deCODE genetics
Diabetes Genetic Risk Identification
Description | Challenge | Solution | Outcomes
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Diabetes affects nearly 200 million people worldwide and an estimated 21 million in the United States or approximately 7% of the population. The vast majority of diabetes patients have type 2 diabetes, and the incidence of type 2 diabetes is increasing rapidly in the industrialized world, in part due to the increase in obesity, one of the major risk factors for developing the disease. According to the American Diabetes Association, one third of Americans with diabetes are not even aware that they have the disease, and a further 54 million Americans have pre-diabetes, a condition characterized by elevated blood sugar levels. More than 10% of those with pre-diabetes develop type 2 diabetes annually. |
Challenge
The American Diabetes Association recently reported that one out of every 10 health care dollars spent in the United States is spent on diabetes and its complications. The U.S. total annual economic cost of diabetes in 2002 was estimated to be $132 billion. Diabetes is a risk factor for other serious conditions including heart disease, blindness, nerve damage, and kidney damage, and if left uncontrolled, the consequences can be life-threatening. However, type 2 diabetes can be managed and most importantly prevented. Eating healthy foods, getting plenty of exercise and maintaining a healthy weight are all known to be components of an effective prevention plan. If diet and exercise aren't enough, there are also medications that can help to manage blood sugar levels and insulin response to reduce the likelihood of developing diabetes.
Solution
deCODE genetics a global leader in applying human genetics to create better healthcare offers deCODE T2™, a non-invasive DNA-based test designed to help individuals, working with their physician, better understand their risk of developing type 2 diabetes and to enable more effective prevention and treatment strategies. Understanding risk can empower prevention. Many major lifestyle and environmental risk factors for type 2 diabetes are well known- obesity and its causes, including poor diet and lack of exercise - and it is well established that addressing these risk factors can reduce the risk of diabetes. Inherited risk factors also influence individual susceptibility to type 2 diabetes. deCODE T2 is the first test ever offered that detects a small variation in the sequence of a person’s DNA (in a gene called TCF7L2) that deCODE has linked to a 2-fold increase in the risk of developing type 2 diabetes. It has been reported that 8-11% of the general population has this DNA variation and will be positive for the deCODE T2 test.
deCODE's findings, published in 2006, have since been validated in studies by independent researchers in tens of thousands of people from populations around the globe. Another published analysis of data from a U.S. government supported clinical trial involving pre-diabetics, the Diabetes Prevention Program, also showed that those patients with this small variation (positive to the deCODE T2 test) were at a two-fold greater risk of progressing to type 2 diabetes within the four-year study period versus those negative to the test.
Importantly, this study also showed that this increased risk could be effectively reduced through weight loss and treatment with certain insulin response-boosting medications such as metformin. The deCODE T2 test may therefore offer a new means to help physicians decide which pre-diabetic patients they wish to treat more aggressively either through lifestyle modification or medications.
Outcomes
In summary, many studies have shown the small variation in DNA identified by the deCODE T2 test, to be an important risk factor for type 2 diabetes. This new risk factor is largely independent of other risk factors such as obesity, family history, pre-diabetes, and ethnicity. This means that a person positive to the deCODE T2 test has an even higher risk for development of diabetes than conferred by the risk factors of pre-diabetes and obesity alone. Aggressive management of lifestyle as in the US Government sponsored Diabetes Prevention Program may have an especially large positive effect on this group. A comprehensive healthcare economic analysis indicates that deCODE T2 is cost-effective, especially when a large portion of the 10% of pre-diabetics who are positive for the test are pushed to lose weight using lifestyle interventions (based on costs associated with these interventions over 4 years). Cost-savings resulting from fewer conversions to type 2 diabetes occur within 5 to 10 years more than balance out the intial investment in testing and lifestyle intervention. This economic analysis indicates the following outcomes for a hypothetical population of 1-million people:
- Based on national averages, the prevalence of pre-diabetes and type 2 diabetes in the 1-million population would be 194,000 and 69,948, respectively.
- Based on an approximate 10% test-positive rate, 21,127 would be deCODE T2 positive
- The healthcare system would normally pay out approximately $2.2 billion over a 15-year period on the health management of these diabetics.
- Incorporating the deCODE T2 testing and lifestyle intervention for positive testers would result in more than a $50 million net savings over the 15-year period with improved patient outcomes
- 8,380 of diabetes cases would be prevented and 4,901 additional patients would achieve normal blood sugar levels
