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Diabetes complications a huge health care burden in poorer countries, not just the developed world


A study published this week in PLoS Medicine finds that major diabetes complications are a huge economic burden to health care systems around the world, adding new evidence in an area that has focused on cost estimates almost exclusively in the developed world.

Philip Clarke from the University of Sydney, Australia, and colleagues estimated the direct costs of different diabetes-related problems to hospitals in 20 low, middle and high-income countries in Asia, Eastern Europe, and the Established Market Economies like Canada, Australia, and those in Western Europe. Using data from the Action in Diabetes and Vascular Disease (ADVANCE) study, their analysis showed that major diabetes complications - such as stroke and heart disease - are a huge economic burden to health systems across all economic regions.

Nearly everyone in the study who developed heart failure attended hospital but only 15󈞆% of people were hospitalized for kidney problems--hospital stays were longest for stroke and shortest for kidney problems. The chances of hospitalization for any complication were lowest in Asia and highest in the Established Market Economies; conversely, lengths of stay were longest in Asia and shortest in the Established Market Economies.

Nearly 250 million people worldwide have diabetes and this number is increasing, with three quarters of all people with diabetes living in the developing world. The authors say that their new estimates can help inform health care decisions, especially in lower-income countries with limited resources.


Citation: Clarke PM, Glasziou P, Patel A, Chalmers J, Woodward M, et al. (2010) Event Rates, Hospital Utilization, and Costs Associated with Major Complications of Diabetes: A Multicountry Comparative Analysis. PLoS Med 7(2): e1000236. doi:10.1371/journal.pmed.1000236

Funding: The ADVANCE study was supported by grants from Servier (the major financial sponsor) and the National Health and Medical Research Council (NHMRC) of Australia (grant no. 211086 and 358395). Servier manufactures gliclazide (modified release) and the fixed combination of perindopril and indapamide. This work was also partly funded through an NHMRC Project Grant (512463) and PMC was funded from an Australian NHMRC Career Development Award (571122). JAS's participation in the study was assisted by a University of Sydney Visiting Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:PMC has received research grants from Servier. PG has received funding from the George Institute for the cost-effectiveness sub-study of the ADVANCE trial. AP reports receiving lecture fees from Servier, Pfizer, and Abbott and grant support from Pfizer, Servier, and Sanofi-Aventis. JC has received research grants from Servier, administered through the University of Sydney, as Co-Chief investigator for ADVANCE and has received lecture fees from Servier for speaking at scientific meetings. He has also received lecture fees from Pfizer and Daiichi and grant support from Servier. MW has received consulting fees from GlaxoSmithKline, AstraZeneca, and Pfizer, lecture fees from Pfizer, and grant support from Pfizer and Sanofi-Aventis. He has received lecture fees from Servier to present on the main results from ADVANCE (not those in this paper). He has also served on a steering committ ee for Roche. SBH has received lecture fees from Pfizer and Servier. JAS and AP are on the Editorial Board of PLoS Medicine.



Philip Clarke
University of Sydney
School of Public Health
+61 2 9351 5424

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