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Stout M, Giavatto C, McDonald N, Bryant L, Ross C, Fitzpatrick C, Mourani J, Lopez-Medina AI. Impact of Risk Stratification in Patients With Diabetes Mellitus in a Health System Specialty Pharmacy Setting. J Pharm Pract 2024:8971900241257293. [PMID: 38809250 DOI: 10.1177/08971900241257293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Background: Integrated pharmacist care into health systems results in significant A1c reduction and improved outcomes in patients with diabetes. However, little is known about the adoption of Health System Specialty Pharmacy (HSSP) chronic disease management (CDM) services within diabetes clinics. Risk stratification is proven to enhance care in various patient populations. Objective: The objective of this study is to describe how the implementation of risk stratification in the HSSP setting results in optimized patient outcomes in diabetes. Method: This is a retrospective descriptive study reporting the results of expanding the HSSP care model to implement risk stratified CDM services for patients with diabetes. A total of 285 patients were enrolled in the HSSP CDM pharmacy services and were stratified into high- or low-risk groups. Results: Eighty-eight patients were stratified as high-risk with an average baseline A1c of 11.47% and a most recent average of 8.84%. The remaining 285 patients were stratified into the low-risk group. Their average baseline A1c was 7.48% and the last recorded average A1c was 7.15%. Patients not enrolled in HSSP CDM services (N = 100) had a lower reduction in average A1c compared to patients enrolled in the program. Conclusion: Patients stratified into high- and low-risk groups had greater reductions in A1c compared to patients who did not use HSSP CDM services. These results showcase the success of risk stratification and demonstrate the impact HSSP has on patients needing CDM services and outlines a strategy to provide the greatest impact in a high-volume patient population.
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Liu Y, Li C, Li X, Yang J, Zheng Y, Li F, Wang X. iGlarLixi for type 2 diabetes: a systematic review and meta-analysis. Endocrine 2024:10.1007/s12020-024-03868-3. [PMID: 38740694 DOI: 10.1007/s12020-024-03868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVES To assess the efficacy and tolerability of iGlarLixi-a novel, fixed-ratio, soluble combination of insulin glargine and lixisenatide-for the treatment of type 2 diabetes (T2D). METHODS The PubMed, Embase, Cochrane Library and ClinicalTrials.gov databases were searched from inception to November 15, 2023 to identify randomized controlled trials (RCTs) comparing iGlarLixi with a placebo or any other antidiabetic agent in adults with T2D. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated to evaluate the outcomes. RESULTS A total of 10 trials enrolling 6071 T2D patients were included. Compared with placebos or other antidiabetic agents, iGlarLixi exerted beneficial effects on changes in HbA1c, the percentage of patients who achieved an HbA1c < 7%, the percentage of patients who achieved an HbA1c < 6.5%, the percentage of patients who achieved an HbA1c < 7.0% without weight gain and/or without severe or blood glucose-confirmed hypoglycemic episodes, changes in fasting plasma glucose, and changes in self-measured plasma glucose. Regarding safety, iGlarLixi did not increase the incidence of severe hypoglycemia or serious adverse events but did increase the incidence of gastrointestinal adverse events, symptomatic hypoglycemia, and adverse events (e.g., nausea, vomiting, diarrhea). CONCLUSIONS iGlarLixi showed improved efficacy and safety in patients with T2D. Additional large, multicenter RCTs are warranted to obtain deeper insights into the efficacy and safety of iGlarLixi, thereby providing guidance for clinical treatment decisions.
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Affiliation(s)
- Yang Liu
- Department of Pharmacy, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Congxin Li
- Department of Pharmacy, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Xuejing Li
- Department of Pharmacy, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Jie Yang
- Department of Pharmacy, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Yingying Zheng
- Department of Pharmacy, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Fan Li
- Department of Pharmacy, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Xianying Wang
- Department of Pharmacy, Hebei Medical University Third Hospital, Shijiazhuang, China.
