Diabetes: The Pandemic and Potential Solutions

A growing diabetes pandemic is unfolding with rapid increases in the prevalence of type 2 diabetes. The direct health care costs of diabetes worldwide amount to 2003 US$129 billion per year. Estimates indicate that developing countries spend between 2.5 and 15.0 percent of their annual direct health budgets on diabetes care, and families with diabetic members spend 15 to 25 percent of their incomes on diabetes care.A whole array of effective interventions to prevent diabetes and its complications is available, and we have attempted to assess their potential cost-effectiveness in developing regions. Using these estimations and a qualitative assessment of the feasibility of implementation, we have prioritized available interventions into the following three categories: level 1—cost saving and highly feasible level 2—cost saving or cost less than US$1,500 per QALY but pose some feasibility challenges level 3—cost between US$1,640 and US$8,550 per QALY and pose significant feasibility challenges. Table 30.4 presents a summary of all major diabetes interventions, major health effects of the interventions, and level of implementation priority.In addition, we propose diabetes education as an essential intervention. However, more organized research into the precise components of diabetes education and its effect on long-term outcomes is needed. We also propose that further research be launched in relation to the novel and potentially promising polypill.Finally, this chapter suggests a number of interventions at the level of the patient, provider, and system that could help address the overall suboptimal quality of diabetes care; notes the possible benefits of making important drugs available at cheaper costs in developing countries; and suggests some research priorities for developing regions.