Skip to main content
Log in

Diabetes Mellitus and the St Vincent Declaration

The Economic Implications

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

Diabetes mellitus imposes significant costs both on individuals and on healthcare delivery systems. Chronic diseases such as diabetes mellitus have lifetime costs, and so resources spent on interventions now may not bring benefits, in terms of reduced complications, for many years.

In Europe, the St Vincent Declaration, which includes targets for the reduction of diabetes mellitus-related complications, is an important initiative set up to address quality and education issues relevant to people with diabetes mellitus. The Declaration is to be welcomed as focusing attention on diabetes mellitus, and its implementation may lead to a reduction in healthcare expenditure on complications in future years.

The aims of the St Vincent Declaration are to set goals and 5-year targets to improve quality of life and life expectancy for people with diabetes mellitus and to reduce the serious complications associated with the disease. Achievement of these targets will depend on good organisation and management of services to people with diabetes mellitus, but the aims are a clear signal that the importans of prevention and education have been recognised.

A major barrier to the implementation of the Declaration is financial. If more people are diagnosed and treated, more services will be required. This will incur costs, although future benefits will be gained in terms of a reduction in complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Nabarro JDN. Diabetes in the United Kingdom: some facts and figures. Diabet Med 1988; 5: 816–22

    Article  PubMed  CAS  Google Scholar 

  2. Williams R. Diabetes: assessing a district’s needs. Times Health Suppl 1991 Apr: 5–7

  3. Bosanquet N, Leese B. Family doctors and economic incentives. Aldershot: Dartmouth Publishing Company, 1989

    Google Scholar 

  4. Diabetes care and Research in Europe. The Saint Vincent Declaration. Diabetologia 1990; 10 Suppl.: 143–4

    Google Scholar 

  5. Piwernetz K, Benedetti MM, Johansen KS. Advanced health care initiatives in Europe: on quality development, epidemiology and medical documentation. Diabete Metab 1993; 19: 213–7

    PubMed  CAS  Google Scholar 

  6. Piwernetz K. Information technology for diabetes care in Europe: the EURODIABETA Initiative. Diabet Med 1990; 7: 639–50

    Article  Google Scholar 

  7. Piwernetz K, Home PD, Snorgaard O, et al. Monitoring the targets of the St Vincent Declaration and the implementation of quality management in diabetes care: the DIABCARE Initiative. Diabet Med 1993; 10: 371–7

    Article  PubMed  CAS  Google Scholar 

  8. Fuller JH. Recent developments in diabetes epidemiology in Europe. World Health Stat Q 1992; 45: 350–4

    PubMed  CAS  Google Scholar 

  9. Sönksen P, Harris A, Jarman B. Perceived strategic and practical problems in the use of information technology for quality improvement in diabetes care in the United Kingdom. Diabete Metab 1993; 19: 80–8

    PubMed  Google Scholar 

  10. Alberti KGMM. The European Patients’ Charter. Diabet Med 1991; 8: 782–3

    Article  Google Scholar 

  11. Diabetes Care and Research in Europe. Implementation of the St. Vincent Declaration for improvement of diabetes care, 2nd meeting, March 1992, Budapest. Diabetologia 1993; 13 Suppl. N2

  12. Krans HMJ, Porta M, Keen H, editors. Diabetes care and re­search in Europe: the St Vincent Declaration action pro­gramme — implementation document. Diabetologia 1992; 12 Suppl. 2

    Google Scholar 

  13. Department of Health. The health of the nation. London: Her Majesty’s Stationery Office, 1991

    Google Scholar 

  14. Department of Health. A consultative document for health in England. London: Her Majesty’s Stationery Office, 1991: Command 1523

    Google Scholar 

  15. Department of Health. On the state of the public health for the year 1992. London: Her Majesty’s Stationery Office, 1993

    Google Scholar 

  16. Wilson AE, Home PD. A data set to allow exchange of information for monitoring continuing diabetes care. Diabet Med 1993; 10: 378–90

    Article  PubMed  CAS  Google Scholar 

  17. Mühlhauser I, Sulzer M, Berger M. Quality assessment of diabetes care according to the recommendations of the St. Vincent Declaration: a population-based study in rural area of Austria. Diabetologia 1992; 32: 429–35

