Costs for managing diabetic peripheral neuropathy, a serious diabetic microvascular complication, are on the rise, particularly in the United Kingdom where 93 per cent of the costs are due to long-term patient care. A new study suggests that annual healthcare costs could be reduced by interventions that can successfully treat diabetic peripheral neuropathy, delay and/or prevent its long-term outcomes. Study results were presented during the 18th annual International Diabetes Federation (IDF) Congress.

Diabetic peripheral neuropathy is associated with underlying microvascular damage that affects nerves outside the brain and spinal cord - primarily in the hands and feet - and can lead to foot ulcers and amputations. The symptoms of diabetic peripheral neuropathy include numbness, prickling, aching pain, burning pain, lancinating pain, and allodynia (a condition in which ordinarily non-painful stimuli evoke pain). These outcomes are associated with relatively resource-intensive, high-cost treatments. No pharmaceutical medication currently exists to directly treat the underlying process of microvascular damage that is responsible for the development of diabetic peripheral neuropathy.

Current treatment options are generally limited to analgesic treatment of pain, and have no beneficial effect on the underlying damage to the nerves.

"Over half of the more than 150 million people worldwide who have diabetes may suffer from diabetic peripheral neuropathy, which puts a considerable strain on health care systems," commented Rhys Williams, professor of clinical epidemiology, The Clinical School, University of Wales Swansea. "A preventative strategy that could target underlying microvascular damage, and reduce the risk of complications such as diabetic peripheral neuropathy, could offer long-term healthcare cost savings and improve quality of life for people with diabetes. This study suggests that such a strategy in the U.K. might save up to £204 million, 29,000 patient life-years and 36,000 quality of life years over a 10-year period."

Currently, Lilly is conducting clinical trials to determine if an investigational compound, ruboxistaurin mesylate, can improve the symptoms of diabetic peripheral neuropathy and vibration detection threshold by targeting a key underlying process that leads to microvascular damage.

The U.K. cost analysis used a mathematical model to estimate costs and outcomes based on vibration detection threshold (VDT) in patients. Reduced vibration detection in patients is a predictor of long-term complications of diabetic peripheral neuropathy, and is associated with higher healthcare costs, a short life, and fewer years of good quality of life, compared to people with normal vibration detection levels.

The VDT represents the lowest voltage level at which a patient can detect vibration; patients with reduced vibration detection (VDT > 25V) are at greater risk for developing foot ulceration leading to amputation. The study found that the number of foot ulcers, recurrent ulcers, duration of first ulcer, duration of recurrent ulcer, total amputations and mean cost per person increased with a VDT = 25V as compared to a VDT < 25V. The results estimate that long-term complications of diabetic peripheral neuropathy experienced by the population with reduced vibration detection could cost the UK National Health System an estimated £292 million over the next 10 years. In a similar abstract, the researchers estimated the total annual cost of diabetic peripheral neuropathy to be £252 million (ranging from £114-£516) with type 2 diabetes costing six times more than type 1 diabetes (£217 versus £35 respectively).