Shaping the conversation on the cost of diabetes: looking back at one of YHEC’s most influential publications

Over 40 years, YHEC has published hundreds of papers on a diverse range of topics. In this blog post, we take a closer look at the impact of one of our most highly cited papers.

In 2012, we published a paper in the Diabetic Medicine journal: Estimating the current and future costs of type 1 and type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. The paper was co-authored by Director of NHS Consulting, Nick Hex, YHEC CEO, Professor Matthew Taylor and Senior Research Consultant, Chris Bartlett.

What was the research about?

The paper set out to estimate the current and future economic burden of type 1 and type 2 diabetes to the UK. A further aim was to provide a distinction between type 1 and type 2 diabetes so that they can be considered separately. The causes and costs of the two forms of diabetes are different, but at the time the research was written, they were rarely distinguished in the media.

How was the research done?

A top-down modelling approach, using aggregated national datasets, was used to estimate the economic burden of diabetes. The national dataset sources included the Association of Public Health Observatories (APHO) Diabetes Prevalence Model, NHS Reference Costs, Hospital Episode Statistics, the British National Formulary, Office for National Statistics data, and national clinical guidelines.

The factors contributing to the direct costs of diabetes were mapped. These included prevalence, incidence and mortality. Several different population groups were considered: people with undiagnosed diabetes, people with diabetes, and people who were newly diagnosed. The impact of ongoing treatment, management and secondary and tertiary care consultations were considered.

What did the research find?

The study estimated that diabetes cost the UK approximately £23.7 billion in 2010/11. Around £9.8 billion of this total related to direct healthcare costs, while indirect societal and productivity costs (for example, absence from work or unpaid caregiver burdens) accounted for a further £13.9 billion. Type 2 diabetes represented the majority of this cost burden.

The analysis also estimated that by 2035/36, the cost of diabetes in the UK would be £39.8 billion: £16.9 billion in direct costs (£1.8 billion for type 1 diabetes and £15.1 billion for type 2 diabetes) and £22.9 billion in indirect costs (£2.4 billion and £20.5 billion, respectively).

At the time the study was written, diabetes accounted for approximately 10% of the total health resource expenditure, and we projected it to account for around 17% in 2035/36.

How many citations did the paper receive?

According to Google Scholar, the publication has been cited over 1,200 times to date. Even though the work is now 14 years old, it continues to be cited, with 50 citations in 2025 and 14 so far in 2026.

It has been cited in textbooks such as the Textbook of Diabetes, international studies on resource use, and in publications on topics as diverse as inflammation control for managing wounds and the importance of nature-based physical activity.

In 2018, it was one of the publications feeding into an international study on the global burden of the disease, which concluded that the absolute global economic burden of diabetes will increase from $1.3 trillion US dollars in 2015 to $2.1 trillion by 2030. The global burden study has subsequently been cited more than 1,500 times.

What has been the impact of the paper?

The influence of the study has also extended beyond academia into healthcare policy, workforce planning, and clinical guidance.

Shortly after publication, the study was cited as background reading for a House of Lords debate on the management of diabetes in the NHS, providing important context for policymakers in the UK. The debate focused on the need for change in current NHS strategies to address inequalities in treating diabetes across the UK, with the development of integrated care pathways seen as crucial.

The research has also been cited in several policy documents. In 2022, the International Labour Organization published a working paper on research into the two-way link between productivity and wellbeing and cited the paper as an example of how certain health conditions may link to poorer productivity as a result of both presenteeism and absenteeism. Furthermore, the findings were referenced in discussions surrounding the development of the UK National Food Strategy in 2020, providing insights into diet-related disease.

The scale of the diabetes burden has been framed as a major challenge for the long-term sustainability of the NHS, with the British Medical Association (BMA) using data from the analysis to make the case for funding for disease prevention and tackling the underlying causes of ill-health.

What about clinical guidelines?

The paper was cited by the newly updated National Institute for Health and Care Excellence (NICE) guideline on the management of type 2 diabetes in adults earlier this year, highlighting that, although the research showed that the NHS spends £1 million every hour on diabetes care, there was still no robust value of information analysis to direct future research.

In 2015, Diabetes UK cited the work in their recommendations for a staff competency framework for the NHS, arguing that the burden of diabetes demonstrated by the research means that “every NHS employee comes into contact with people living with diabetes in their day-to-day work”, and so all healthcare workers require the appropriate knowledge, skills and attitudes to manage people presenting with the condition.

The work also provides important context to international guidance. In 2018, the International Society for Pediatric and Adolescent Diabetes (ISPAD) cited the publication in its guideline on the delivery of ambulatory diabetes care to children and adolescents with diabetes. Data from the research were used to show the impact of complications on costs in type 1 diabetes, and this led the clinical experts to conclude that improved early treatment of diabetes was essential for effective management of the condition.

In guidelines on type 1 diabetes in adults produced by the government in Ireland, the work was cited to compare healthcare costs with a similar study by Sharma et al. (2021) on the burden of diabetes in Ireland. The Sharma study also used data from the paper to check that the Irish and UK costs were broadly aligned, and to demonstrate the potential for investment and savings for the Irish healthcare system.

How did we follow up this work?

YHEC has undertaken further research on the burden of illness of diabetes since this paper was published.

In 2024, Nick Hex, Rachael MacDonald, Jessica Pocock, Barbara Uzdzinska and Matthew Taylor co-authored a publication to update the estimates reported in the 2012 paper with more recent and accurate data sources. Estimation of the direct health and indirect societal costs of diabetes in the UK using a cost of illness model was published in Diabetic Medicine. It found that the estimated direct costs of diabetes in the UK in 2021/22 were £10.7 billion, of which just over 40% related to diagnosis and treatment and the rest related to the excess costs of complications. Indirect costs were estimated at £3.3 billion. While rates of some complications are reducing, prevalence continues to increase and effective approaches to primary and secondary prevention continue to be needed.

The research was presented at ISPOR in Barcelona in 2024. By the end of 2024, the update was one of the most highly cited papers in the Diabetic Medicine journal and was reported by several news outlets, including The Guardian.

More than a decade after its publication, the original study continues to shape discussions around prevention, healthcare resource allocation, and the growing economic burden of diabetes. The updated 2024 analysis demonstrates that, while some complications are declining, diabetes remains one of the most significant long-term pressures facing healthcare systems in the UK and internationally.

YHEC’s other publications

If you’re interested in exploring YHEC’s publications in a particular area, such as diabetes, you can search our Publication Hub under the Resources section of our website. Publications can be filtered by keyword, therapeutic area and other criteria to help you find relevant research.

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