    Article  Google Scholar 

  18. Redmond S, Stammer C. Morbidity chart. Pulse 1990 Oct 27: 10

    Google Scholar 

  19. MacLeod J, editor. Davidson’s principles and practice of medicine. London: Churchill Livingstone, 1974: 676

    Google Scholar 

  20. Reenders K, De Nobel E, van den Hoogen HJM, et al. Diabetes and its long-term complications in general practice: a survey in a well-defined population. Fam Pract 1993; 10: 169–72

    Article  PubMed  CAS  Google Scholar 

  21. McKeigue PM, Pierpoint T, Ferrie JE, et al. Relationship of glucose intolerance and hyperinsulinaemia to body fat pattern in South Asians and Europeans. Diabetologia 1992; 35: 785–91

    PubMed  CAS  Google Scholar 

  22. Simmons D, Williams DRR, Powell MJ. Prevalence of diabetes in different regional and religious South Asian communities in Coventry. Diabet Med 1992; 9: 428–31

    Article  PubMed  CAS  Google Scholar 

  23. Cruickshank JK, Cooper J, Burnett M, et al. Ethnic differences in fasting plasma c-peptide and insulin in relation to glucose tolerance and blood pressure. Lancet 1991; 338: 842–7

    Article  PubMed  CAS  Google Scholar 

  24. Simmons D. Diabetes — inpatient utilisation, costs and data validity. N Z Med J 1992 Sep 23: 388

    Google Scholar 

  25. Raheja BS, Sadicot SM, Phatak RB, et al. Prevalence of diabetes in Asian Indians. Diabetes Care 1993; 16: 844–5

    PubMed  CAS  Google Scholar 

  26. Sinclair A, Barnett AH. Special needs of elderly diabetic patients. BMJ 1993; 306: 1142–3

    Article  PubMed  CAS  Google Scholar 

  27. Funnell MM, Merritt JH. The challenges of diabetes and older adults. Nurs Clin North Am 1993; 28: 45–60

    PubMed  CAS  Google Scholar 

  28. Oklahoma State Department of Health. Diabetes mellitus — its economic impact. J Okla State Med Assoc 1991; 84: 30

    Google Scholar 

  29. Ruwaard D, Hoogenveen RT, Verkleij H, et al. Forecasting the number of diabetic patients in The Netherlands in 2005. Am J Public Health 1993; 83: 989–95

    Article  PubMed  CAS  Google Scholar 

  30. Gatling W, Houston AC, Hill RD. The prevalence of diabetes mellitus in a typical English community. J R Coll Physicians Lond 1985; 19: 248–50

    PubMed  CAS  Google Scholar 

  31. Helms RB. Implications of population growth on prevalence of diabetes. Diabetes Care 1992; 15 Suppl. 1: 6–9

    PubMed  Google Scholar 

  32. Fisher U, Kohnert K-D. EASD-DO IT study group: diabetes epidemiology in Europe — contributions to the implementation of the St. Vincent Declaration. Diabetologia 1993; 36: 28–9

    PubMed  Google Scholar 

  33. Kelly WF, Mahmood R, Kelly MJ. The influence of social deprivation on illness in diabetic patients. BMJ 1993; 307: 1115–6

    Article  PubMed  CAS  Google Scholar 

  34. Crow YJ, Alberti KGMM, Parkin JM. Insulin dependent diabetes in childhood and material deprivation in Northern England, 1977–86. BMJ 1991; 303: 158–60

    Article  PubMed  CAS  Google Scholar 

  35. Surveys show socioeconomic trends in diabetes. Hospitals 1991 Feb 20: 14

  36. Morbidity and Mortality Weekly Report. Economic cost of diabetes mellitus — Minnesota, 1988. Washington, DC: US Department of Health and Human Services, 1991: 40 (14): 229–31

    Google Scholar 

  37. Rice DP. Estimating the costs of illness. Washington, DC: Government Printing Office, 1966: Health Economics Series. PHS Publication No. 947–6

    Google Scholar 

  38. Drummond MF, Davies LM, Ferris FL. Assessing the costs and benefits of medical research: the diabetic retinopathy study. Soc Sci Med 1992; 34: 973–81

    Article  PubMed  CAS  Google Scholar 

  39. Triomphe A, Flori YA, Costagliola D etal. The cost of diabetes in France. Health Policy 1988; 9: 34–48

    Article  Google Scholar 

  40. Matsushima M, Tajima N, Agata T, et al. Social and economic impact on youth-onset diabetes in Japan. Diabetes Care 1993; 16: 824–7

