Technology and the issue of cost/benefit in diabetes

Diabetes mellitus is the most common endocrine disease in childhood and adolescence. Type 1 diabetes accounts for over 90% of diabetes in children. During the past decades, epidemiological studies have clearly shown a worldwide increase in the incidence of both type 1 and type 2 diabetes in many countries. The worldwide incidence of diabetes and especially the diabetes-related complications highlight the relevant economic burden of this disease. In fact, its costs affect health services, national productivity as well as individuals and families. Hospital in-patient costs for the treatment of complications are the largest single contributor to direct healthcare costs. Anyway, many of these complications and, therefore, their costs, as well as most of the indirect costs, are partially or completely preventable. In fact, intensive therapy, directed at controlling blood glucose, blood pressure and lipid levels, has been shown to be cost effective in that, although initial costs are high, longer term costs decrease as a result of delayed or prevented complications. From this point of view, technological advances have provided new therapeutic options to achieve metabolic control as close to normal as possible in children and adolescents with diabetes. In fact, the relevant technological devices that have been adopted till now, if adequately utilized, should allow patients to achieve intensive management with improved metabolic control, quality of life as well as reduced mortality and morbidity. However, new technologies are not a panacea, and the benefit they provide can be completely achieved only if adequately and especially individually determined. Furthermore, it is inevitable that new modalities of treatment for people with diabetes will be considered critically by healthcare planners and providers in the prevailing global environment of increasing costs of medical care and pressure for rational allocation of resources. Therefore, new technologically derived devices and therapeutic opportunity for diabetes should be rationally utilized in order to offer real advantages and reduce the relevant worldwide cost of diabetes.