title: The "cost" of treating to target: cross-sectional analysis of patients with poorly controlled type 2 diabetes in Australian general practice.
abstract: BACKGROUND
  To describe the current treatment gap in management of cardiovascular risk factors in patients with poorly controlled type 2 diabetes in general practice as well as the associated financial and therapeutic burden of pharmacological treatment.
  
  
  METHODS
  Cross-sectional analysis of data from the Patient Engagement and Coaching for Health trial. This totalled 473 patients from 59 general practices with participants eligible if they had HbA1c > 7.5%. Main outcome measures included proportions of patients not within target risk factor levels and weighted average mean annual cost for cardiometabolic medications and factors associated with costs. Medication costs were derived from the Australian Pharmaceutical Benefits Schedule.
  
  
  RESULTS
  Average age was 63 (range 27-89). Average HbA1c was 8.1% and average duration of diabetes was 10 years. 35% of patients had at least one micro or macrovascular complication and patients were taking a mean of 4 cardio-metabolic medications. The majority of participants on treatment for cardiovascular risk factors were not achieving clinical targets, with 74% and 75% of patients out of target range for blood pressure and lipids respectively. A significant proportion of those not meeting clinical targets were not on treatment at all. The weighted mean annual cost for cardiometabolic medications was AUD$1384.20 per patient (2006-07). Independent factors associated with cost included age, duration of diabetes, history of acute myocardial infarction, proteinuria, increased waist circumference and depression.
  
  
  CONCLUSIONS
  Treatment rates for cardiovascular risk factors in patients with type 2 diabetes in our participants are higher than those identified in earlier studies. However, rates of achieving target levels remain low despite the large 'pill burden' and substantial associated fiscal costs to individuals and the community. The complexities of balancing the overall benefits of treatment intensification against potential disadvantages for patients and health care systems in primary care warrants further investigation.
authors.affiliation: Department of General Practice, The University of Melbourne, Melbourne, Australia. j.furler@unimelb.edu.au
authors.forename: John
authors.initials: J
authors.lastname: Furler
authors.forename: Justin W S
authors.initials: JW
authors.lastname: Hii
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.forename: Irene
authors.initials: I
authors.lastname: Blackberry
authors.forename: James
authors.initials: J
authors.lastname: Best
authors.forename: Leonie
authors.initials: L
authors.lastname: Segal
authors.forename: Doris
authors.initials: D
authors.lastname: Young
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D001315:Australia; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000188:drug therapy / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000191:economics; D058065:Diabetic Cardiomyopathies / Q000188:drug therapy* / Q000191:economics; D050171:Dyslipidemias / Q000188:drug therapy / Q000191:economics; D005260:Female; D058006:General Practice; D006442:Glycated Hemoglobin; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000191:economics; D000960:Hypolipidemic Agents / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000191:economics; D011306:Prescription Fees; D011507:Proteinuria / Q000188:drug therapy / Q000191:economics; D012307:Risk Factors; D013997:Time Factors; D055105:Waist Circumference
chemical_list: D000928:Antidepressive Agents; D000959:Antihypertensive Agents; D006442:Glycated Hemoglobin; D000960:Hypolipidemic Agents; C517652:hemoglobin A1c protein, human