1. 1 The Costs of Diabetes in Europe Don’t Lose Sight of the Costs Rhys Williams Prifysgol Cymru Abertawe (University of Wales Swansea, UK)

2. 2 The Costs of Diabetes in Europe What are the costs? What can be done about them?

3. 3 What are the costs? Direct costs (of health care) –to society –to the individual and the family Indirect costs (of ‘lost production’) –Sickness absence, premature retirement and premature death Intangible costs –Reduced quality of life - anxiety, pain, discomfort etc.

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5. CODE-2 – the Cost of Type 2 Diabetes BEL FRA GER ITA NED SPA SWE UK All countries 735 751 809 1263 909 1004 773 756 7000 Direct cost (Billions of Euros - 1998) 1.1 4.0 12.4 5.8 0.4 2.0 0.7 2.6 29.0

6. 6 Complications and Hospital Costs 2.1x 3.1x 5.5x

7. 7 What can be done be done about them? People with existing diabetes (type 1 & type 2) –Reducing the risk of complications For people at risk of type 2 diabetes –Primary prevention ‘stopping diabetes before it starts’ These will reduce direct, indirect and intangible costs

8. 8 Intensive therapy is costly to start but less costly in the long run

9. 9 Trials have now shown that physical activity and weight loss reduce risk Source: The N Engl J Med, Volume 346, No 6, page 399

10. 10 Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle Among 522 Overweight Subjects with IGT. The Finnish Diabetes Prevention Study. Weight Change (kg) & Cumulative Incidence of Type 2 Diabetes (%) -3.5 kg -0.8 kg 11% 23% Tuomilehto et al. N. Engl. J. Med (2001). 344, 1343. P < 0.001 intervention control

11. 11 The Costs of Diabetes in Europe Costs are high and getting higher Complications are the most important ‘cost driver’ Costs can be reduced through primary and secondary prevention