Economic considerations in treating patients with type 2 diabetes mellitus.

Economic considerations in treating patients with type 2 diabetes mellitus are reviewed. Glycemic control, lipid profiles, and adherence to standards of care are less than optimal in many patients with type 2 diabetes mellitus. Diabetes has an enormous economic impact, and its related costs in the United States are expected to increase as the frequency of the disease increases. A substantial portion of diabetes-related health care expenditures is allotted to the treatment of cardiovascular disease, a major complication of diabetes. Significant health care resources are spent in a reactive manner (i.e., after complications have developed), with little emphasis on preventive care. One large study conducted in the United Kingdom demonstrated that providing intensive blood glucose control significantly reduced the risk of microvascular complications, such as retinopathy, nephropathy, and neuropathy, in patients with type 2 diabetes mellitus. Factors to consider in selecting pharmacotherapy for these patients include the magnitude of change in measures of glycemic control provided by the medication, other desired metabolic changes and outcomes (e.g., blood pressure and lipid changes), mechanism of action, adverse effects, contraindications, patient adherence, and cost. Early interventions, such as annual urinalysis and screening for microalbuminemia, annual comprehensive eye examination by an ophthalmologist or optometrist, and screening for neuropathy and foot problems are cost-effective ways of reducing diabetes-related complications. Interventions recommended for reducing the risk for cardiovascular complications in patients with type 2 diabetes mellitus include lipid control, blood pressure control, aspirin therapy, smoking cessation, and weight loss. Achieving and maintaining glycemic control in patients with type 2 diabetes mellitus improves quality of life and is cost-effective, especially among patients with comorbid heart disease, hypertension, or both.