    Article  PubMed  CAS  Google Scholar 

  41. Gerard K, Donaldson C, Maynard A. The cost of diabetes. Diabet Med 1989; 6: 164–70

    Article  PubMed  CAS  Google Scholar 

  42. Laing W, Williams R. Diabetes: a model for health care management. London: Office of Health Economics, 1989

    Google Scholar 

  43. Berry R, Stone C, Thompson M, et al. The incidence-based economic costs of diabetes mellitus. In: Evaluation of cost of illness ascertainment methodology, part II: applications of methodology of ascertain lifetime economic costs of illness in an incidence cohort. Hyattsville, MD: Department of Health and Human Services, 1981

    Google Scholar 

  44. Entmacher PS, Sinnock P, Bostic E, et al. Economic impact of diabetes. In: National Diabetes Data Group. Diabetes in America. Bethesda, MD: US Department of Health and Human Services, 1985: NIH Publication no.85: 1468

    Google Scholar 

  45. Jönsson B, Persson U. Diabetes: a study in health economics. Lund: Swedish Institute for Health Economics, 1981. IHE Report No. 1981: 7

    Google Scholar 

  46. Huse DM, Oster G, Killen AR, et al. The economic costs of non-insulin dependent diabetes mellitus. JAMA 1989; 262: 2708–13

    Article  PubMed  CAS  Google Scholar 

  47. Herman WH, Teutsch SM, Geiss LS. Diabetes mellitus. In: Amler RW, Dull HB, editors. Closing the gap: the burden of unnecessary illness. Oxford: Oxford University Press, 1987: 72–82

    Google Scholar 

  48. American Diabetes Association. Direct and indirect costs of diabetes in the United States in 1987. Washington, DC: American Diabetes Association, 1988

    Google Scholar 

  49. Persson U. The economics of diabetes — a review. Lund: Swedish Institute for Health Economics, 1989. IHE Working Paper No. 1989: 3

    Google Scholar 

  50. Leese B. The costs of diabetes and its complications. Soc Sci Med 1992; 35: 1303–10

    Article  PubMed  CAS  Google Scholar 

  51. Fishbein HA. Patient outcomes research and type II diabetes. Diabetic Care 1993; 16: 656–7

    CAS  Google Scholar 

  52. Gagliardino EM, Olivera H, Barragan H, et al. A simple economic evaluation model for selecting diabetes health care strategies. Diabet Med 1993; 10: 351–4

    Article  PubMed  CAS  Google Scholar 

  53. Chale SS, Swai ABM, Mujinja PGM, et al. Must diabetes be a fatal disease in Africa? Study ofcosts oftreatment. BMJ 1992; 304: 1215–8

    Article  PubMed  CAS  Google Scholar 

  54. Alexander WD. Diabetes care in a UK health region: activity, facilities and costs. Diabet Med 1988; 5: 577–81

    Article  PubMed  CAS  Google Scholar 

  55. Leese B. The cost of diabetes and its complications: a review. York: Centre for Health Economics, University of York, 1991. Discussion Paper 94

    Google Scholar 

  56. Bransome ED. Improving the financing of diabetes care in the 1990s: recommendations of the 1989 conference. Diabetes Care 1992; 15 Suppl. 1: 66–71

    Article  PubMed  Google Scholar 

  57. WHO. Diabetes mellitus: report of a WHO study group. World Health Organ Tech Rep Ser 1985: 727

  58. Bradshaw C, Eccles MP, Choi HY. Can general practitioners assess diabetic control? Can anybody do any better? Diabet Med 1991; 8: 543–6

    Article  PubMed  CAS  Google Scholar 

  59. Drury TF. Disability among adult diabetics. In: National Diabetes Data Group. Diabetes in America: diabetes data compiled 1984. Bethesda, MD: US Department of Health and Human Services, 1985: NIH Publication No. 85: 1468

    Google Scholar 

  60. McKendry JBR. Direct costs of diabetes care: a survey in Ottawa, Ontario, 1986. Can J Public Health 1989; 80: 124–8

    PubMed  CAS  Google Scholar 

  61. Damsgaard F. Known diabetes and fasting hyperglycaemia in the elderly. Dan Med Bull 1990; 37: 530–48

    PubMed  CAS  Google Scholar 

  62. Weinberger M, Cowper PA, Kirkman MS, et al. Economic impact of diabetes mellitus in the elderly. Clin Geriatr Med 1990; 6: 959–69

