Managing care of type 2 diabetes. Learnings from T2ARDIS*

Abstract

The T²ARDIS* survey reported total resource use in the NHS and Social Services for people with type 2 diabetes.

Patients and methods Cross-sectional postal survey data were acquired from a random sample of people diagnosed with type 2 diabetes from population-wide diabetes registers. Aggregated resource use, implications for healthcare management, and costs in the NHS and Social Services were considered. The data were compared to resource data in the general population to determine the impact of developing diabetic complications, particularly vascular disease. Implications for services were also considered.

Results At a population level, on average one in four patients reported microvascular complications, one in 10 macrovascular complications and one in 14 reported both. Compared to the general population, people with type 2 diabetes were admitted to hospital more often and stayed longer as in-patients. This trend was similar for out-patient care. Across the whole cohort, more than 40% of the NHS cost was due to in-patient care. Diabetic complications increased costs in the NHS and Social Services, costs of insulin products and other drugs. The average annual spend on oral antidiabetic drugs accounted for only 2% of NHS costs for diabetes.

Conclusion Most of the costs of care for the person with type 2 diabetes are borne by the NHS and the hospital sector. T²ARDIS* has probably under-estimated costs of the co-morbidity of type 2 diabetes. Complications significantly increase costs across all sectors. Evidence indicates that preventing the vascular complications of diabetes could avoid or delay hospitalisations and disability. Targeting resources should optimise the use of available services.