According to the German Federal Ministry of Health (BMG), around 7.2 percent of adults aged 18 to 79 in Germany suffer from diabetes mellitus. 90 to 95 percent of them have type 2 diabetes. It is caused on the one hand by a reduced sensitivity of the body's cells to insulin (insulin resistance), and on the other hand by years of overproduction of insulin, which leads to "exhaustion" of the insulin-producing cells, so that the pancreas cannot supply enough insulin to meet the increased demand. In addition to a hereditary predisposition, obesity and lack of exercise are considered the most important contributors to type 2 diabetes.

The costs of routine diabetes management and the treatment of diabetes complications represent a considerable health burden for patients as well as an economic burden for health care systems and societies. The Assistant Professorship of Public Health and Prevention headed by DZD scientist Prof. Dr. Michael Laxy therefore conducted a study to estimate the long-term health and economic consequences of improved risk factor control in German adults with type 2 diabetes. The results have now been published in the journal "Diabetologia" under the title "Health and economic impact of improved glucose, BP and lipid control among German adults with type 2 diabetes: a modelling study". The journal has an impact factor of 10.460.

"Patients with type 2 diabetes are unfortunately often not optimally controlled when you look at the risk factors," says Min Fan, first author of the study and a research associate at the Chair of Public Health and Prevention. "These include glycemic control, as well as blood pressure and lipid control. Here, the various professional societies make recommendations on the range of threshold values or which targets should be adhered to. In the study, we looked at what would happen if all patients achieved certain treatment targets for these risk factors, as recommended in guidelines."

Using the UK Prospective Diabetes Study Outcome Model 2 (UKPDS-OM2), health outcomes and costs of care in the healthcare system of people with type 2 diabetes in Germany were calculated over the five-, 10-, and 30-year time periods. The scenarios modeled were sustained reductions in HbA1c, which describes how high blood glucose has been in the last eight to 12 weeks, systolic blood pressure, and LDL cholesterol.

"We tried to analyze what the health impact would be of achieving certain treatment targets for risk factors at the population level," Prof. Laxy explains. "The end parameter we looked at is quality-adjusted life. This is made up of quality of life and person lifespan. In addition, we calculated what the economic implications of a guideline-adjusted setting would be within the health care system in terms of costs for outpatient and inpatient care, medication, etc."

The researchers found that sustained achievement of a target value of below 7% for HbA1c, below 140 mmHg for systolic blood pressure, and below ≤2.6 mmol/l for LDL cholesterol would lead to substantial cost savings and gains in quality-adjusted lifetime for all individuals with type 2 diabetes in Germany. On a national level, this could reduce care costs by more than 1.9 billion euros over a ten-year period. In this respect, sustainable improvements in diabetes patients in Germany would lead to substantial health benefits and significantly reduce healthcare expenditures.

"This is a health economic modeling with certain assumptions," Prof. Laxy puts the results into perspective. "If I want to provide better care to affected individuals in the first place, which can lead to cost savings in the long run, then of course more resources have to be devoted to therapy and management. We didn't account for these investments for better or more intensive prevention and care in our study."

The expected long-term health and economic benefits analyzed in the course of the study can now help German decision-makers in the next step to evaluate interventions and therapy options from the point of view of efficiency.
 

Original publication:
Min Fan, Anna-Janina Stephan, Karl Emmert-Fees, Annette Peters, Michael Laxy: Health and economic impact of improved glucose, blood pressure and lipid control among German adults with type 2 diabetes: a Modeling Study. Diabetologia 2023. doi.org/10.1007/s00125-023-05950-3

Scientific Contact:
Prof. Dr. Michael Laxy
Assistant Professorship of Public Health and Prevention
Georg-Brauchle-Ring 60/62
80992 München
phone: +49 (0)89 289 24977
e-mail: michael.laxy(at)tum.de

Min Fan
Assistant Professorship of Public Health and Prevention
Georg-Brauchle-Ring 60/62
80992 München
phone: +49 (0)89 289 24982
e-mail: min.fan(at)tum.de

The German Center for Diabetes Research (DZD) is a national association that brings together experts in the field of diabetes research and combines basic research, translational research, epidemiology and clinical applications. The aim is to develop novel strategies for personalized prevention and treatment of diabetes. Members are Helmholtz Munich – German Research Center for Environmental Health, the German Diabetes Center in Düsseldorf, the German Institute of Human Nutrition in Potsdam-Rehbrücke, the Paul Langerhans Institute Dresden of Helmholtz Munich at the University Medical Center Carl Gustav Carus of the TU Dresden and the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the Eberhard-Karls-University of Tuebingen together with associated partners at the Universities in Heidelberg, Cologne, Leipzig, Lübeck and Munich. www.dzd-ev.de/en