Trends of drug use and economic cost of the treatment of diabetes mellitus

Abstract The impact of diabetes mellitus (DM) on public health is growing worldwide due to its increasing prevalence and the severity of complications. According to the ARNO observational study, a population-oriented database containing 20 years of medical prescriptions for over 10 million Italians in 30 Local Health Districts of 7 regions, the prevalence of pharmacologically treated DM increased from 3% to over 5% from 1997 to 2008; the associated direct costs may be estimated to be 54% higher per population unit compared to similar patients without DM. Over the years, pharmacological treatment has been modified according to the results of recent trials (metformin as initial treatment, larger use of cholesterol and blood pressure lowering drugs), but drug use remains far below the standards proposed by guidelines, and clinical targets are not systematically reached. More aggressive treatment based on both standard and innovative pharmacological approaches would be needed to reduce the clinical burden of the disease, but such a policy would increase the total cost of DM to levels largely incompatible with economic resources in an era of financial crisis. A policy that promotes primary prevention, involving decision makers at different levels, even outside the National Health System, is urgently needed.