title: Costs, outcomes and challenges for diabetes care in Spain.
abstract: BACKGROUND
  Diabetes is becoming of increasing concern in Spain due to rising incidence and prevalence, although little information is known with regards to costs and outcomes. The information on cost of diabetes in Spain is fragmented and outdated. Our objective is to update diabetes costs, and to identify outcomes and quality of care of diabetes in Spain.
  
  
  METHODS
  We performed systematic searches from secondary sources, including scientific literature and government data and reports.
  
  
  RESULTS
  Diabetes Type II prevalence is estimated at 7.8%, and an additional 6% of the population is estimated to be undiagnosed. Four Spanish diabetes cost studies were analyzed to create a projection of direct costs in the NHS and productivity losses, estimating €5.1 billion for direct costs along with €1.5 billion for diabetes-related complications (2009) and labour productivity losses represented €2.8 billion. Glycemic control (glycolysated hemoglobin) is considered acceptable in 59% of adult Type II cases, in addition to 85% with HDL cholesterol ≥40mg/dl and 65% with blood pressure <140/90 mmHg, pointing to good intermediate outcomes. However, annual figures indicate that over half of the Type II diabetics are obese (BMI >30), 15% have diabetic retinopathy, 16% with microalbuminuria, and 15% with cardiovascular disease.
  
  
  CONCLUSIONS
  The direct health care costs (8% of the total National Health System expenditure) and the loss of labour productivity are high. The importance of a multi-sectoral approach in prevention and improvements in management of diabetes are discussed, along with policy considerations to help modify the disease course.
authors: University Castilla La Mancha, Avda Real Fábrica de Seda s/n, Talavera de la Reina, Toledo, Spain. julio.lopezbastida@uclm.es
authors: Julio
authors: J
authors: Lopez-Bastida
authors: Mauro
authors: M
authors: Boronat
authors: Juan Oliva
authors: JO
authors: Moreno
authors: Willemien
authors: W
authors: Schurer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D004526:Efficiency; D004651:Employment / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D011787:Quality of Health Care; D013030:Spain / Q000453:epidemiology; D013222:State Medicine / Q000191:economics*; D016896:Treatment Outcome; D055815:Young Adult
references: Rev Esp Salud Publica. 2007 Sep-Oct;81(5):443-9
references: 18274349
references: Rev Esp Cardiol. 2005 Dec;58(12):1411-9
references: 16371200
references: Eur J Health Econ. 2006 Dec;7(4):270-5
references: 16850331
references: Rev Clin Esp. 2002 Aug;202(8):421-9
references: 12199991
references: Diabetes Care. 1998 Dec;21 Suppl 3:C7-10
references: 9850479
references: Pharmacoeconomics. 1995;8 Suppl 1:46-51
references: 10159003
references: Aten Primaria. 2002 Feb 28;29(3):145-50
references: 11879600
references: An Pediatr (Barc). 2011 Oct;75(4):259-65
references: 21684229
references: Diabetes Care. 2008 Feb;31(2):233-5
references: 18024850
references: Aten Primaria. 2003 May 15;31(8):493-9
references: 12765587
references: Aten Primaria. 2003;31(6):386-8
references: 12716575
references: Rev Esp Cardiol. 2002 Jun;55(6):657-70
references: 12113725
references: Diabetes Care. 2004 Nov;27(11):2616-21
references: 15504995
references: Diabetes Care. 1997 Apr;20(4):534-6
references: 9096976
references: Med Clin (Barc). 2006 Apr 15;126(14):521-6
references: 16756902
references: J Intern Med. 2001 Jul;250(1):57-65
references: 11454143
references: Gac Sanit. 2002 Nov-Dec;16(6):511-20
references: 12459134
references: Diabetologia. 2003 Jul;46(7):899-909
references: 12830379
references: Health Syst Transit. 2010;12(4):1-295, xix-xx
references: 21224176
references: Diabetes Care. 2008 Jan;31(1):90-2
references: 17909089
references: Rev Clin Esp. 2000 May;200(5):257-60
references: 10901003
references: BMC Public Health. 2012 Sep 20;12:812
references: 22994940
references: Diabetes Res Clin Pract. 1995 Nov;30(2):137-42
references: 8833635
references: Diabetologia. 2012 Jan;55(1):88-93
references: 21987347
references: Med Clin (Barc). 2010 Nov 6;135(13):600-7
references: 19765772
references: Med Clin (Barc). 2010 Sep;135 Suppl 2:27-32
references: 21420535
references: An Med Interna. 1995 Sep;12(9):431-7
references: 8924547
references: Diabetes Res Clin Pract. 2006 Feb;71(2):202-9
references: 16107290
references: An Esp Pediatr. 2001 Sep;55(3):213-8
references: 11676895
references: Diabetes Care. 1998 Jul;21(7):1122-8
references: 9653606
references: Diabetes Care. 1998 Aug;21(8):1370-1
references: 9702454
references: Endocrinol Nutr. 2008 Dec;55(10):442-7
references: 22980459
references: Rev Clin Esp. 2011 Mar;211(3):147-55
references: 21376312
references: Diabetes Res Clin Pract. 1999 Jan;43(1):33-40
references: 10199586
references: Diabetes Care. 1996 May;19(5):494-7
references: 8732715
references: BMC Public Health. 2010 Nov 05;10:675
references: 21054832
references: Nat Med. 2006 Jan;12(1):75-80
references: 16397575