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Zakaria H, Said Y, Aleabova S, Bangayan J, Dandan M, Debs J, Dahlstrom N, Divino D, Hashemi A, Almarzooqi I. Measuring the effectiveness of hybrid diabetes care over 90 days through continuous data monitoring in type 2 diabetic patients. Front Endocrinol (Lausanne) 2024; 15:1355792. [PMID: 38774233 PMCID: PMC11106412 DOI: 10.3389/fendo.2024.1355792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/08/2024] [Indexed: 05/24/2024] Open
Abstract
Background Diabetes Mellitus, a global health challenge, affects 537 million individuals. Traditional management relies on periodic clinic visits, but technological advancements, including remote monitoring, offer transformative changes. Telemedicine enhances access, convenience, adherence, and glycemic control. Challenges include trust-building and limitations in face-to-face interactions. Integrating remote monitoring with in-person healthcare creates a hybrid approach. This study evaluates the impact on Type 2 Diabetes patients over 3 months. Methods A retrospective case-control observational study. Inclusion criteria involved previous Type 2 Diabetes diagnosis and a minimum 3-month GluCare model period with two physical visits. Patients in the case group had in-clinic visits, bi-weekly app engagement, and monthly body weight readings. Control group had in-clinic visits only. Outcomes measured included HbA1c, lipid profile, CV risk, eGFR, urine Albumin/Creatinine Ratio, Uric Acid, and CRP. Results Case group showed significant HbA1c improvements (-2.19%), especially in higher baseline levels. Weight, BMI, LDL, total cholesterol, and CVD risk also improved. Controls showed smaller improvements. Higher digital interactions correlated with better outcomes. Patients with ≥11 interactions showed significant reductions in HbA1c (-2.38%) and weight (-6.00 kg). Conclusion The GluCare.Health hybrid model demonstrates promising outcomes in Type 2 diabetes management. The integration of in-clinic consultations with continuous remote monitoring leads to substantial improvements in glycemic control and clinical parameters. The study highlights the importance of patient engagement in achieving positive outcomes, with higher digital interactions associated with greater reductions in HbA1c and weight. The hybrid approach proves more effective than digital-only interventions, emphasizing the need for comprehensive, end-to-end solutions in diabetes care.
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Affiliation(s)
- Hala Zakaria
- GluCare Integrated Diabetes Center, Dubai, United Arab Emirates
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Hussin SA, Mohamad NA, Othman MK, Wan Mohamed WMI. Evaluating the Impact of Intensifying Treatment from Human to Analogue Insulin on Glycaemic Control and Insulin Expenditure in Patients with Type 2 Diabetes: A Retrospective Cohort Study. Malays J Med Sci 2024; 31:159-169. [PMID: 38694591 PMCID: PMC11057824 DOI: 10.21315/mjms2024.31.2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/28/2023] [Indexed: 05/04/2024] Open
Abstract
Background Achieving good glycaemic control is essential to reducing the risk of diabetes complications. Insulin is the most effective therapy for achieving good glycaemic control; however, it is associated with a higher risk of hypoglycaemia, especially with human insulin. This study aimed to evaluate the efficacy of intensification from human to analogue insulin and its added cost. Methods This retrospective study was conducted at the Hospital Universiti Sains Malaysia (HUSM). Patients with type 2 diabetes mellitus (T2DM) who underwent intensification for at least 3 months from human to analogue insulin were included in this study. The patients' medical records, haemoglobin A1c (Hba1c) and fasting blood sugar (FBS) were retrieved. The total cost pre- and post-intensification of insulin was obtained from the pharmacy database. Differences in HbA1c, FBS and total insulin cost pre- and post-intensification were analysed. Results A total of 163 patients with T2DM who had intensification from human to analogue insulin were included in this study. HbA1c and FBS levels were significantly lower in analogue insulin. However, the differences were not clinically significant, as the mean reduction in HbA1c was less than 0.5%. Meanwhile, the total costs of analogue insulin for 3 months were higher. Conclusion There were no clinically significant improvements in patients' HbA1c and FBS after the intensification of insulin, despite the extra costs spent. Hence, it is vital to choose the right group of patients to receive an insulin analogue to maximise its benefit but at the most optimal cost.
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Affiliation(s)
- Siti Aisyah Hussin
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nur Aimi Mohamad
- Department of Pharmacy, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Khairi Othman
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Wan Mohd Izani Wan Mohamed
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Boye KS, Bae JP, Thieu VT, Lage MJ. An Economic Evaluation of the Relationship Between Glycemic Control and Total Healthcare Costs for Adults with Type 2 Diabetes: Retrospective Cohort Study. Diabetes Ther 2024; 15:395-407. [PMID: 38038897 PMCID: PMC10838884 DOI: 10.1007/s13300-023-01507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Glycemic control is associated with better outcomes among individuals with type 2 diabetes (T2D). This research examines total US all-cause medical costs for adults with T2D with recommended glycemic control (HbA1c < 7%) compared to poor glycemic control (HbA1c ≥ 7%). METHODS The study used administrative claims data linked to HbA1c laboratory test results from January 1, 2015 through June 30, 2021 to identify adults with T2D with a recorded HbA1c test. Patients with recommended glycemic control at index date were propensity score matched to patients with poor glycemic control. General linear models and two-part models were used to compare all-cause outpatient, drug, acute care and total costs for 1 year post index date. RESULTS The study included 59,830 propensity-matched individuals. Results indicate that recommended glycemic control, compared to poor glycemic control, was associated with statistically significantly lower all-cause acute care ($23,868 ± $21,776 vs. $24,352 ± $22,223), drug ($10,277 ± $14,671 vs. $10,540 ± $14,928), and total medical costs ($41,381 ± $42,757 vs. $42,054 ± $43,422) but significantly higher outpatient costs ($7290 ± $12,028 vs. $7026 ± $11,587) (all p < 0.0001). Sensitivity analyses examined results based upon alternative HbA1c thresholds of ≤ 6.5% and < 8%. Results were generally robust to alternative HbA1c thresholds, with higher HbA1c thresholds associated with higher all-cause total costs as well as increased savings for having HbA1c below threshold. CONCLUSIONS Glycemic control was associated with significantly lower all-cause total, drug, and acute care medical costs. Given the high prevalence of T2D in the USA, our results suggest potential economic benefits associated with glycemic control for healthcare providers.
