Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses

Figures & data

Table 1. Prevalence of Type 2 diabetes in emerging vs established markets

Country	Latest prevalence estimate (%)	Reference year for prevalence estimate	Proportion of undiagnosed (%)	Incidence	Reference year for incidence estimate	Mortality	Reference year for mortality estimate
Emerging markets
Brazil [15,26]	6.9%	2013	46%	Male: 2.45 per 1,000 people Female: 2.46 per 1,000 people	2008	N/A
China [27,28,121]	10.9%	2013	53.6%	Male: 9.2 per 1,000 PY Female: 9.5 per 1,000PY	2010	19.4 per 1,000 PY	1986–2009
Philippines [29–31]	5.4%	2013	66.7%	163 per 1,000 people	1998–2007	0.27 per 1,000 people	2013
Taiwan [43,55]	6.4%	2008	42.8%	9.32 per 1,000 people	2008	Men: 45.9 per 1,000 PY Female: 36.0 per 1,000 PY	2000–2009
Russia [8,56]	5.4%	2013-2015	37%	N/A		0.76 per 1,000 people	2016
Saudi Arabia [9]	23.1%	2011	39.4%	N/A		N/A
Turkey [21,32,51]	18.4%	2007-2012	38.2%	Male: 12.4 per 1000 PY Female: 11.0 per 1000 PY	2003	13.2 per 1,000 PY	1990–2013
UAE [33,54]	10.2%	2006	40.7%	Males: 3.3 per 1000 PY Females: 6.3 per1000 PY	2010	N/A
Established markets
Australia [46,60]	5.7%	2017-2018	35.6%	N/A		Male: 0.19 per 1,000 people Female: 0.13 per 1,000 people	2017
Canada [16,34,35,57]	7.4%	2012	30.5%	Male: 6.8 per 1,000 people Female: 5.7 per 1,000 people	2008/2009	Male: 0.24 per 1,000 people Female: 0,22 per 1,000 people	2004–2008
France [12]	4.8%	2013	37.5%	Male: 1.54 per 1,000 people Female: 1.21 per 1,000 people		N/A
Germany [48,59]	9.9%	2010	34.2%	Male: 16 per 1,000 PY Female: 13 per 1,000 PY	2009–2010	N/A^a
Italy [36,50,61]	5.4%	2015	35.8%	3.8 per 1,000 people	2007	40.3 per 1,000 patients	2007
Spain [11,58]	13.8%	2010	28.4%	N/A		0.21 per 1,000 people	2013
UK [10,13,37]	5.3%	2013	18.5%	Male: 3.99 per 1,000 PY Female: 3.73 per 1,000 PY	2013	Male: 0.09 per 1,000 people Female: 0.13 per 1,000 people	2015

Abbreviations: N/A, not available; PY, person-years

^aon graph

Table 2. Prevalence of Type 2 diabetes complications in emerging and established markets

	Retinopathy	Nephropathy/CKD	Neuropathy	Any CVD	Congestive heart failure	Cerebrovascular event/Stroke
Emerging markets
China [66,75–83,122]	6.5–31.1%^a	4–10%/1% – 8%	5.4–20.4%	13.5%	NA	NA/3.3–6.6%
Taiwan [65,127]	19.5–27.3%	32.8%/16%	21.3–29.7%	33–49 %	10–13%	20–24.8%/2.2%
Russia [105]	12.5–64.1%^b	NA	NA	NA	NA	NA
Saudi Arabia [67,84,85,106,125]	6.3–21.8%^b	11%/23.8%	71%	22.7%	2%	1.8%/0.8%
Brazil [86,118]	45.2–46.2%	NA/9.9%	NA	NA	NA	8%
UAE [44]	54.2%	41%/15.4%	34.7%	NA	NA	NA
Turkey	NA	NA/NA	NA	NA	NA	NA
Established markets
Australia [110]	16.4–22.4%	NA/17–24%	30.8–58.8%^b	28.4%	NA	8.5–10%/NA
Canada [87,88]	27.2%	NA/2–4%	12.50%	NA	8–14%	NA/1.7%
France [89,107]	21–38.2%	7–39%^b/1%	45%	28.3%	3%	1.7%/2.6%
Germany [64,90–92,113]	3.6–20.1%^b	9–14%/NA	5.70–14.4%^b	NA	9.9%	4.6–9.6%
Italy [93]	18.60%	NA/23.5%	30.6%	NA	NA	NA
Spain [74,94–98,108]	7.2–26%^b	10–19%/21% – 23%	4–8.8%	7–29%	5.5%	4.9–7.5%/5.9–7%
UK & Scotland [99–104,111]	14.7–30.3%	0.5–13%^b/7.7–21.1%	2.4–21.7%	10–25.4%	4–9%	7.5–9%/4.6%–9.8%