    PubMed  CAS  Google Scholar 

  63. Olivera EM, Duhalde EP, Gagliardino JJ. Costs of temporary and permanent disability induced by diabetes. Diabetes Care 1991; 14: 593–6

    Article  PubMed  CAS  Google Scholar 

  64. Alberti KGMM. Role of diabetes. BMJ 1991; 303: 769–72

    Article  PubMed  CAS  Google Scholar 

  65. Glauber HS, Brown JB. Use of health maintenance organisation data bases to study pharmacy resource usage in diabetes mellitus. Diabetes Care 1992; 15: 870–6

    Article  PubMed  CAS  Google Scholar 

  66. Jacobs J, Sena M, Fox N. The cost of hospitalisation for the late complications of diabetes in the United States. Diabet Med 1991; 8 Suppl.: S23–9

    Article  Google Scholar 

  67. Newsholme EA, Leech AR. Biochemistry for the medical sciences. Chichester: John Wiley, 1983

    Google Scholar 

  68. Chukwuma C, Tyre I. Diabetic nephropathy: clinical characteristics and economic impact. J Diabetes Complications 1993; 7: 15–27

    Article  PubMed  Google Scholar 

  69. Smith DG, Harlan LC, Hawthorne VM. The charges for ESRD treatment of diabetics. J Clin Epidemiol 1989; 42: 111–8

    Article  PubMed  CAS  Google Scholar 

  70. Borch-Johnsen K, Wenzel H, Viberti GC, et al. Is screening and intervention for microalbuminuria worthwhile in patients with insulin dependent diabetes? BMJ 1993; 306: 1722–3

    Article  PubMed  CAS  Google Scholar 

  71. Department of Health. On the state of the public health for the year 1990. London: Her Majesty’s Stationery Office, 1991

    Google Scholar 

  72. Javitt JC, Aiello LP, Bassi LJ, et al. Detecting and treating retinopathy in patients with type I diabetes mellitus. Ophthalmology 1991; 98: 1565–73

    PubMed  CAS  Google Scholar 

  73. Ackerman SJ. Benefits of preventive programs in eye care are visible on the bottom line. Diabetes Care 1992; 15: 580–1

    PubMed  CAS  Google Scholar 

  74. Rand LI. Financial implications of implementing standards of care for diabetic eye disease. Diabetes Care 1992; 15 Suppl. 1: 32–5

    PubMed  Google Scholar 

  75. Dyck PJ, Stiller R. Signposts to the detection of diabetic peripheral neuropathy. Wyeth-Ayerst, 1990

  76. Reiber GE. Diabetic foot care: financial implications and practice guidelines. Diabetic Care 1992; 15 Suppl. 1: 29–31

    Google Scholar 

  77. Deckert T, Poulsen JE, Larsen M. Prognosis of diabetics with diabetes onset before the age of thirty-one. 1: survival, causes of death, and complications. Diabetologia 1978; 14: 363–70

    Article  PubMed  CAS  Google Scholar 

  78. Nathan DM. Long-term complications of diabetes mellitus. N Engl J Med 1993; 328: 1676–85

    Article  PubMed  CAS  Google Scholar 

  79. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin­dependent diabetes mellitus. N Engl J Med 1993; 329: 977–85

    Article  Google Scholar 

  80. Amiel SA. Diabetic control and complications. BMJ 1993; 307: 881–2

    Article  PubMed  CAS  Google Scholar 

  81. Wang PH. Tight glucose control and diabetic complications. Lancet 1993; 342: 129

    Article  PubMed  CAS  Google Scholar 

  82. Rendell M, Kimmel DB, Bamisedun O, et al. The health care status of the diabetic population as reflected by physician claims to a major insurer. Arch Intern Med 1993; 153: 1360–6

    Article  PubMed  CAS  Google Scholar 

  83. Songer TJ. Health services and costing in diabetes. Med J Aust 1990; 152: 115–7

    PubMed  CAS  Google Scholar 

  84. Mazze RS, Franz MJ, Monk A, et al. Practice guidelines for nutrition care by dietetics practitioners for outpatients with non-insulin-dependent diabetes mellitus: methodologies for field-testing and cost-effectiveness analysis. J Am Diet Assoc 1992; 92: 1139–42

    PubMed  CAS  Google Scholar 

  85. Kaplan RM, Atkins CJ, Wilson DK. The cost-utility ofdiet and exercise interventions in non-insulin-dependent diabetes mellitus. Health Promotion 1988; 2: 331–40

