title: Assessing the impact of complications on the costs of Type II diabetes.
abstract: OBJECTIVE
  'The Cost of Diabetes in Europe-Type II (CODE-2) study' provides the first coordinated attempt to assess the total costs of managing people with Type II (non-insulin-dependent) diabetes mellitus in Europe. Type II diabetes is associated with a number of serious long-term complications, which are a major cause of morbidity, hospitalisation and mortality in diabetic patients.
  
  
  METHODS
  Patients were divided into four broad categories defining their complication status in terms of no complications, one or more microvascular complications, one or more macrovascular complications or one or more of each microvascular and macrovascular complication. The prevalence of complications and associated costs were assessed retrospectively for 6 months.
  
  
  RESULTS
  In total, 72% of patients in the CODE-2 study had at least one complication, with 19% having microvascular only, 10% having macrovascular only and 24% of the total having both microvascular and macrovascular complications. Of patients with microvascular complications, 28% had neuropathy, 20% renal damage, 20% retinopathy and 6.5% required treatment for eye complications. Among the patients with macrovascular complications, 18% had peripheral vascular disease, 17% angina, 12% heart failure and 9% had myocardial infarction. Percutaneous transluminal coronary angioplasty, coronary artery bypass graft or stroke occurred in 3%, 4% and 5% of the patients, respectively. In patients with both microvascular and macrovascular complications, the total cost of management was increased by up to 250% compared to those without complications.
  
  
  CONCLUSIONS
  Complications have a substantial impact on the costs of managing Type II diabetes. This study has confirmed that the prevention of diabetic complications will not only benefit patients, but potentially reduce overall healthcare expenditure.
authors.affiliation: Nuffield Institute for Health, Division of Public Health, University of Leeds, 71-75 Clarendon Road, Leeds, LS2 9PL, UK. d.r.r.williams@leeds.ac.uk.
authors.forename: R
authors.initials: R
authors.lastname: Williams
authors.affiliation: Flemish Diabetes Association, Vlaamse Diabetes Vereniging, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Van Gaal
authors.affiliation: Institute of Health Economics, Institute of Economics Sanitaria, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Lucioni
keywords: CODE-2; Type II diabetes; complication; costs; management; pharmacoeconomics