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Affiliation(s)
- Kristina S Boye
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46225, USA
| | - Jay P Bae
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46225, USA
| | - Vivian T Thieu
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46225, USA
| | - Maureen J Lage
- HealthMetrics Outcomes Research, 28 Riverside Lane, Madison, CT, 06443, USA.
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Berthoumieux A, Linke S, Merry M, Megliola A, Juusola J, Napoleone J. Long-Term Results of a Digital Diabetes Self-Management and Education Support Program Among Adults With Type 2 Diabetes: A Retrospective Cohort Study. Sci Diabetes Self Manag Care 2024; 50:19-31. [PMID: 38240247 DOI: 10.1177/26350106231221456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE The purpose of this study is to examine the long-term impact of a digital diabetes self-management education and support (DSMES) program on A1C among adults with type 2 diabetes (T2DM). METHODS Data analyzed were from a retrospective cohort of commercially insured members with T2DM enrolled in the Omada for Diabetes program between January 1, 2019, and January 31, 2022 (n = 1,322). Linear mixed models measured changes in A1C and weight across 12 months (collected at baseline and every 3 months over 1 year) overall and stratified by A1C at baseline (≥8% vs <8%). RESULTS On average, members were 53.5 years old, 56.9% female, and 71.5% White, with a mean baseline body mass index (BMI) of 36.9 and A1C of 7.6%. Members with baseline A1C ≥8% demonstrated clinically and statistically significant adjusted mean reductions in A1C during follow-up, from 9.48% at baseline to 7.33%, 7.57%, 7.59%, and 7.47% at 3, 6, 9, and 12 months, respectively. Those with A1C <8% maintained glycemic stability (6.73%, 6.50%, 6.54%, 6.62%, and 6.51%, respectively). Collectively, members experienced a -1.17 kg/m2 mean reduction in BMI over 12 months. CONCLUSIONS This study provides real-world evidence that members with elevated baseline A1C (≥8%) enrolled in a digital DSMES program experienced clinically meaningful and statistically significant reductions in A1C. Those with baseline A1C within goal treatment range (<8%) maintained glycemic stability over 1 year. The findings support existing evidence that scalable digital DSMES solutions can help individuals with T2DM manage their condition.
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Whittington MD, Goggin K, Tsolekile L, Puoane T, Fox AT, Resnicow K, Fleming KK, Smyth JM, Materia FT, Hurley EA, Vitolins MZ, Lambert EV, Levitt NS, Catley D. Cost-effectiveness of Lifestyle Africa: an adaptation of the diabetes prevention programme for delivery by community health workers in urban South Africa. Glob Health Action 2023; 16:2212952. [PMID: 37220094 PMCID: PMC10208125 DOI: 10.1080/16549716.2023.2212952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/06/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Lifestyle Africa is an adapted version of the Diabetes Prevention Program designed for delivery by community health workers to socioeconomically disadvantaged populations in low- and middle-income countries (LMICs). Results from the Lifestyle Africa trial conducted in an under-resourced community in South Africa indicated that the programme had a significant effect on reducing haemoglobin A1c (HbA1c). OBJECTIVE To estimate the cost of implementation and the cost-effectiveness (in cost per point reduction in HbA1c) of the Lifestyle Africa programme to inform decision-makers of the resources required and the value of this intervention. METHODS Interviews were held with project administrators to identify the activities and resources required to implement the intervention. A direct-measure micro-costing approach was used to determine the number of units and unit cost for each resource. The incremental cost per one point improvement in HbA1c was calculated. RESULTS The intervention equated to 71 United States dollars (USD) in implementation costs per participant and a 0.26 improvement in HbA1c per participant. CONCLUSIONS Lifestyle Africa reduced HbA1c for relatively little cost and holds promise for addressing chronic disease in LMIC. Decision-makers should consider the comparative clinical effectiveness and cost-effectiveness of this intervention when making resource allocation decisions. TRIAL REGISTRATION Trial registration is at ClinicalTrials.gov (NCT03342274).