^ahigher estimate in study which had as a primary objective to document the prevalence of retinopathy; ^bdifference due to variation in disease duration. NA, not available

Table 3. Economic burden of T2D in emerging markets

Country	Direct costs^a	Indirect costs^a	Drug/Medication costs^a	Inpatient costs^a
Brazil[135,145,146,169]	€396 to €1,136	€655	€871	€181 to €232
China[136,138,139,147–153,170,175,178–180,185]	€719 to €2,906	€537 to €5,881	NA	€185 to €3,401
Philippines	NA	NA	NA	NA
Taiwan^a[154,181]	€1,388 to €2,849	NA	€75 to €152	€110 to €328
Russia[155]	NA	NA	€3,506 to €4,919	NA
Saudi Arabia[143]	€1,937	NA	€733 to €1,840	€337 to €918
Turkey[156]	€399 to €466	NA	NA	NA
UAE	NA	NA	NA	NA

^aCosts are presented per patient unless specified otherwise

Table 4. Economic burden of T2D in established markets

Country	Direct costs^a	Indirect costs^a	Drug/Medication costs^a	Inpatient costs^a
Australia	NA	NA	NA	NA
Canada[157]	€4,880	NA	NA	NA
France[134,158]	€2,003 to €6,506	NA	NA	€1,216 to €3,866
Germany[144,159–161,171]	€2,197 to €5,146	€4,103	€498 to €869	€848 to €2,057
Italy[133,137,162,163,176]	€1,279 to €3,532	NA	€385 to €974	NA
Spain[140,142,164,165]	€2,331 to €3,432	NA	NA	€436 to €1,467
UK[166–168]	€2,882 to €3,605	NA	€1,015	€1,430

^aCosts are presented per patient unless specified otherwise

Figure 1. Mean total annual direct cost per patient in patients with and without the presence of any complication

Figure 2. Mean total annual direct cost per patient in patients with different types of complications Abbreviations: CARD: coronary artery disease; CeVD: cerebrovascular disease; CHF: congestive heart failure; CKD: chronic kidney disease; CVD: cardiovascular disease; MIC: microvascular events; MAC: macrovascular events; NEPH: nephropathy; RETI: retinopathy; PVD: peripheral vascular disease

de Almeida-pititto B, Dias ML, de Moraes ACF, et al. Type 2 diabetes in Brazil: epidemiology and management. Diabetes Metab Syndr Obes. 2015;8:17–28.

 PubMed Web of Science ®Google Scholar

Costa AF, Flor LS, Campos MR, Oliveira AF, Costa MD, Silva RS, Lobato LC, Schramm JM. Burden of type 2 diabetes mellitus in Brazil. Cad Saude Publica. 2017;33(2):684–690. DOI:10.1590/0102-311x00197915.

 Web of Science ®Google Scholar

Wang L, Gao P, Zhang M, et al.. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. Jama. 2017;317(24):2515–2523. DOI:10.1001/jama.2017.7596.

 PubMed Web of Science ®Google Scholar

Wang C, Li J, Xue H, Li Y, Huang J, Mai J, Chen J, Cao J, Wu X, Guo D, Yu L. Type 2 diabetes mellitus incidence in Chinese: contributions of overweight and obesity. Diabetes Res Clin Pract. 2015;107(3):424–432. DOI:10.1016/j.diabres.2014.09.059.

