Type 2-diabetes - Sundhedsstyrelsen

Treatment of hyperglycaemia
H Foreign cost-effectiveness studies indicate that intensive polypharmacological
treatment of hyperglycaemia can entail cost savings with a cost-effectiveness
ratio of up to DKK 300,000 per quality-adjusted-life-year.
Treatment of hypertension
H Intensive polypharmacological treatment of hypertension can entail cost
savings with a cost-effectiveness ratio in the order of DKK 10,000 per
life-year (not quality-adjusted). A precondition for these calculations of
the cost-effectiveness ratio is that diabetic complications are avoided and
not just delayed. Whether or not this assumption is valid is unknown,
however.
The Project Group’s recommendations concerning pharmacological treatment
of Type 2 diabetes
H Glycaemic regulation should be intensified in Type 2 diabetes so that
more patients attain a satisfactory blood glucose level. With the current
pharmacological treatment possibilities this means that more patients
should receive insulin treatment (A).
H The pharmacological treatment of hypertension in Type 2 diabetes should
be intensified. In most cases this will entail treatment with several drugs
(A).
H All Type 2 diabetes patients with atherosclerosis in the heart, brain and
leg vessels should be offered intensive polypharmacological treatment containing
salicylic acid, cholesterol-lowering statins and possibly also antihypertensive
treatment based on an ACE inhibitor/angiotensin II receptor
antagonist in accordance with the same criteria that apply to patients with
coronary atherosclerosis (AπB).
H Type 2 diabetes patients who have developed complications in the form
of albuminuria should be offered individualised intensive polypharmacological
treatment containing salicylic acid, cholesterol-lowering statins and
ACE inhibitor/angiotensin II receptor antagonist, possibly supplemented
with antihypertensive treatment and hypoglycaemic agents (A).
H The remaining Type 2 diabetes patients should undergo regular risk assessment
and on this basis should be offered treatment with a documented
risk-lowering effect. Special attention should be paid to changes in the
blood lipids in Type 2 diabetes (A).
H At the county level, at least one organisation should be established to
ensure coordinated, uniform and quality-assured implementation of evidence
based non-pharmacological and pharmacological treatment that reduces
morbidity and mortality among Type 2 diabetes patients (D).
Type 2-diabetes. Medicinsk teknologivurdering af screening, diagnostik og behandling 85