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in HbA1c from baseline led to improvements in both clinical
and economic outcomes. Reducing HbA1c from 9.8% to 8.8%
was predicted to improve life expectancy from 10.07 years to
10.69 years (a difference of 0.61 years) and quality-adjusted life
expectancy from 6.56 quality-adjusted life years (QALYs) to
7.04 QALYs (a difference of 0.48 QALYs). In the reduced HbA1c
arm, incidence of macular edema and background diabetic
retinopathy were reduced by 20%, falling from 23.5% to 18.6%
and from 29.0% to 23.7%, respectively. Incidence of micro
albuminuria fell from 42.1% to 33.5%, incidence of gross
proteinuria fell from 22.9% to 15.1% and incidence of end-
stage renal disease fell from 13.7% to 8.3%. Also there is a
significant reduction in diabetic foot complications, besides
modest reduction in incidence of cardiovascular diseasewhich
was clinically more significant. Direct medical costs were
lower by EUR 541 per patient in the reduced HbA1c group
over the 35-year time horizon of the analysis. Cost savings
were driven by the reduced expenditure as a result of renal
complications (EUR 2,838 in the control arm versus EUR 2,040
in the active arm). Treatment costs as a result of cardiovascular
disease, neuropathy/diabetic foot and eye disease were also
lower in the reduced HbA1c group. This study concludes
that 1% reduction in HbA1c from baseline was associated with
improved life expectancy and quality of life, as well as being
cost-saving over a 35-year time horizon.
Another study was done to estimate current direct costs
associated with managing diabetes-related complications
from a healthcare payer perspective in Indonesia. A structured
literature search of EMBASE, Medline and the Cochrane Library
databases was carried out to identify published studies
containing the costs of diabetes-related complications and
management in Indonesia. Results showed that Myocardial
infarction was the most costly complication in the year of
onset, associated with a cost of USD 22,673. Renal complica-
tions were also associated with significant costs. Transplant-
ation was estimated to cost approximately USD 21,532
in the first year and USD 5,033 in each subsequent year,
hemodialysis cost over USD 9,994 annually and peritoneal
dialysis cost over USD 6,391 each year. Ketoacidosis and lactic
acidosis were associated with costs of USD 1,007, whilst minor
hypoglycemia was the least costly at USD 36. Neuropathy/
diabetic foot complications especially gangrene treatment
was the most costly, at a cost of USD 3,356 in the year of
onset. Amputation was also associated with significant costs.
Study concludes that estimates of complication costs suggest
that the seven million patients with diabetes represent a
substantial economic burden in Indonesia. Also, this study
highlights that cardiovascular and renal complications pose
major economic burden, both in the year of onset and
subsequent years for diabetic patients in Indonesia. Key ini-
tiatives to overcome the barriers and their outcomes: Mapping
out key barriers to diabetes care and control, national action
plan 2015
–
2019 to control the rapid rise of non-communi-
cable disease (NCD) in Indonesia including diabetes consists
include the following initiatives; advocacy and Public Private
Partnership (PPP), health promotion and reduce risk factors,
strengthening healthcare service system within the scope of
integrating NCD care at primary care, improving quality of
human resources, improving access to medicines and infra-
structure as well as synchronizing policy. Moreover, surveil-
lance, monitoring and evaluation (monev) and research.
Today, ranked as top seventh country with highest diabetes,
the number has increased to 10 million people in Indonesia
living with diabetes. Key stakeholders including government,
national health insurance, HCP
’
s, patient support groups,
media and private sector are working in partnership to esta-
blish a functional health system in Indonesia that recognizes
the importance of diabetes awareness, diagnosis and treat-
ment. Awareness is low, and most people do not know what
they do not know about diabetes, its care and its conse-
quences. There is a great need to make care more accessible by
improving HCP skills and by encouraging teamwork among
healthcare disciplines. Currently, the ability to afford insulin in
Indonesia is dependent on income and health insurance
coverage, more people should be able to afford care. Through
the National Healthcare Insurance, government will expand
its 250 million citizens to health care by end of 2019. Lack of
availability, this is where multi stakeholder partnership to
make healthcare available and affordable in rural areas is a
factor in suboptimal quality of care. The issues stemming from
these barriers are interconnected and resolving them will
require a patient-centric, holistic approach.
S05-3
Landscape of diabetes in the Philippines
Rima TAN
1
.
1
Diabetes Philippines, Mandaluyong, Philippines
The Philippines is an archipelago composed of more than 7,500
islands and is considered the seventh most populated country
in Asia, with a populace of over 100 million.
In the past decade, a decline has been seen in communicable
diseases, such as tuberculosis and malaria, however non-
communicable diseases have been on the rise. Diabetes now
follows diseases of the heart, vascular system and malignant
neoplasms as leading causes of death.
In the latest national survey, the prevalence of chronic energy
deficient adults is lower compared to the prevalence of those
who are overweight and obese. Almost half of the population is
insufficient in physical activity. These are contributors to the
rising epidemic of diabetes in the Philippines, where indivi-
duals affected are in the working age group and mostly living
in urban areas. The increase in prevalence of diabetes and its
implications is alarming for this emerging market economy
and requires a more focused and unified intervention from all
sectors.
Who Does What in the Health Care for
Diabetes in Taiwan
S12-3
Health governance and strategy and the challenge of non-
communicable diseases: Viewpoints from lifestyle
intervention in diabetes prevention
Kuo-Liong CHIEN
1,2
.
1
Institute of Epidemiology and Preventive
Medicine, College of Public Health, National Taiwan University,
2
Department of Internal Medicine (Cardiology Section), National
Taiwan University Hospital, Taipei, Taiwan
The issues of noncommunicable diseases (NCDs) prevention
and control are a growing global public health concern, and a
target of a 25% relative reduction in NCD mortality by 2025,
known as the 25 × 25 strategy, has been proposed fromWHO
’
s
Global NCD Action Plan. Control and Management of type 2
diabetes, a major NCD, through lifestyle intervention for
primary prevention and secondary prevention is a high prio-
rity of health policy. In Taiwan, through the programs of
Diabetes Shared Care Network and The Improvement Program
of National Health Insurance Payment for Diabetes Medical
Treatment by emphasizing integrated team work, the univer-
sal healthcare system has provided an affordable service
for diabetes care. However, the primary prevention of diabetes,
including screening and identifying high risk individuals
as well as lifestyle intervention, is still a challenge in clinical
practice. Prediction models for type 2 diabetes from cross-
sectional and cohort data provided a useful tool for screening.
In addition, the Diabetes Prevention Programs from various
countries provided many feasible strategies to prevent dia-
betes occurrence. Moreover, secondary prevention of
diabetes complications, through health promotion activities
such as modest alcohol intake, smoking, dietary habits,
Speech Abstracts / Diabetes Research and Clinical Practice 120S1 (2016) S1
–
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