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ADVERSE EFFECTS AND COSTS OF INTENSIVE INSULIN THERAPY.

The Diabetes Control and Complications Trial (DCCT) compared intensive insulin therapy (three or more injections per day or continuous pump infusion) with conventional therapy (one or two injections daily) in patients aged 13 to 39. During 6.5 years of follow-up, the trial showed that tight glycemic control with intensive therapy can reduce microvascular complications (see Journal Watch accession number 931005001 and N Engl J Med 1993; 329:977). Two new reports from the DCCT illustrate some of the problems associated with intensive therapy. When compared with the conventional-therapy group, the intensive-therapy group had three times as many hypoglycemic episodes requiring the help of another person (61 vs. 19 per 100 patient-years), and three times as many episodes of hypoglycemia-induced coma or seizure (16 vs. 5 per 100 patient-years). Another adverse effect was weight gain: while only about 7 percent of subjects were overweight at baseline, intensively treated patients were more likely than conventionally treated patients to be overweight by the end of the trial (42 percent vs. 27 percent). The two groups had similar rates of death, accidents, and hospitalization. A second study examined the costs of physician and nurse labor, equipment, supplies, tests, and treatment of side effects in the DCCT. The annual cost of intensive insulin therapy was about $4000 per patient for multiple daily injections and $5800 per patient for continuous infusion by pump -- substantially higher than that for conventional therapy ($1700). Comment: Hypoglycemia, weight gain, and increased expense are unavoidable short-term tradeoffs of intensive insulin therapy. But those tradeoffs will be acceptable to most patients and policy makers if the reductions in end-organ complications endure with long-term follow-up.

— AS Brett

Published in Journal Watch General Medicine November 10, 1995

Citation(s):

DCCT Research Group. Resource utilization and costs of care in the Diabetes Control and Complications Trial. Diabetes Care 1995 Nov 18 1468-1478.

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DCCT Research Group. Adverse events and their association with treatment regimens in the Diabetes Control and Complications Trial. Diabetes Care 1995 Nov 18 1415-1427.

• Medline abstract (Free)