Patients on intensive therapy who maintain near normal blood sugar for life are predicted to gain on average an extra 5 years of life, 8 years of sight, 6 years free from kidney disease, and 6 years free from amputations and nerve damage, compared with patients on standard therapy, according to Richard C. Eastman, M.D., of the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases.

Intensive treatment costs about $4500 per patient each year and requires three or four insulin injections as well as multiple tests for blood sugar daily to keep blood sugar as close to normal as possible. Standard treatment, which costs $1,700 per patient annually, involves one or two insulin injections daily and fewer daily tests of blood sugar levels.

"The challenge now is to convince health care providers and payers to look past the immediate cost of intensive therapy and consider the potential gains in quantity and quality of life for persons with IDDM," Eastman says. However, he cautions that intensive therapy must be carefully monitored by a knowledgeable physician since the treatment can double or triple the risk of severe low blood sugar, which can cause seizure and coma.

The cost effectiveness of intensive treatment is comparable to interventions that are considered a good value, such as therapy for hypertension.

The study used a computer simulation model applied to a hypothetical sample of 120,000 persons with IDDM, who were similar to the patients studied in NIDDK’s Diabetes Control and Complications Trial (DCCT), completed in 1993.

"The DCCT established that intensive diabetes management provides a major reduction in long-term complications," said David M. Nathan, M.D., the Chairman of DCCT publications. "The economic analysis allows us to project the savings, in human and financial terms, and the costs of implementing intensive therapy. In my opinion, it’s a bargain."

The model estimates the lifetime costs of standard and intensive treatment, complications, and health care resulting from added years of life.

The study is the first to compare the lifetime benefits and costs of intensive therapy versus standard treatment.

About 800,000 people in the United States suffer from IDDM, an autoimmune disorder in which the body produces little or no insulin, a hormone that enables the body to derive energy from food. Eventually, diabetes may cause blindness, kidney disease, and nerve damage, which can lead to amputations. To reduce the risk of these long-term complications, patients should keep blood sugar levels as close to normal as is safely possible. Diabetes costs the United States nearly $100 billion annually.

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