Better diabetes care could save billions per year

If 80% of Americans with type 2 diabetes met recommended treatment goals, over $150 billion in medical costs would be saved in the next 30 years. If 80% of patients met just five goals — a hemoglobin A1c less than 70%, blood pressure less than 130/80 mm Hg, LDL cholesterol below 100 mg/dL, HDL greater than 40 mg/dL for men and greater than 50 mg/dL for women, and use of a daily baby aspirin — there would be 5 million fewer heart attacks, 600,000 fewer strokes, 1.2 million fewer cases of renal failure, 1.8 million fewer cases of blindness/eye surgery, and 1.8 million fewer premature deaths. The increased costs of achieving the goals would be offset by the savings that result from prevention of the complications, explained by the ADA president for medicine and science. They simply have to commit their selves to achieving the ADA goals in 80% of their patients. It’s not pie-in-the-sky. The projections were made using Archimedes, a large-scale mathematical model with equations that stimulate metabolic pathways and processes leading to complications.

By creating detailed virtual patients and modeling what happens to them over time, Archimedes can evaluate the effects of an intervention on disease prevalence and progression. The model, developed by Kaiser Permanente and supported by an unrestricted grant from Novo Nordisk, has already accurately predicted the results of several large-scale clinical trials prior to their completion. Archimedes also predicted that if 80% of type 2 diabetics took a daily generic "polypill" consisting of 1,000 mg metformin, 75 mg aspirin, 40 mm statin, and 10 mg of an ACE inhibitor, the number of heart attacks over the next 30 years would drop by 50% renal failure by 4%, and blindness and eye surgery by 33%. Such a pill — with an all-generic formulation — would cost about $100 year while saving about $400 per year.

And even if the treatment cost $500, the health care system would still see a savings within 5 years. This confirms what has been intuitively obvious to [us], but which seems to have escaped the policy makers. Namely, that it costs less to properly treat diabetes. It’s a wise investment no matter how you look at it. Of course, a cure for diabetes would go much further, saving 8.4 million lives preventing 41 million serious diabetes-related complications over 30 years. In the absence of a cure, the US health care system will spend $6.6 trillion on diabetes complications over the next 30 years. A cure would save over the next $700 billion, suggesting that "there is an overwhelming and irrefutable economic case for finding a cure. Given these projections, outlined a four-point proposal that the ADA plans to issue in an upcoming official document:

• America must invest heavily in diabetes research aimed at find a cure.

• The size of the investment must be commensurate with the risk that diabetes represents to the country.

• Financial support must be established to sustain systems of care that ensure every person with diabetes the best possible care.

• And a message for physicians: We must all renew our commitment to our patients, acknowledge that the current level of care for people with diabetes is simply not acceptable, and do everything in our power to make it better.