Insulin therapy for diabetes mellitus: treatment regimens and associated costs.

AIMS: To describe insulin therapy in patients with diabetes, to determine treatment costs and to compare costs among treatment regimens. METHODS: This observational study was performed by 734 French pharmacists. Adult patients filling an insulin prescription were invited to participate. Participants provided information on their diabetes history and management. Levels of intensification of insulin therapy were determined by the number of injections in type 1 diabetes mellitus (T1DM) patients, and by the different schemes used in type 2 (T2DM) patients, such as basal/intermediate-acting insulin only, and regimens using both basal and rapid-acting insulin. Costs were evaluated according to official medication costs, nurse visits and glucose monitoring kits. RESULTS: A total of 361 patients with T1DM and 1902 with T2DM were enrolled in the survey. Patients with T1DM more frequently took 1-2 injections per day (46.3% of patients) and used single-dose basal insulin together with ≥1 dose of rapid insulin (43.8%). Patients with T2DM used multiple treatment regimens, with 58 different combinations documented. Most took basal/intermediate insulin only (42.5%) or combinations of basal/intermediate and rapid insulins (52.7%). Mean cost of insulin therapy was €27.4/week for T1DM and €45.4/week for T2DM. In T1DM, insulin was the biggest cost component and increased with the number of injections/day. In T2DM, nurse visits were the most important cost contributors irrespective of treatment regimen. Overall, the cost of insulin therapy increased with the complexity of the insulin schemes. CONCLUSION: Considerable heterogeneity is found in insulin treatment regimens used in everyday diabetes care. Payers should consider the full costs associated with the use of insulin rather than the cost of insulin alone. Treatment algorithms to harmonize insulin therapy should help to improve care, while encouraging patients to self-inject insulin should help to reduce costs.

Prevalence and treatment of diabetes in France: trends between 2000 and 2005.

AIMS: To estimate the prevalence of diabetes mellitus in France from 2000 to 2005, to monitor changes in its medical management and to determine the resultant costs to the French national healthcare system. METHODS: Using patients' data from the permanent sample of healthcare affiliates, we defined a treated diabetic patient as anyone who had been reimbursed for insulin or oral hypoglycaemic drugs at least twice within one calendar year. RESULTS: The prevalence of treated diabetic patients in 2005 in the French population covered by the general healthcare scheme was 3.6% (+/-0.1). The average annual increase between 2000 and 2005 was 5.7%, of which 0.7% can be attributed to population ageing. In 2005, the maximum prevalence of treated diabetic patients among those aged 70-79 years was 17.7% for men and 11.5% for women. Cardiovascular risk factors associated with diabetes were treated more often with drug therapy in 2005 than in 2000. In 2005, 73.8% of diabetic patients were given antihypertensive drugs and 54.9% received cholesterol-lowering agents. In 2005, the annual cost of treatment with antidiabetic drugs and treatment of cardiovascular risk factors was 760 euros per diabetic patient. CONCLUSION: The number of treated diabetic patients greatly increased between 2000 and 2005. At the same time, their associated cardiovascular risk factors were more frequently managed by drug therapy. As a result, the total expenditures for the healthcare system for treating diabetes and its associated cardiovascular risk factors doubled in five years, amounting to 1.8 billion euros in 2005.