 PubMed Web of Science ®Google Scholar

Chuang YC, Chung M-S, Wang P-W, et al.. Albuminuria is an independent risk factor of erectile dysfunction in men with type 2 diabetes. J Sex Med. 2012;9(4):1055–1064. DOI:10.1111/j.1743-6109.2011.02586.x.

 PubMed Web of Science ®Google Scholar

Jiang Y-D, Chang C-H, Tai T-Y, et al.. Incidence and prevalence rates of diabetes mellitus in Taiwan: analysis of the 2000–2009 Nationwide Health Insurance database. J Formosan Med Assoc. 111(11): 599–604. 2012. . doi:10.1016/j.jfma.2012.09.014.

 PubMed Web of Science ®Google Scholar

Dedov II, Shestakova MV, Vikulova OK. and Olga Konstantinovna Vikulova., Epidemiology of diabetes mellitus in Russian Federation: clinical and statistical report according to the federal diabetes registry. Diabetes Mellitus. 2017;20(1):13–41.

 Web of Science ®Google Scholar

Dedov II, Shestakova MV, Galstyan GR. The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study). Diabetes Mellitus. 2016;19(2):104–112.

 Web of Science ®Google Scholar

Statistics Canada. Mortality from diabetes mellitus, 2004 to 2008: a multiple-cause-of-death analysis. 2015 11/October/2019]; Available from: https://www150.statcan.gc.ca/n1/pub/82-003-x/2014003/article/11909-eng.htm.

 Google Scholar

Al-Daghri NM, Al-Attas OS, Alokail MS, et al.. Diabetes mellitus type 2 and other chronic non-communicable diseases in the central region, Saudi Arabia (Riyadh cohort 2): a decade of an epidemic. BMC Med. 2011;9(1):76. DOI:10.1186/1741-7015-9-76.

 PubMed Web of Science ®Google Scholar

Satman I, Omer B, Tutuncu Y, et al.. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. 28(2): 169–180. 2013. . doi:10.1007/s10654-013-9771-5.

 PubMed Web of Science ®Google Scholar

Onat A, Hergenç G, Uyarel H, et al.. Prevalence, incidence, predictors and outcome of type 2 diabetes in Turkey. Anadolu Kardiyol Derg. 2006;6(4):314–321.

 PubMedGoogle Scholar

International Diabetes Federation. IDF Diabetes Atlas Eighth Edition 2017. Available at: http://fmdiabetes.org/wp-content/uploads/2018/03/IDF-2017.pdf Accessed on: 10/10/2019.

 Google Scholar

Saadi H, Carruthers SG, Nagelkerke N, et al.. Prevalence of diabetes mellitus and its complications in a population-based sample in Al Ain, United Arab Emirates. Diabetes Res Clin Pract. 2007;78(3):369–377. DOI:10.1016/j.diabres.2007.04.008.

 PubMed Web of Science ®Google Scholar

Lin WH, Hsu C-H, Chen H-F, et al.. Mortality of patients with type 2 diabetes in Taiwan: a 10-year nationwide follow-up study. Diabetes Res Clin Pract. 2015;107(1):178–186. DOI:10.1016/j.diabres.2014.09.021.

 PubMed Web of Science ®Google Scholar

Du Y, Heidemann C, Gößwald A, et al.. Prevalence and comorbidity of diabetes mellitus among non-institutionalized older adults in Germany-results of the national telephone health interview survey ‘German Health Update (GEDA)’2009. BMC Public Health. 2013;13(1):166. DOI:10.1186/1471-2458-13-166.

 PubMed Web of Science ®Google Scholar

Monesi L, Baviera M, Marzona I, et al.. Prevalence, incidence and mortality of diagnosed diabetes: evidence from an Italian population‐based study. Diabetic Med. 2012;29(3):385–392. DOI:10.1111/j.1464-5491.2011.03446.x.

 PubMed Web of Science ®Google Scholar

Brown K, Nevitte A, Szeto B, et al.. Growing social inequality in the prevalence of type 2 diabetes in Canada, 2004-2012. Can J Public Health = Revue canadienne de santé publique. 2015;106(3):e132–e139. DOI:10.17269/CJPH.106.4769.

