Health outcomes in type 2 diabetes

Outcome evaluation is of great interest throughout the healthcare field, bu t which outcomes are important depends on the viewpoint one holds. For the healthcare organisation costs and resource utilisation are paramount, where as patients may be interested in being able to work and lead a productive l ife without long-term complications. Healthcare policy decisions are influe nced by varying degrees of social forces, existing regulations and outcome research findings. Ideally, all three are in agreement but often they may b e competitive or may not even be included in policy decision making. With respect to improving outcomes, much energy has been spent on developin g diabetes care guidelines. However, these have had minimal impact on physi cian behaviour. Soon after onset or diagnosis of diabetes, we are most conc erned with process measures such as micro-albumin levels, blood pressure mo nitoring, routine eye and foot examinations and lipid profiles. These proce ss measures are related to the development of intermediate outcomes -protei nuria, retinopathy, foot ulcers and dyslipidaemia. Diabetes is an expensive disease but there is accumulating evidence that improved care can lead to better quality of life and reduction in health care resource utilisation. T he UKPDS demonstrated that for one percentage point decrease in HbA(1c) the re was a 35% reduction in the risk of complications. Preliminary data from various diabetes management programmes indicate that instituting standardis ed care may lead to cost savings and improved health. Rationing health care resources wisely requires consideration of multiple f actors including quality of life years (QALYs) and healthy year equivalents (HYEs). Formal quantitative methods are used to measure overall desirabili ty of a medical intervention. Questions to be answered include predictabili ty of responsiveness or adverse events to drug therapy. Outcomes research w ill have a key role in future development of models of diabetes care.