Over- and Under-Provision of Diabetes Screening: Making More Efficient Use of Healthcare Resources

National medical care expenditure in Japan exceeded 43 trillion yen in FY2018, with over 1.2 trillion yen of this total being spent on diabetes care. The sales of diabetes drugs continue to increase by several percent every year, and in FY2020 were second only to anti-cancer drugs. Even with such huge healthcare and drug expenditure on the treatment of diabetes, the number of patients undergoing dialysis due to diabetes continues to increase, and the number of chronic dialysis patients in Japan per capita was shown to be by far the largest in an international comparison. At the end of 2020, there were 275.4 dialysis patients per 100,000 people in Japan, of which 39.5% of chronic dialysis patients had diabetic nephropathy, in which the kidneys are damaged due to diabetes. A previous analysis of the length of hospitalization for diabetes patients in Japan showed that the average number of days spent in hospital was extremely long, with a cost-benefit analysis indicating that this is difficult to justify. The results of the data analysis carried out in this paper suggest that many people suffering from severe diabetes may not actually be receiving treatment. In contrast with the major diabetes screening programs overseas, it is clear that the Japanese program (1) does not evaluate the risk of developing diabetes, although it does include an age limit; (2) carries out annual screening regardless of the risk and/or blood sugar level; and (3) is not updated by the best available evidence from the latest clinical research. Many stakeholders, including local governments, health insurance associations, and the Ministry of Health, Labour and Welfare, have already pointed out the importance of preventing diabetes aggravation. In this paper, we explore the reasons why Japan’s efforts to encourage people at high risk to receive preventive medical care are failing, and propose necessary measures to achieve organic cooperation between screening programs and healthcare provision.