Several observations align to indicate the increasing need to prevent type 2 diabetes, rather than simply treat it, once established. Chapter 1 has mentioned the increasing prevalence and incidence, excess mortality and limited effectiveness of interventions. In addition to these, diabetes, and particularly type 2 diabetes, incurs high health care costs.
Estimates of costs vary depending on the methods used17, but from $6018 to $100 billion19 in health care costs were spent on diabetes in the USA in 1995, which is variously estimated to be 6-17% of all health care costs. The majority of health care costs for diabetes are spent in developed countries, whereas estimates suggest that the majority of disability-adjusted life years (DALYs) are lost in developing countries, where limited health care budgets are available to deal with the problems of diabetes18. Recent studies from US health maintenance organizations (HMOs) have shown approximately two-fold increases in medical care expenses within the first year after diagnosis20, with the highest expenses being incurred for hospitalizations due to coronary heart disease (CHD) and end-stage renal disease21 (ESRD).
Eastman et al.22 have estimated that primary prevention of type 2 diabetes, given reasonable assumptions, could be cost-effective, and within the range of other primary prevention activities currently undertaken23 if there were efficacious interventions available. It is the purpose of this chapter to review relevant data to determine if such interventions exist.
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