Drug Combo Could Lower Diabetes Complications, Costs
A highly detailed mathematical simulation model can help people with undiagnosed diabetes identify whether they likely have the disease and can predict ways for dramatically reducing the costs and complications associated with this now epidemic illness.
The May issue also includes a study showing that diabetes, which has been steadily rising in prevalence for decades, now affects an alarming number of pregnancies in the United States.
Model Predicts Pill Combination Could Save Money and Lives
Giving most people with diabetes an inexpensive combination of medications could dramatically reduce the number of diabetes-related complications and deaths in America and ultimately save money, according to a highly detailed mathematical model developed to simulate human physiology and health care systems.
The Archimedes Model, originally developed by researchers at Kaiser Permanente, was used to make predictions in three areas: What would happen if diabetes were cured, if all people with diabetes reached their treatment goals, or if the disease were treated more aggressively?
Not surprisingly, curing diabetes would dramatically reduce the risk of heart attacks in the United States (by 40 percent) and prevent nearly 4.5 million deaths over a 30-year period. It would also reduce health care costs by a whopping $444 billion over the same period of time.
Absent a cure, providing optimal care -- bringing 100 percent of those with diabetes to their treatment goals -- would save $325 billion in health costs and add 3.55 million life years to people who have diabetes today. Adding a "polypill" to the usual care given people with diabetes -- the most practical scenario analyzed -- would cut the number of heart attacks in half, reduce eye complications by a third and result in 10 percent fewer diabetes-related deaths, the model found. Overall, giving an inexpensive drug combination consisting of generic glucose, cholesterol and blood pressure-lowering drugs along with low-dose aspirin to all people with diabetes would result in 7.3 million fewer serious complications over the next 30 years.
Diabetes continues to increase at an alarming rate in the U.S. and around the world. Currently, about 10 percent of all American adults and 20 percent of adults over the age of 60 have been diagnosed with the disease. In 2007, Americans spent $174 billion on type 1 and type 2 diabetes, including $58 billion in reduced national productivity.
The Archimedes Model was used to see whether and how the human and financial costs of this epidemic could be reduced. The authors concluded that research for a cure should be made a national priority and innovative solutions such as a polypill cocktail should be pursued more aggressively.
"A world without diabetes and its complications is certainly possible and the appropriate care for people with diabetes is within our grasp," the authors wrote. "Both, however, require unrelenting commitment and resolve."
Diabetes Risk Calculator Identifies Those Likely to Have Diabetes
People who have diabetes and don't know it -- and those who have a condition known as pre-diabetes -- will soon have access to a free tool to assess their health status online. The Diabetes Risk Test, based on a model developed by researchers at Archimedes, Inc., a company that uses mathematical simulation models to address healthcare problems, accurately assesses a person's chances of having or developing undiagnosed diabetes or pre-diabetes, a condition that often leads to diabetes.
The assessment tool, which will soon replace the American Diabetes Association's existing online risk test, calculates a person's chances of having diabetes using the answers to a series of questions, such as age, weight, history of gestational diabetes and other variables. The tool is intended to help people determine if they should see a physician for further testing. It can be found at www.diabetes.org
"We know that the prevalence of diabetes continues to rise, and that at least a quarter of people who have diabetes don't yet know it," said David Eddy, lead researcher on the study and founder of Archimedes, Inc. "But it's not cost effective or even efficient to screen every single patient. This no-cost, easy-to-use tool can help identify those people most likely to have diabetes or pre-diabetes, so that they can receive the appropriate testing and subsequent medical care."
The prevalence of diabetes has risen rapidly over the past several decades. New guidelines from the ADA recommend screening for diabetes among adults who are overweight or obese or who have one or more risk factors for diabetes before the age of 45. For those who have no risk factors, testing should begin at age 45.
The Diabetes Risk Test is the only currently available noninvasive screening tool designed and scientifically validated to detect both pre-diabetes and undiagnosed diabetes in the U.S. population.
Increase in Diabetes Among Younger Women Affects More Pregnancies
In less than seven years, the number of pregnant women giving birth in a large managed health care plan who have type 1 or type 2 diabetes has more than doubled, leading to increased health risks for both the mothers and their unborn children.
The increased prevalence of pre-existing diabetes among pregnant women exists across all age groups and racial and ethnic backgrounds. Because women are developing diabetes at younger ages, the number of women affected during their early, reproductive years has risen dramatically.
This study, by researchers at Kaiser Permanente in Southern California, found the prevalence of pre-existing type 1 or type 2 diabetes among pregnant women doubled, from less than one (0.81) out of 100 pregnancies in 1999 to close to two (1.82) out of 100 pregnancies in 2005. During the same period, the prevalence of gestational diabetes (diabetes that develops during pregnancy and then disappears after the baby is born) remained relatively stable.
Both pre-existing diabetes and gestational diabetes have health implications for mother and child that extend far beyond pregnancy. However, for women with pre-existing diabetes, maternal hyperglycemia that exists prior to pregnancy and continues into the first 8 weeks of gestation exposes the fetus to an increased risk of miscarriage and birth defects. Additionally, the earlier onset and longer duration of maternal diabetes also suggests the women may develop diabetes-related complications at an earlier age, the researchers concluded.
Dr. Jean Lawrence, the lead author on this study, suggests that "interventions that focus on reducing overweight and obesity can help decrease the number of women who have diabetes during their reproductive years. Given the increasing prevalence of diabetes in childbearing-age women, the awareness that preconception care reduces maternal and infant complications for women with diabetes as well as the availability of these services becomes increasingly important."