A prospective audit was undertaken to characterise Ametabolic control, risk-factor profiles and costs of pharmaceutical agents required to achieve quality target measures in 100 type 2 diabetic patients attending a diabetic clinic in UK general practice. Despite reasonable glycaemic control, the coronary risk of these patients was high due to age, diabetes and dyslipidaemia. It proved impossible to quantify coronary risk for many older patients exactly since existing scales do not apply to patients aged over 75 years. The extra cost of initiating new treatments to modify coronary heart disease (CHD) risk for an average patient with type 2 diabetes was estimated to be £400—£860 (average £633) per annum. The treatment costs of instituting treatment to achieve quality measures should be considered when new quality standards are introduced. Without this investment the long-term costs of managing the complications of diabetes will be much higher.
Alberti KG, Gries FA for the European NIDDM Policy Group1988. Management of non-insulin-dependent diabetes mellitus in Europe: a consensus view. Diabet Med1988 ;5:275-81.
2.
Diabetes UK.Recommendations for the management of diabetes in primary care; http://www.diabetes.org.uk
3.
Epsom and St Helier Hospital Trust; local guidelines.
4.
National Service Framework for Coronary Heart Disease. March 2000. Department of Health. London .
5.
British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society endorsed by the British Diabetic Association. Joint British recommendations on the prevention of coronary heart disease in clinical practice. Heart1998;80(suppl 2):S1-S29.
6.
Mead M.Targeting lipids in diabetes. Update2002;64(9):618-28.
7.
National Institute for Clinical Excellence. March 2001. Guidance on the use of orlistat for the treatment of obesity in adults. Technology appraisal guidance - No. 22.
8.
National Institute for Clinical Excellence. October 2001. Guidance on the use of sibutramine for the treatment of obesity in adults. Technology appraisal guidance - No. 31.
9.
Ramsay LE, Williams B., Johnson GD et al. British Hypertension Society guidelines for hypertension management1999: summary. BMJ1999;319:630-5.
10.
Haffner SM, Lehto S., Ronnemaa T. et al. Mortality from coronary heart disease in subjects with type 2 diabetes mellitus and in non-diabetic subjects without prior myocardial infarction. N Engl J Med1998;339:229-34.
MIMS monthly index of medical specialities. March 2002.
13.
Bottomley J.Managing care of type 2 diabetes. Learnings from T2ARDIS. Br J Diabetes Vasc Dis2001;1:68-72.
14.
Holmes J., McGill S., Kind P., Bottomley J., Gillam S., Murphy M.Health-related quality of life in type 2 diabetes (T2ARDIS-2). Value in Health2000;3(S1):S47.
15.
UK Prospective Diabetes Study (UKPDS).Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ2000;321:405-12.
16.
UK Prospective Diabetes Study (UKPDS).Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study . BMJ2000;321: 412-19.
17.
UK Prospective Diabetes Study Group.Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group. BMJ1998;317:703-13.