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Affiliation(s)
- Melanie D. Whittington
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kathy Goggin
- Department of Pediatrics, University of Missouri – Kansas City School of Medicine, Kansas City, MO, USA
- Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Lungiswa Tsolekile
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Andrew T. Fox
- Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Joshua M. Smyth
- College of Health and Human Development, Penn State University, University Park, PA, USA
| | - Frank T. Materia
- Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Emily A. Hurley
- Department of Pediatrics, University of Missouri – Kansas City School of Medicine, Kansas City, MO, USA
- Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Mara Z. Vitolins
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Estelle V. Lambert
- UCT Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Division of Research Unit for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Naomi S. Levitt
- Department of Medicine and Chronic Disease Initiative for Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Delwyn Catley
- Department of Pediatrics, University of Missouri – Kansas City School of Medicine, Kansas City, MO, USA
- Center for Children’s Healthy Lifestyles and Nutrition, Children’s Mercy Kansas City, Kansas City, MO, USA
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Ken-Opurum J, Srinivas SSS, Jain D, Shah T, Samnaliev M, Dex T, Charland S, Revel A, Preblick R. Budget Impact Analysis of Intensification with iGlarLixi Compared to Alternative Treatment Strategies Among Patients with Type 2 Diabetes Mellitus. Diabetes Ther 2023; 14:2109-2125. [PMID: 37801225 PMCID: PMC10597971 DOI: 10.1007/s13300-023-01477-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION The clinical benefits of treating patients with type 2 diabetes mellitus (T2DM) with fixed-ratio combination of insulin iGlar (iGlar) plus lixisenatide (iGlarLixi) were demonstrated in clinical trials and real-world evidence studies; however, its cost impact to healthcare payers is unknown. METHODS A budget impact model was developed from a United States (US) payer's perspective for a hypothetical healthcare plan of 1 million people over a 1-year time horizon. In scenario analysis, patients with uncontrolled glycated hemoglobin (HbA1c) treated with 60 units or less of daily insulin (insulin cohort) or oral antidiabetic drugs (OADs) only (OAD cohort) were intensified to iGlarLixi/rapid-acting insulin (RAI)/glucagon-like peptide 1 receptor agonists (GLP-1RA) or iGlarLixi/iGlar/GLP-1RA, respectively. Model inputs from real-world data (RWD) included baseline market shares, proportion of patients intensifying to respective treatments, and dosing inputs; unit costs were obtained from published literature. One-way sensitivity analyses assessed the impact of individual parameters. RESULTS Intensification with iGlarLixi resulted in the lowest incremental per member per month (PMPM) budget impact compared to other intensifying drugs (iGlar, RAI, and GLP-1RA). In the insulin cohort, the incremental PMPM cost for intensification with iGlarLixi ($0.03) was the lowest among intensifying drugs; GLP-1RA ($72.20) and RAI ($4.81). Similarly, the incremental PMPM cost for intensification with iGlarLixi was the lowest ($1.25) in the OAD cohort among intensifying drugs; GLP-1RA ($321.65) and iGlar ($114.82). In scenario analyses, when equal market intensification shares for iGlarLixi and GLP-1RA were explored, the incremental PMPM cost for iGlarLixi ($0.03) remained lower than GLP-1RA ($2.28) and RAI ($10.44) in the insulin cohort. CONCLUSIONS Intensification with iGlarLixi was associated with lower costs compared to other treatment intensifications, as well as overall budget reductions compared to pre-intensification when considering cost savings attributable to reduction in HbA1c; therefore, its inclusion for the treatment of T2DM would represent a budget saving.