 PubMed Web of Science ®Google Scholar

Ross NA, Gilmour H, Dasgupta K. 14-year diabetes incidence: the role of socio-economic status. Health Rep. 2010;21(3):19.

 PubMed Web of Science ®Google Scholar

Govenrment of Canada. Chapter 1: Diabetes in Canada: Facts and figures from a public health perspective – Burden. 2011 11/October/2019]; Available from: https://www.canada.ca/en/public-health/services/chronic-diseases/reports-publications/diabetes/diabetes-canada-facts-figures-a-public-health-perspective/chapter-1.html#Inc1.

 Google Scholar

Orozco-Beltrán D, Sánchez E, Garrido A, et al.. Evolución de la mortalidad por diabetes mellitus en España: análisis del periodo 1998-2013. Revista Española de Cardiología. 2017;70(6):433–443. DOI:10.1016/j.recesp.2016.07.007.

 PubMed Web of Science ®Google Scholar

Sante Publique France. Prevalence and incidence of diabetes. [ cited 2019 January]; Available from: http://invs.santepubliquefrance.fr/Dossiers-thematiques/Maladies-chroniques-et-traumatismes/Diabete/Donnees-epidemiologiques/Prevalence-et-incidence-du-diabete. Accessed: 10/10/2019

 Google Scholar

Heidemann C, Du Y, Paprott R, et al.. Temporal changes in the prevalence of diagnosed diabetes, undiagnosed diabetes and prediabetes: findings from the German Health Interview and Examination Surveys in 1997–1999 and 2008–2011. Diabetic Med. 2016;33(10):1406–1414. DOI:10.1111/dme.13008.

 PubMed Web of Science ®Google Scholar

Harding JL, Shaw JE, Peeters A, et al.. Age-specific trends from 2000–2011 in all-cause and cause-specific mortality in type 1 and type 2 diabetes: a cohort study of more than one million people. Diabetes Care. 2016;39(6):1018–1026. DOI:10.2337/dc15-2308.

 PubMed Web of Science ®Google Scholar

Sistema statistico nazionale, Annuario statistico italiano 2013. 2013.

 Google Scholar

Onat A, et al.. Turkish adult risk factor survey 2013: rapid rise in the prevalence of diabetes. Turk Kardiyoloji Dernegi Arsivi. 2014;42(6):511–516. DOI:10.5543/tkda.2014.27543.

 PubMedGoogle Scholar

Liu X, Yu C, Wang Y, et al.. Trends in the Incidence and Mortality of Diabetes in China from 1990 to 2017: a joinpoint and age-period-cohort analysis. Int J Environ Res Public Health. 16(1): 158. 2019. . doi:10.3390/ijerph16010158.

 PubMed Web of Science ®Google Scholar

Soriguer FEA, Goday A, Bosch-Comas A. Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the [email protected] Study. Diabetologia. 2011;55(1):88–93.

 PubMed Web of Science ®Google Scholar

Jacobs E, Hoyer A, Brinks R, et al.. Burden of Mortality Attributable to Diagnosed Diabetes: a nationwide analysis based on claims data from 65 million people in Germany. Diabetes Care. 2017;40(12):1703–1709. DOI:10.2337/dc17-0954.

 PubMed Web of Science ®Google Scholar

Sharma M, Nazareth I, Petersen I. Trends in incidence, prevalence and prescribing in type 2 diabetes mellitus between 2000 and 2013 in primary care: a retrospective cohort study. BMJ Open. 2016 Jan 1;6(1):e010210.

 Web of Science ®Google Scholar

Holden SE, Jenkins-Jones S, Morgan CL, et al.. Prevalence, glucose control and relative survival of people with Type 2 diabetes in the UK from 1991 to 2013. Diabet Med. 2017;34(6):770–780. DOI:10.1111/dme.13332.

 PubMed Web of Science ®Google Scholar

Read SH, Kerssens JJ, McAllister DA, et al.. Trends in type 2 diabetes incidence and mortality in Scotland between 2004 and 2013. Diabetologia. 2016;59(10):2106–2113. DOI:10.1007/s00125-016-4054-9.

