Intended for healthcare professionals

Clinical Review

Prevention and early detection of vascular complications of diabetes

BMJ 2006; 333 doi: (Published 31 August 2006) Cite this as: BMJ 2006;333:475

Trends in the volume and cost of diabetic medications and monitoring equipment in England 1991-2004

Marshall and Flyvberg reinforce the importance of tight control of
blood glucose levels to minimise the devastating complications of
diabetes(1). Appropriate use of hypoglycaemic agents is a key factor in
achieving this objective. Yet the UK spends less on hypoglycaemic
medication per diabetic patient than many other European countries, even
though it is much more expensive to treat the complications of long-term
poor glycaemic control.(2)

We examined trends in the amount and cost of diabetic medications and
monitoring equipment prescribed in England between 1991-2004. Data on all
community dispensed prescriptions for diabetes was obtained from the
Prescription Cost Analysis system (PCA), which compiles data for the
Department of Health. The number of prescriptions (medicines and
monitoring) rose from 7,613,000 (1991) to 24,325,640 (2004), more than a
300% increase. Total expenditure increased by 650%, from £68.5 million to
£448.6 million. Insulins were the biggest contributor to costs (£196.8
million), followed by monitoring equipment (£131.5 million) and then oral
medications (£120.3 million). Insulins accounted for over 60% of the cost
of drugs but comprised only 23% of total prescriptions. Metformin,
currently the most widely used anti-diabetic medication accounted for 40%
of prescriptions but comprised only 7% of the total medications bill.
Since 1991, the proportion of total prescribing accounted for by metformin
has doubled, whilst that for sulphonylureas has almost halved. In 2004
spending on glitazones (£50.6 million) was higher than on metformin (£22.6
million) or sulphonylureas (£40.1) million).

We found a sharp increase in prescribing expenditure on diabetes over
the last 14 years. Nevertheless, we are probably still spending less on
drugs for diabetes then our European counterparts. In the US, the more
costly glitazones are used at least twice as much as they are in the
UK.(3) Unfortunately, there is insufficient evidence to determine whether
our lower spending is due to differential prescribing habits, prevalence
patterns or other reasons. Nonetheless, healthcare planners need to
proactively provide more funding for treating diabetes, otherwise costs
due to the burden of complications will increase still further.


1. Marshall S, Flyvberg A. Prevention and early detection of vascular
complications of diabetes. BMJ 2006;333:475-80.

2. Jonsson B. CODE-2 advisory board. Revealing the cost of type II
diabetes in Europe. Diabetologica 2002;45:S5-12.

3. Wysowski D, Armstrong G, Governale L. Rapid increase in the use of
oral anti-diabetic drugs in the United States, 1990-2001. Diabetes Care

Competing interests:
Professor Azeem Majeed is an Associate Director (Primary Care) for the Diabetes Research Network.

Competing interests: No competing interests

18 September 2006
Hitesh Patel
SHO Oncology
Janakan Srishanmuganathan, Josip Car, and Azeem Majeed.
Charing Cross Hospital, London W6 8RF