Diabetes Management and Economic Burden in Saudi Arabia

Introduction

Diabetes management in Saudi Arabia is a pressing public health challenge, as the prevalence of Type 2 diabetes mellitus (T2DM) continues to rise. T2DM, which accounts for about 90% of all diabetes cases, is marked by the body’s inability to respond adequately to insulin, leading to elevated blood glucose levels. In 2021, the global prevalence of diabetes in adults was estimated at 536.6 million. Within Saudi Arabia, the prevalence of diabetes is projected to increase from 18.7% in 2021 to 21.4% by 2045. This rise is driven by factors such as increased life expectancy and lifestyle changes linked to urbanisation.

Current Treatment Guidelines and Real-World Practices

The Saudi National Diabetes Center (SNDC) has established guidelines to assist healthcare providers in managing T2DM. The goal is to maintain glycosylated haemoglobin (HbA1c) levels below 7%. Initial treatment involves lifestyle modifications, followed by metformin if necessary. For patients with elevated risks, additional therapies may include GLP-1 receptor agonists or SGLT2 inhibitors. However, real-world practices often differ due to factors like drug cost and patient preferences. Only about 25% of T2DM patients in Saudi Arabia achieve the recommended HbA1c levels, highlighting the need for improved management strategies.

Study Design and Setting

AlHarbi et al. conducted a longitudinal and observational study in order to demonstrate the clinical and economic burden of T2DM in the Kingdom of Saudi Arabia (KSA). The study took place over a 5-year period across 15 centers, including general hospitals and specialised tertiary diabetes centers under the Ministry of Health (MoH) in the KSA.

Study Population and Treatment Patterns

The study focused on patients newly diagnosed with T2DM over a decade, ensuring a minimum follow-up period of five years. The study included a subpopulation of 638 patients with available HbA1c data. HbA1c levels of ≥ 6.5% (48.5 mmol/mol) or fasting plasma glucose (FPG) levels of ≥ 126 mg/dL confirmed the diagnosis.  Biguanides, often combined with sulfonylureas, were the most common first-line treatments, used by 81.5% of patients. The preference for these drugs is partly due to their lower cost compared to newer medications. The study also revealed that drug costs are a major factor influencing treatment choices. Despite the availability of newer drugs, clinical inertia often leads to the continued use of older, more established therapies.

The Burden of Complications and Costs

T2DM significantly increases the risk of complications, which can severely impact quality of life. Patients face both microvascular complications, such as nephropathy and retinopathy, and macrovascular issues, including coronary artery disease. Cardiovascular diseases (CVD) are the leading cause of death among T2DM patients. These complications lead to substantial direct medical costs, including treatment and hospitalisations, and indirect costs, such as lost productivity. In Saudi Arabia, diabetes medications are among the most commonly used, contributing to a significant financial burden. The annual per-person healthcare expenditure for diabetes was $1,743 in 2021, with direct costs for T2DM patients estimated at $1,947 per patient.

Conclusions

This research paints a comprehensive picture of baseline demographics, clinical characteristics, and treatment patterns of T2DM patients within the KSA. The burden of illness analysis revealed significantly higher healthcare costs associated with T2DM treatment from a payer perspective in the KSA. To mitigate these costs, there is a need for improved adherence to treatment guidelines and increased awareness about diabetes management. Understanding the clinical and economic burden of T2DM is vital for informing healthcare policies and resource allocation in the KSA.  Implementing lifestyle changes and individualised treatment programmes can help manage obesity, a key risk factor for T2DM. By addressing these challenges, Saudi Arabia can improve outcomes for patients with T2DM and reduce the associated economic impact.