Schiel Ralf, Müller Ulrich A, Stein Günter
Klinik für Innere Medizin III, Friedrich-Schiller-Universität Jena, Jena.
Med Klin (Munich). 2005 Aug 15;100(8):453-61. doi: 10.1007/s00063-005-1059-4.
Diabetes mellitus, its treatment with oral antidiabetic drugs and insulin, self-monitoring and the development of diabetesrelated long-term complications raise multiple socioeconomic problems. Hence, diabetes is one of the major challenges to modern health care systems. To date, there are only few data analyzing diabetes-related costs. Therefore, it was the aim of this trial to assess the costs of therapy of insulin-treated patients with diabetes mellitus out of a selection-free population over a period of 5 years.
JEVIN (Jena's St. Vincent trial) is a prospective population-based trial of all patients with type 1 and insulin-treated type 2 diabetes mellitus aged 16-60 years and living in the city of Jena, Thuringia, Germany. In addition to parameters of diabetes control (relative hemoglobin A(1c) [= HbA(1c)/mean normal], long-term complications, blood pressure), the costs of therapy in respect of insulin and oral antidiabetic drugs and materials to perform self-monitoring were analyzed in 1999/2000 compared to 1994/95. In 1994/95, 244 patients, in 1999/2000, 291 patients were examined.
During the period from 1994/95 to 1999/2000, relative HbA(1c) improved in both patients with type 1 (1.65 +/- 0.35 [n = 127] vs 1.48 +/- 0.30 [n = 114]; p < 0.0001) and insulin-treated type 2 diabetes (1.75 +/- 0.40 [n = 117] vs. 1.47 +/- 0.25 [n = 147]; p < 0.0001). The quality of blood pressure control remained constant. In 1999/2000 the costs per unit insulin for patients with type 1 diabetes were calculated at about 0.078 +/- 0.035 DM, in 1994/95 at 0.075 +/- 0.032 DM (p = 0.873). For patients with type 2 diabetes the costs were calculated at 0.070 +/- 0.032 DM in 1999/2000 and at 0.070 +/- 0.028 DM (p = 0.954) in 1994/95. In 1999/2000, to perform blood glucose self-monitoring the costs were 4.08 +/- 1.39 DM/d for patients with type 1 diabetes and 3.07 +/- 1.36 DM/d for patients with type 2 diabetes. In 1994/95 the costs for patients with type 1 diabetes amounted to 3.56 +/- 1.69 DM/d (p = 0.012), and for patients with insulin-treated type 2 diabetes mellitus to 2.77 +/- 1.66 DM/d (p = 0.138). In 1999/2000 the costs for antihypertensive drugs in 46/114 patients with type 1 diabetes were calculated at about 1.43 +/- 1.10 DM/d. In 1994/95 the costs for 32/127 patients amounted to 1.76 +/- 1.00 DM/d (p = 0.501). For 104/147 patients with insulin-treated type 2 diabetes, the costs of antihypertensive drugs were 2.02 +/- 1.48 DM/d in 1999/2000. In 1994/95 the costs amounted to 1.77 +/- 1.11 DM/d (p = 0.141) for 54/117 patients. In 1994/95 the total costs for patients with type 1 diabetes mellitus were calculated at about 7.10 +/- 2.69 DM/d. In 1999/2000 the costs amounted to 7.70 +/- 2.75 DM/d (p = 0.085). In patients with insulin-treated type 2 diabetes mellitus there was a significant increase in 1999/2000 versus 1994/95 (1994/95: 6.43 +/- 3.16, 1999/2000: 7.57 +/- 3.56 DM/d; p = 0.007).
Despite a tendency toward an increase in the costs for daily life, the therapy-related costs for patients with type 1 diabetes mellitus were constant in 1999/2000 versus 1994/95. In patients with type 2 diabetes, there was an increase of about 18%. For both patients with type 1 and type 2 diabetes, the costs were substantially higher than calculated in theoretical models.
糖尿病及其口服降糖药和胰岛素治疗、自我监测以及糖尿病相关长期并发症的发生引发了多个社会经济问题。因此，糖尿病是现代医疗保健系统面临的主要挑战之一。迄今为止，分析糖尿病相关成本的数据很少。因此，本试验的目的是评估在5年期间，从无选择人群中选取的接受胰岛素治疗的糖尿病患者的治疗成本。
耶拿圣文森特试验（JEVIN）是一项基于人群的前瞻性试验，研究对象为年龄在16 - 60岁、居住在德国图林根州耶拿市的所有1型糖尿病患者和接受胰岛素治疗的2型糖尿病患者。除了糖尿病控制参数（相对糖化血红蛋白A1c[=HbA1c/正常均值]、长期并发症、血压）外，还分析了1999/2000年与1994/95年相比，胰岛素、口服降糖药以及自我监测所需材料的治疗成本。1994/95年检查了244例患者，1999/2000年检查了291例患者。
在1994/95年至1999/2000年期间，1型糖尿病患者（1.65±0.35[n = 127]对比1.48±0.30[n = 114]；p < 0.0001）和接受胰岛素治疗的2型糖尿病患者（1.75±0.40[n = 117]对比1.47±0.25[n = 147]；p < 0.0001）的相对HbA1c均有所改善。血压控制质量保持不变。1999/2000年，1型糖尿病患者每单位胰岛素成本约为0.078±0.035德国马克，1994/95年为0.075±0.032德国马克（p = 0.873）。2型糖尿病患者的成本在1999/2000年为0.070±0.032德国马克，1994/95年为0.070±0.028德国马克（p = 0.954）。1999/2000年，1型糖尿病患者进行血糖自我监测的成本为4.08±1.39德国马克/天，2型糖尿病患者为3.07±1.36德国马克/天。1994/95年，1型糖尿病患者的成本为3.56±1.69德国马克/天（p = 0.012），接受胰岛素治疗的2型糖尿病患者为2.77±1.66德国马克/天（p = 0.138）。1999/2000年，46/114例1型糖尿病患者的降压药成本约为1.43±1.10德国马克/天。1994/95年，32/127例患者的成本为1.76±1.00德国马克/天（p = 0.501）。对于104/147例接受胰岛素治疗的2型糖尿病患者，1999/2000年降压药成本为2.02±1.48德国马克/天。1994/95年，54/117例患者的成本为1.77±1.11德国马克/天（p = 0.141）。1994/95年，1型糖尿病患者的总成本约为7.10±2.69德国马克/天。1999/2000年成本为7.70±2.75德国马克/天（p = 0.085）。接受胰岛素治疗的2型糖尿病患者在1999/2000年与1994/95年相比成本显著增加（1994/95年：6.43±3.16，1999/2000年：7.57±3.56德国马克/天；p = 0.007）。
尽管日常生活成本有增加趋势，但1型糖尿病患者1999/2000年与1994/95年相比治疗相关成本保持不变。2型糖尿病患者成本增加了约18%。1型和2型糖尿病患者的成本均大大高于理论模型中的计算值。