    Article  Google Scholar 

  86. Connor H. Diabetic management and education: costs and benefits. In: Balesi AK, Hilde DW, Giles G, editors. Diabetes education. Chichester: Wiley, 1984

    Google Scholar 

  87. Geffner DL. Diabetes care in health maintenance organisations. Diabetes Care 1992; 15 Suppl. 1: 44–50

    PubMed  Google Scholar 

  88. MacLeod CA, Murchison LE, Russell EM, et al. Measuring outcome of diabetes: a retrospective survey. Diabet Med 1989; 6: 59–63

    Article  PubMed  CAS  Google Scholar 

  89. Javitt JC, Canner JK, Frank RG, et al. Detecting and treating retinopathy in patients with type 1 diabetes mellitus. Ophthalmology 1990; 97: 483–5

    PubMed  CAS  Google Scholar 

  90. Buxton MJ, Sculpher MJ, Ferguson B, et al. Screening for treatable diabetic retinopathy: a comparison ofdifferent methods. Diabet Med 1991; 8: 371–7

    Article  PubMed  CAS  Google Scholar 

  91. Dasbach EJ, Fryback DG, Newcomb PA, et al. Cost-effectiveness strategies for detecting diabetic retinopathy. Med Care 1991; 29: 20–39

    Article  PubMed  CAS  Google Scholar 

  92. Siegel JE, Krolewski AS, Warram JH, et al. Cost-effectiveness of screening and early treatment of nephropathy in patients with insulin-dependent diabetes mellitus. J Am Soc Nephrol 1992; 3 Suppl. 1: S 111–9

    Google Scholar 

  93. Gupta SK, Veith FJ. Is arterial reconstruction cost-effective compared with amputation? In: Greenhalgh RM, Jamieson CW, Nicolaides AN, editors. Limb salvage and amputation for vascular disease. London: Saunders, 1988: 447–52

    Google Scholar 

  94. O’Malley BC. Medicare admission criteria for diabetes mellitus in Florida. Diabetes Care 1992; 15 Suppl. 1: 54–8

    PubMed  Google Scholar 

  95. Alberti KGMM. Preventing insulin dependent diabetes mellitus. BMJ 1993; 307: 1435–6

    Article  PubMed  CAS  Google Scholar 

  96. Kannell NB, McGee DL. Diabetes and cardiovascular disease: the Framingham Study. JAMA 1979; 241: 2035–8

    Article  Google Scholar 

  97. Warren BH, Nugent C. The effects of cost containment on the care of elderly diabetics. Arch Intern Med 1991; 151: 2146–7

    Article  PubMed  CAS  Google Scholar 

  98. Wheeler ML, Warren-Boulton E. Diabetes patient education programs: quality and reimbursement. Diabetes Care 1992; 15 Suppl 1: 36–40

    PubMed  Google Scholar 

  99. Tobin CT. Third-party reimbursement coverage for diabetes outpatient education programs. Diabetes Care 1992; 15 Suppl. 1: 41–3

    PubMed  Google Scholar 

  100. Songer TJ, Deberry K, LaPorte RE, et al. International comparisons of IDDM mortality: clues to prevention and the role of diabetes care. Diabetes Care 1992; 15 Suppl. 1: 15–21

    Article  PubMed  Google Scholar 

  101. Department of Health. GP contract health promotion package: guidance on implementation. London: NHS Management Executive, 1993. FHSL Report No. (93) 3

    Google Scholar 

  102. Wing RR, Nowalk MP, Guare JC. Diabetes mellitus. In: Blachman EA, Brownell KD, editors. Handbook of behavioural medicine for women. New York: Pergamon, 1988: 236–52

    Google Scholar 

  103. Williams R, Guy M. Health care utilisation, organisation and evaluation. In: Williams R, Papoz L, Fuller J, editors. Diabetes in Europe. London: John Libbey, 1993: 117–23

    Google Scholar 

  104. Keen H, Cruickshank JK. Diabetes in Europe: retrospect and prospect for applying clinical epidemiology. In: Williams R, Papoz L, Fuller J, editors. Diabetes in Europe. London: John Libbey, 1993: 173–9

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leese, B. Diabetes Mellitus and the St Vincent Declaration. Pharmacoeconomics 7, 292–307 (1995). https://doi.org/10.2165/00019053-199507040-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199507040-00004

Keywords

Navigation