Intense multifactorial treatment for type 2 diabetes shown to be cost effective

When patients with type 2 diabetes receive intensified, multifactorial treatment combining lifestyle modification and pharmacological therapy for modifiable risk factors, there is no significant increase in medical costs, compared to patients who receive conventional, multifactorial treatment, according to a study presented at the American Diabetes Association conference.

People with type 2 diabetes have an increased risk of damage to the eyes, kidneys, nerves, legs, heart and brain, and many of these complications can ultimately affect mortality. The 1993 Steno 2 study investigated whether a targeted, intensified, multifactorial regimen would have an impact on the mortality rate of patients with type 2 diabetes from any cause, including cardiovascular causes. The trial enrolled 160 Danish people with type 2 diabetes with consistent microalbuminuria and an average age of 55 years.

The patients were randomly assigned to two groups: 80 patients received conventional multifactorial treatment, based upon recommendations of the Danish Medical Association at the time; and 80 patients received intensified multifactorial intervention. In the intensified treatment group, all modifiable risk factors were treated ambitiously, and the group’s target levels for blood glucose, HbA1c, blood pressure, total cholesterol, LDL cholesterol and triglycerides were lower than those for the conventional treatment group. Treatment focused on polypharmacological approaches to cardiovascular issues, as well as improved health behaviours via nutrition, exercise and smoking cessation.

After 7.8 years of treatment, the intensified treatment group had an approximate 50% reduction in diabetes-related damage to the heart, brain and legs, compared to the patients receiving conventional care. All patients were subsequently followed observationally for an average of 5.5 years in a post-trial setting in which all study participants received intensified, multifactorial treatment. At 13.3 years follow-up, the group originally allocated to intensified treatment had a 50% reduction in mortality, and at 21.2 years follow-up, a median of 7.9 years of gain of life was demonstrated.

“The Steno-2 trial was instrumental in establishing treatment standards for people with type 2 diabetes, so it was important that we weighed the costs of the intensified multifactorial treatment recommended in the study,” said junior lead study author Joachim Gaede, a graduate student in the medicine program at the University of Copenhagen in Denmark.

“We discovered that while intensified, multifactorial treatment may lead to an initial increase in health care costs, this investment is recouped over time by the impressive health benefits and increased longevity the patients experienced. Additionally, the total direct costs of intensified, multifactorial intervention, which leads to disease-free-life length improvement of about eight years, was neutral compared to conventional treatment. So, in terms of cost, investing in early-intensified intervention of all known modifiable risk factors in high-risk individuals with type 2 diabetes will pay for itself over time due to a reduced cost of complications incurred by patients.”