 PubMed Web of Science ®Google Scholar

Al-Rubeaan K, Abu El-Asrar AM, Youssef AM, et al.. Diabetic retinopathy and its risk factors in a society with a type 2 diabetes epidemic: a Saudi National Diabetes Registry-based study. Acta Ophthalmol. 2015;93(2):e140–7. DOI:10.1111/aos.12532.

 PubMed Web of Science ®Google Scholar

Alzahrani HA, Wang D, Bakhotmah BA, et al.. Risk factors for peripheral artery disease among patients with diabetes in Saudi Arabia. Vasc Med (United Kingdom). 2014;19(2):103–111. DOI:10.1177/1358863X14526948.

 Web of Science ®Google Scholar

Xu J, Wei WB, Yuan MX, et al.. Prevalence and risk factors for diabetic retinopathy: the Beijing communities diabetes study 6. Retina. 2012;32(2):322–329. DOI:10.1097/IAE.0b013e31821c4252.

 PubMed Web of Science ®Google Scholar

Henriques RS, Steimbach LM, Baptista DR, et al.. Direct costs of type 2 diabetes: a Brazilian cost-of-illness study. Int J Technol Assess Health Care. 2018;34(2):180–188. DOI:10.1017/S026646231800017X.

 PubMed Web of Science ®Google Scholar

Baba M, Davis WA, Norman PE, et al. Temporal changes in the prevalence and associates of diabetes-related lower extremity amputations in patients with type 2 diabetes: the Fremantle Diabetes Study. Cardiovasc Diabetol. 2015;14:152.

 PubMed Web of Science ®Google Scholar

Salvotelli L, Stoico V, Perrone F, et al.. Prevalence of neuropathy in type 2 diabetic patients and its association with other diabetes complications: the Verona diabetic foot screening program. J Diabetes Complications. 2015;29(8):1066–1070. DOI:10.1016/j.jdiacomp.2015.06.014.

 PubMed Web of Science ®Google Scholar

Douros A, Dell’Aniello S, Yu OH, Filion KB, Azoulay L, Suissa S. Sulfonylureas as second line drugs in type 2 diabetes and the risk of cardiovascular and hypoglycaemic events: population based cohort study. BMJ. 2018;362:k2693.

 PubMed Web of Science ®Google Scholar

Bringer J, Fontaine P, Detournay B, et al.. Prevalence of diagnosed type 2 diabetes mellitus in the French general population: the INSTANT study. Diabetes Metab. 2009;35(1):25–31. DOI:10.1016/j.diabet.2008.06.004.

 PubMed Web of Science ®Google Scholar

Kontopantelis E, Springate DA, Reeves D, et al.. Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study. Diabetologia. 2015;58(3):505–518. DOI:10.1007/s00125-014-3473-8.

 PubMed Web of Science ®Google Scholar

Yan BP, Zhang Y, Kong AP, et al.. Borderline ankle-brachial index is associated with increased prevalence of micro- and macrovascular complications in type 2 diabetes: A cross-sectional analysis of 12,772 patients from the Joint Asia Diabetes Evaluation Program. Diab Vasc Dis Res. 2015;12(5):334–341. DOI:10.1177/1479164115590559.

 PubMed Web of Science ®Google Scholar

Bramlage P, Gitt AK, Schneider S, et al.. Clinical course and outcomes of type-2 diabetic patients after treatment intensification for insufficient glycaemic control - results of the 2 year prospective DiaRegis follow-up. BMC Cardiovasc Disord. 2014;14(1):162. DOI:10.1186/1471-2261-14-162.

 PubMed Web of Science ®Google Scholar

Cea Soriano L, Johansson S, Stefansson B, et al.. Cardiovascular events and all-cause mortality in a cohort of 57,946 patients with type 2 diabetes: associations with renal function and cardiovascular risk factors. Cardiovasc Diabetol. 2015;14(1):38. DOI:10.1186/s12933-015-0204-5.

 PubMed Web of Science ®Google Scholar

Moody A, Cowley G, Ng Fat L, et al.. Social inequalities in prevalence of diagnosed and undiagnosed diabetes and impaired glucose regulation in participants in the Health Surveys for England series. BMJ Open. 6(2): e010155. 2016. . doi:10.1136/bmjopen-2015-010155.

