Policies that support incremental as well as breakthrough innovation are essential to improving clinical and economic outcomes in the treatment of diabetes.

Most medical advances come from incremental improvements on existing therapies-from a series of small steps forward rather than from great leaps or breakthroughs. Pharmaceutical research has yielded an array of incremental advances that offer substantial clinical and economic benefits in the treatment of diabetes.

Because of the many pharmaceutical options available, diabetes treatment can be tailored to individual patient needs. "Medications for diabetes reduce blood glucose levels in several different ways. Some increase the amount of insulin secreted from pancreatic cells. Others allow insulin that is already present to be used more effectively. A third group reduces the breakdown of carbohydrates in the gastro-intestinal tract so that less sugar is absorbed. No single currently available agent appears to be superior when used as monotherapy and combination therapy is often indicated."

The primary cost of treating diabetes comes from short-term hyperglycemia and from long term complications. An analysis of intensive treatment of type II diabetes found that achieving normal blood sugar levels reduced the incidence of serious complications (see chart) and raised life expectancy by 1.4 years.

Controlling diabetes demands individualized patient care because of the complex nature of the disease, the diversity of the diabetic population and the fact that diabetes often occurs concurrently with other medical conditions. Improved diabetes management leads to quality, cost-effective outcomes and underscores the importance of policies that encourage and support the research that fosters incremental as well as breakthrough innovation. It also reinforces the importance of ensuring that patients have access to choices in drug treatments.