even in the youngest age-group.

CODE‐2† UK: our contribution to a European study of the costs of type 2 diabetes

AbstractCODE‐2 UK is the UK contribution to the Cost of Diabetes in Europe – Type 2 (CODE‐2) study, the first to examine the health care resource use of people with type 2 diabetes in more than one European country. CODE‐2 UK studied samples of people with type 2 diabetes from population based registers in Bradford, Jersey and Salford. Data on NHS resource use were obtained retrospectively, covering the period 1 January 1998 to 31 December 1998, from the registers and from primary and secondary care records. Hospital admissions and ambulatory care accounted for 36.2% and 37.7% of total direct costs, which were, on average, £1505 per patient per year. Oral anti‐diabetic drugs accounted for 2.7% of total costs. Based on these data and an estimated prevalence of type 2 diabetes in the UK of 2%, the estimated total annual NHS cost of type 2 diabetes is £1.8 billion or 4.1% of total NHS expenditure. Similar findings were evident in other European countries. Copyright © 2001 John Wiley &amp; Sons, Ltd.

The diabetes education study group and its activities to improve the education of people with diabetes in Europe

In this article the activities of the diabetes education study group (DESG) are presented. It is an important example of the coordination of the European patient education in the field of diabetes. Given the therapeutic role of patient education, doctors must be involved in the entire process, as members of the multi-professional team, who carry the responsibility for the planning and implementation of the educational process. Based on these assumptions, the DESG concentrated on the following activities: workshops, congresses, teaching letters, a 5-min education kit, a web-site, and a basic curriculum in therapeutisc patient education. The future of therapeutic patient education in the field of diabetes is discussed.

American Diabetes Association 60th Scientific Sessions, 2000: the diabetic foot.

This is the seventh in a continuing series of articles on the American Diabetes Association (ADA) 60th Scientific Sessions held in San Antonio, TX, in June 2000. It covers topics related to the diabetic foot. Gayle E. Reiber, Seattle, WA, gave the Roger Pecoraro Lecture on the economics of lower-limb amputations in diabetes. A number of clinicians over recent decades have implemented programs leading to substantial decreases in amputations among participants in the U.S. and Europe. However, the target of a 40% decrease in amputation rates, based on these studies and set more than a decade ago, has not been met, and rates have actually increased. With the aging of the populations of the U.S. and Europe and the greater prevalence of diabetes, amputation rates and costs may increase further. Using the Veterans Administration system and Medicare data sets in the U.S. and the Cost of Diabetes in Europe, Type 2 (CODE-2) data set, Reiber presented trends for foot ulcers. There are ∼300,000 hospitalizations annually for foot cellulitis, ulcers, and deep infections among individuals with diabetes and 400,000 hospitalizations among individuals without diabetes in the U.S. Amputation rates are increasing among patients with diabetes, while decreasing among those without diabetes. In 1999, there were ∼92,000 amputations among those with and 42,000 among those without diabetes. There are tremendous variations among regions in the U.S. in the frequency of amputations and footwear prescriptions. However, <1% of Medicare patients in the U.S. obtained therapeutic footwear in 1995. Low-level amputations comprise 53% of the total, and this fraction has increased over recent years, suggesting improved limb preservation. Direct costs in the U.S. are ∼$17,000 for an episode of foot infection and $35,000 for a hospitalization leading to amputation. Reiber noted that reimbursement rates are well below these charges. Revascularization rates have tripled over …

Variation and trends in incidence of childhood diabetes in Europe

Variation and trends in incidence of childhood diabetes in Europe

Seasonality of birth in children with diabetes in Europe: multicentre cohort study

There is increasing evidence that environmental factors in early life, particularly viral infections, influence the risk of developing type 1 (insulin dependent) diabetes.1 The high incidence of diabetes in the...

Reducing the costs of diabetes in Europe

Reducing the costs of diabetes in Europe