 PubMed Web of Science ®Google Scholar

Charbonnel B, Simon D, Dallongeville J, et al.. Direct Medical Costs of Type 2 Diabetes in France: An Insurance Claims Database Analysis. Pharmacoecon Open. 2018;2(2):209–219. DOI:10.1007/s41669-017-0050-3.

 PubMed Web of Science ®Google Scholar

Bramlage P, Binz C, Gitt AK, et al.. Diabetes treatment patterns and goal achievement in primary diabetes care (DiaRegis) - study protocol and patient characteristics at baseline. Cardiovasc Diabetol. 2010;9(1):53. DOI:10.1186/1475-2840-9-53.

 PubMed Web of Science ®Google Scholar

Jacob L, Kostev K. Prevalence of depression in type 2 diabetes patients in German primary care practices. J Diabetes Complications. 2016;30(3):432–437.

 PubMed Web of Science ®Google Scholar

De Cosmo S, Rossi MC, Pellegrini F, et al.. Kidney dysfunction and related cardiovascular risk factors among patients with type 2 diabetes. Nephrol Dialysis Transplantation. 2014;29(3):657–662. DOI:10.1093/ndt/gft506.

 PubMed Web of Science ®Google Scholar

Lee KM, Sum WM. Prevalence of diabetic retinopathy in patients with recently diagnosed diabetes mellitus. Clin Exp Optom. 2011;94(4):371–375.

 PubMed Web of Science ®Google Scholar

Pan C-W, Wang S, Qian D-J, et al.. Prevalence, awareness, and risk factors of diabetic retinopathy among adults with known type 2 diabetes mellitus in an Urban Community in China. Ophthalmic Epidemiol. 2017;24(3):188–194. DOI:10.1080/09286586.2016.1264612.

 PubMed Web of Science ®Google Scholar

Van Buren PN, Toto R. Hypertension in diabetic nephropathy: epidemiology, mechanisms, and management. Adv Chronic Kidney Dis. 2011;18(1):28–41.

 PubMed Web of Science ®Google Scholar

Barrot‐de la Puente J, Mata-Cases M, Franch-Nadal J, et al.. Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database. Int J Clin Pract. 2015;69(12):14861495. DOI:10.1111/ijcp.12741.

 Web of Science ®Google Scholar

Jin P, Peng J, Zou H, et al.. The 5-year onset and regression of diabetic retinopathy in Chinese type 2 diabetes patients. PLOS One. 2014;9(11):e113359. DOI:10.1371/journal.pone.0113359.

 PubMed Web of Science ®Google Scholar

Hammes H-P, Welp R, Kempe H-P, et al.. Risk Factors for Retinopathy and DME in Type 2 Diabetes—Results from the German/Austrian DPV Database. PLOS One. 2015;10(7):e0132492. DOI:10.1371/journal.pone.0132492.

 PubMed Web of Science ®Google Scholar

López M, Cos FX, Álvarez-Guisasola F, et al. Prevalence of diabetic retinopathy and its relationship with glomerular filtration rate and other risk factors in patients with type 2 diabetes mellitus in Spain. DM2 HOPE study. J Clin Transl Endocrinol. 2017;9:61–65.

 PubMedGoogle Scholar

Almutairi N, Alkharfy KM. Direct medical cost and glycemic control in type 2 diabetic Saudi patients. Appl Health Econ Health Policy. 2013;11(6):671–675.

 PubMedGoogle Scholar

Wong CK, Jiao F, Tang EHM, et al.. Direct medical costs of diabetes mellitus in the year of mortality and year preceding the year of mortality. Diabetes Obesity Metab. 2018;20(6):1470–1478. DOI:10.1111/dom.13253.

 PubMed Web of Science ®Google Scholar

Cheng S-H, Chen -C-C, Tseng C-H. Does medication adherence lead to lower healthcare expenses for patients with diabetes?. Am J Manag Care. 2013;19(8):662–670.

