Four growing diabetes trends

A new University of California, San Diego-led review has interesting findings about diabetes costs, patient care models and medication therapy.

Improved patient care models and medication therapy can have a significant impact on reducing the financial burden of diabetes, according to a new review published in the American Journal of Managed Care.

The cost of treating diabetes in the United States increased from $174 billion in 2007 to $245 billion in 2012, or 41% over five years, according to the American Diabetes Association.

For the review, researchers from the University of California, San Diego (UCSD), conducted an appraisal of relevant literature and available national statistics. They found that the cost of treating patients with diabetes is very high and has been increasing in recent years due to increased number of patients diagnosed and treated for diabetes as well as increased cost of treatments.


“The cost is not limited to medical costs but extends to losses in productivity due to the morbidity and mortality associated with diabetes,” says Jan D. Hirsch, BSPharm, PhD, professor of clinical pharmacy, and chair, division of clinical pharmacy and executive director, Partners in Medication Therapy, UCSD. “Patients who have yet to be diagnosed with diabetes also contribute to a growing additional cost to society since they are being treated for elevated blood glucose values.”

The study showed that four trends in diabetes treatment are emerging:

1.     Providing patient-centered care that meets the specific goals for patients and addresses barriers and challenges that are unique to that patient.

2.     Using medications with complementary mechanisms of action that improve glycemic control by targeting different pathophysiologic defects of diabetes.

3.     Using collaborative teams to treat diabetes; physicians, pharmacists, nurse practitioners, physician assistants, dietitians, certified diabetes educators (CDEs), medical assistants, and social workers.

4.     Educating patients to empower them as decision makers in their own care; much of diabetes depends more on patient behavior than clinical interventions.

Collaborative care models have demonstrated positive clinical outcomes and cost savings, according to the researchers. For example, patients with diabetes managed in a pharmacist-endocrinologist collaborative practice model, received additional visit time (average of three 60 minute visits within six months) beyond usual care and patient-specific education, had significant positive outcomes and cost avoidance.

Next: What these models can do




“Models like these can also free up specialists or primary care providers to focus on other chronic diseases,” says Candis M. Morello, PharmD, professor of clinical pharmacy and associate dean for student affairs UCSD, Skaggs School of Pharmacy and Pharmaceutical Sciences.

Collaborative management, coupling personalized clinical care with real-time, patient-specific diabetes education has been shown to improve glycemic control in a short time period and produces cost savings, according to Morello.

“Allowing more time per patient visit for a short intensive treatment period can quickly improve glucose control in a cost-efficient manner,” she says. “Collaborative diabetes care models can also free up other providers to focus on other chronic conditions. Newer therapeutic agents, and certain agents used in combination, may reduce direct costs by improving glycemic control and preventing negative outcomes associated with diabetes comorbidities.”

Patients will benefit from additional diabetes education, increased time to understand medication adherence and diabetes monitoring, and having affordable care, according to Hirsch.

The treatment of diabetes is challenging involving diet and life-style changes, adherence to medication regimens that can be complex and costly, and ongoing medical visits for monitoring blood glucose, blood pressure, body weight, and cholesterol levels, according to the study.

“Patients need a broad spectrum of support from clinicians and healthcare systems,” Hirsch says. “Accepted treatment guidelines exist for patients at every stage of the disease. Initial medication therapy often involves generic medications that are cost-efficient [e.g. metformin]. Some newer agents, though more expensive, can improve metabolic and cardiovascular outcomes as well as glycemic control, and when available as a combination product, may also improve adherence; all of which can offset additional product costs.”

The good news is that improving diabetes control, often measured by a glycated hemoglobin (A1c) concentration, has been shown to prevent and delay diabetes-related complications and to decrease direct medical costs in a number of healthcare systems like Kaiser Permanente and other U.S. health plans, according to Morello.

“Providers and health systems can work together to mitigate cost by improving patient outcomes, medication adherence, and access to care, including earlier identification and intervention for patients with undiagnosed diabetes,” she says.

Hirsch and Morello offer these top takeaways from the study:

1.     Consider alternative care delivery models. Patients with diabetes who were managed in a pharmacist-endocrinologist collaborative practice model and who received additional time beyond usual care to receive patient education and clinical care had significant positive outcomes and cost avoidance.

2.     Effectively communicate and take time with each patient to educate. Educate about the synergistic relationship among diet, exercise and medications to empower patients as decision makers in their own care.  

3.     Educate patients about adherence. Stress the importance of adherence and provide methods for patients to improve their medication adherence to maximize the benefit gained from medications and reduce costs associated with poor glycemic control and product wastage.

4.     Ensure medication regimens are optimized to produce positive outcomes and reduce cost. Use generics as possible; capitalize on cost benefits of newer agents that can improve metabolic and cardiovascular outcomes as well as glycemic control; and use combination products that may improve patient adherence to prescribed medications, according to the authors.