COSTS OF INSULIN-DEPENDENT DIABETES-MELLITUS

Insulin-dependent diabetes mellitus (IDDM) is a prevalent chronic dise ase that causes marked personal and financial costs for patients, thei r families and society, Accurate information on costs of the disease i s scarce. In this article, we review studies on disease and disease st age-connected costs at the individual and societal levels, and discuss possibilities of decreasing or preventing costs attributable to IDDM. The 3 disease stages are the initial treatment, follow-up after the i nitial treatment and late treatment. Total costs of IDDM in a given co untry depend on the incidence of the disease and the efficiency (cost effectiveness) of treatment. Besides everyday treatment costs, the acu te and long term complications of the disease cause major additional c osts. The lifetime financial costs of IDDM and the amount of human suf fering are always substantial. The costs of the 3 clinical stages of I DDM differ markedly. The initial and late periods induce cost peaks, b ut the costs of follow-up after initial treatment are small. During in itial treatment, costs depend mostly on the possible length of hospita lisation. During the late treatment period, costs begin to accumulate rapidly because of long term complications such as diabetic nephropath y, retinopathy, neuropathy and macrovascular disease. Intensive ambula tory care, effective patient education that results in normoglycaemia or near-normoglycaemia in patients and, if needed, shortening of hospi talisations, are the only means to restrict or decrease the costs of I DDM until primary prevention is available. Postponing complications by any length of time will always decrease human suffering and lead to m arked savings in healthcare resources.