 PubMed Web of Science ®Google Scholar

Wang W, Fu CW, Pan CY, et al.. How do type 2 diabetes mellitus‐related chronic complications impact direct medical cost in four major cities of urban China?. Value Health. 12(6): 923–929. 2009. . doi:10.1111/j.1524-4733.2009.00561.x.

 PubMed Web of Science ®Google Scholar

Jacobs E, Hoyer A, Brinks R, et al.. Healthcare costs of Type 2 diabetes in Germany. Diabet Med. 2017;34(6):855–861. DOI:10.1111/dme.13336.

 PubMed Web of Science ®Google Scholar

Bahia LR, Araujo DV, Schaan BD, et al.. The costs of type 2 diabetes mellitus outpatient care in the Brazilian public health system. Value Health. 2011;14(5):S137–S140. DOI:10.1016/j.jval.2011.05.009.

 PubMed Web of Science ®Google Scholar

Li W, Zhang Y, Tang JL, Guo XH, Lou QQ, Sun ZL.  Self-management obedience rate, metabolic control and cost of diabetes associated with medical insurance in China. Diabetologia. 2016 Aug 1 (Vol. 59, pp. S396-S397) SPRINGER 233 SPRING ST, NEW YORK, NY 10013 USA

 Web of Science ®Google Scholar

Liu Q, Chen Y, Chu Y. Direct Medical Cost and Healthcare Resource Utilization in Elderly Patients with Type 2 Diabetes Mellitus Among Insured Urban Population in China. Value Health. 2016;19(7):A670.

 PubMed Web of Science ®Google Scholar

Akalin S, Satman I, Ozdemir O. PDB28 Cost of Disease and its Relationship With Diabetic Complications in Turkish Patients With Type 2 Diabetes Mellitus. Value Health. 2012;15(7):A498.

 Web of Science ®Google Scholar

Zheng Y, Wu J, Österle A. PDB61 Research on the Incidence and Cost of Hypoglycemia Episode in Patients With Type 2 Diabetes Mellitus (T2DM). Value Health. 2012;15(7):A504–A505.

 PubMed Web of Science ®Google Scholar

Bruno G, Karaghiosoff L, Merletti F, et al.. The impact of diabetes on prescription drug costs: the population-based Turin study. Diabetologia. 2008;51(5):795–801. DOI:10.1007/s00125-008-0957-4.

 PubMed Web of Science ®Google Scholar

Veronese G, Marchesini G, Forlani G, et al.. Costs associated with emergency care and hospitalization for severe hypoglycemia. Nutr Metab Cardiovasc Dis. 2016;26(4):345–351. DOI:10.1016/j.numecd.2016.01.007.

 PubMed Web of Science ®Google Scholar

Demurtas J, Alba N, Rigon G, Nesoti MV, Bovo C, Vaona A. Epidemiological trends and direct costs of diabetes in a northern Italy area: 2012 health administrative records analysis LHT n. 20 Verona. Prim Care Diabetes. 2012;344(feb22 1):570–576. DOI:10.1016/j.pcd.2017.06.001.

 Web of Science ®Google Scholar

Bao X, Yang C, Fang K, et al.. Hospitalization costs and complications in hospitalized patients with type 2 diabetes mellitus in Beijing, China: 中国北京市 2 型糖尿病住院患者费用与并发症的关系分析. J Diabetes. 9(4): 405–411. 2017. . doi:10.1111/1753-0407.12428.

 PubMed Web of Science ®Google Scholar

Sicras-Mainar A, Font-Ramos B, Roldán-Suárez C, et al.. [Characterization of and costs associated to the profile of patients with type 2 diabetes treated with metformin who are added a second oral antidiabetic drug: a population study]. Endocrinol Nutr. 2013;60(10):557–569. DOI:10.1016/j.endonu.2013.04.011.

 PubMedGoogle Scholar

Sicras-Mainar A, Rejas-Gutiérrez J, Navarro-Artieda R, et al.. Effect of smoking status on healthcare costs and resource utilization in patients with type 2 diabetes in routine clinical practice: a retrospective nested case-control economic study. Eur Addict Res. 2014;20(2):94–104. DOI:10.1159/000355171.

