Considerations in assessing effectiveness and costs of diabetes care: lessons from DARTS

Use of a population-based diabetes clinical information system is crucial to understanding the nature and magnitude of disease burden, effects of treatment, and personal and economic costs of diabetes. Information from the DARTS (Diabetes Audit and Research in Tayside Scotland) project has shown that patients with diabetes account for a disproportionate amount of cardiovascular disease, have a poorer associated prognosis, and do not receive effective secondary preventive therapies as frequently as do patients without diabetes. In addition, the prevalence of type 2 diabetes is associated with lower socioeconomic status - as, in turn, is significantly increased body mass index (BMI). The DARTS findings also revealed that much of the cost of diabetes treatment is accounted for by costs associated with treatment of coronary vascular disease and hospitalization. The vast majority of type 2 patients have inadequately controlled blood pressure, and many of these patients do not adhere to prescribed oral therapy. It is clear that much work remains to be done to implement and maintain standards of care that will improve outcome in diabetes. Efforts in this regard can best be monitored by effective population-based programs.