 PubMed Web of Science ®Google Scholar

Mata-Cases M, Casajuana M, Franch-Nadal J, et al.. Direct medical costs attributable to type 2 diabetes mellitus: a population-based study in Catalonia, Spain. Eur J Health Econ. 2016;17(8):1001–1010. DOI:10.1007/s10198-015-0742-5.

 PubMed Web of Science ®Google Scholar

Currie CJ, Poole CD, Woehl A, et al.. The financial costs of healthcare treatment for people with Type 1 or Type 2 diabetes in the UK with particular reference to differing severity of peripheral neuropathy. Diabet Med. 2007;24(2):187–194. DOI:10.1111/j.1464-5491.2006.02057.x.

 PubMed Web of Science ®Google Scholar

Long Q, He M, Tang X, et al.. Treatment of Type 2 diabetes mellitus in Chongqing of China: unaffordable care for the poor. Diabetic Med. 2017;34(1):120–126. DOI:10.1111/dme.13193.

 PubMed Web of Science ®Google Scholar

Cao P, Wang K, Zhang H, et al.. Factors influencing the hospitalization costs of patients with type 2 diabetes. Asia Pac J Public Health. 2015;27(2_suppl):55S60S. DOI:10.1177/1010539515573831.

 Web of Science ®Google Scholar

Von Lengerke T, Hagenmeyer E-G, Gothe H, et al.. Excess health care costs of obesity in adults with diabetes mellitus: a claims data analysis. Exp Clin Endocrinol Diabetes. 2010;118(8):496–504. DOI:10.1055/s-0030-1253400.

 PubMed Web of Science ®Google Scholar

Saad R, Piedade A, Wiens A, et al.. Hospitalization Costs of Type 2 Diabetes Mellitus (T2dm) Patients In A Public Hospital In Brazil. Value Health. 2015;18(7):A809. DOI:10.1016/j.jval.2015.09.095.

 Web of Science ®Google Scholar

Le C, Lin L, Jun D, et al.. The economic burden of type 2 diabetes mellitus in rural southwest China. Int J Cardiol. 2013;165(2):273–277. DOI:10.1016/j.ijcard.2011.08.039.

 PubMed Web of Science ®Google Scholar

Ulrich S, Holle R, Wacker M, Stark R, Icks A, Thorand B, Peters A, Laxy M. Cost burden of type 2 diabetes in Germany: results from the population-based KORA studies. BMJ Open. 6(11): e012527. 2016. . doi:10.1136/bmjopen-2016-012527.

 PubMed Web of Science ®Google Scholar

Bao X, Yang C, Fang K, et al.. Hospitalization costs and complications in hospitalized patients with type 2 diabetes mellitus in Beijing, China. J Diabetes. 2017;9(4):405–411.

 PubMed Web of Science ®Google Scholar

Kumar M, Gupta S, Liu G, et al.. Demographics And Health Outcomes Associated With Adherence And Non-Adherence Among Type2 Diabetcics In China. Value Health. 2014;17(7):A746. DOI:10.1016/j.jval.2014.08.169.

 PubMed Web of Science ®Google Scholar

Wang H, Lin X, Zhang Z, et al.. The economic burden of inpatients with type 2 diabetes: a case study in a Chinese hospital. Asia Pac J Public Health. 2015;27(2_suppl):49S54S. DOI:10.1177/1010539515572220.

 Web of Science ®Google Scholar

Bouee S, Cochinaire A, Godard C, et al.. Real World Incidence of Type 2 Diabetes (T2D) Complications Leading to Hospitalization in France: The Recode Study. Value Health. 2013;16(7):A434. DOI:10.1016/j.jval.2013.08.637.

 PubMed Web of Science ®Google Scholar

McMeekin P, Geue C, Wu O, Mocevic E, Hoxer CS, Ochs A, McGurnaghan S, Colhoun H. Costs of prevalent and incident cardiovascular disease in patients with type 2 diabetes in Scotland using routinely collected data. Diabetologia. 2018 Oct 1;Vol. 61, p. S115–S115; SPRINGER 233 SPRING ST, NEW YORK, NY 10013 USA

 Web of Science ®Google Scholar