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Han G, Spencer MS, Ahn S, Smith ML, Zhong L, Andreyeva E, Carpenter K, Towne SD, Preston VA, Ory MG. Group-based trajectory analysis identifies varying diabetes-related cost trajectories among type 2 diabetes patients in Texas: an empirical study using commercial insurance. BMC Health Serv Res 2023; 23:1116. [PMID: 37853393 PMCID: PMC10585813 DOI: 10.1186/s12913-023-10118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The trend of Type 2 diabetes-related costs over 4 years could be classified into different groups. Patient demographics, clinical factors (e.g., A1C, short- and long-term complications), and rurality could be associated with different trends of cost. Study objectives are to: (1) understand the trajectories of cost in different groups; (2) investigate the relationship between cost and key factors in each cost trajectory group; and (3) assess significant factors associated with different cost trajectories. METHODS Commercial claims data in Texas from 2016 to 2019 were provided by a large commercial insurer and were analyzed using group-based trajectory analysis, longitudinal analysis of cost, and logistic regression analyses of different trends of cost. RESULTS Five groups of distinct trends of Type 2 diabetes-related cost were identified. Close to 20% of patients had an increasing cost trend over the 4 years. High A1C values, diabetes complications, and other comorbidities were significantly associated with higher Type 2 diabetes costs and higher chances of increasing trend over time. Rurality was significantly associated with higher chances of increasing trend over time. CONCLUSIONS Group-based trajectory analysis revealed distinct patient groups with increased cost and stable cost at low, medium, and high levels in the 4-year period. The significant associations found between the trend of cost and A1C, complications, and rurality have important policy and program implications for potentially improving health outcomes and constraining healthcare costs.
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Affiliation(s)
- Gang Han
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States of America
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, United States of America
| | - Matthew Scott Spencer
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, United States of America
| | - SangNam Ahn
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States of America
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States of America
| | - Matthew Lee Smith
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States of America
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, United States of America
| | - Lixian Zhong
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States of America
- College of Pharmacy, Texas A&M University, College Station, TX, United States of America
| | - Elena Andreyeva
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States of America
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, United States of America
| | - Keri Carpenter
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States of America
| | - Samuel D Towne
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States of America
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, United States of America
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, United States of America
- Southwest Rural Health Research Center, Texas A&M University, College Station, TX, United States of America
| | - Veronica Averhart Preston
- Blue Cross and Blue Shield of Texas a subsidiary of Health Care Service Corporation, Richardson, TX, USA
| | - Marcia G Ory
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States of America.
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States of America.
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Tanumihardjo JP, Davis H, Zhu M, On H, Guillory KK, Christensen J. Enhancing Chronic-Disease Education through Integrated Medical and Social Care: Exploring the Beneficial Role of a Community Teaching Kitchen in Oregon. Nutrients 2023; 15:4368. [PMID: 37892443 PMCID: PMC10609968 DOI: 10.3390/nu15204368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Teaching kitchens (TKs) are rapidly being utilized as models to integrate culinary education and chronic-disease education into healthcare settings. Our observational study details the structure and organizational processes (e.g., referral, services, medical and social care integration) of the Community TK at Providence Milwaukie Hospital in Portland, OR. We utilize electronic medical-record data from engaged TK participants (n = 3077) to evaluate between the association of engagement and clinical outcomes (e.g., HbA1c, blood pressure, weight and cholesterol). Mean baseline HbA1c of Highly Engaged TK patients with diabetes (n = 88) reduced from 9.8% to 8.6% at 6 months (p < 0.0001) and sustained significant reductions at 12, 18, 24, 30, and 36 months (p < 0.05). Highly Engaged patients with hypertension (n = 152) had significant, sustained reductions in blood pressure (p < 0.0001). Engaged patients in the same high-risk groups also had significant improvements in HbA1c and blood pressure. Both engagement subgroups had moderate improvements in weight change and cholesterol. This study shows promising associations of TK services that promote chronic-disease self-management with improved clinical outcomes among higher risk patients (e.g., high blood pressure, high HbA1c, high low-density lipoprotein) with different medical issues (e.g., diabetes, obesity) and social barriers (e.g., food insecurity).
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Affiliation(s)
- Jacob P. Tanumihardjo
- Section of General Internal Medicine, University of Chicago, Chicago, IL 60637, USA; (J.P.T.)
| | - Heidi Davis
- Community Teaching Kitchen, Providence Milwaukie Hospital, Providence Health & Services, Milwaukie, OR 97222, USA; (K.K.G.)
| | - Mengqi Zhu
- Section of General Internal Medicine, University of Chicago, Chicago, IL 60637, USA; (J.P.T.)
| | - Helen On
- Population Health Division, Providence Health & Services, Portland, OR 97213, USA;
| | - Kayla K. Guillory
- Community Teaching Kitchen, Providence Milwaukie Hospital, Providence Health & Services, Milwaukie, OR 97222, USA; (K.K.G.)
| | - Jill Christensen
- Community Teaching Kitchen, Providence Milwaukie Hospital, Providence Health & Services, Milwaukie, OR 97222, USA; (K.K.G.)
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Ory MG, Han G, Jani SN, Zhong L, Andreyeva E, Carpenter K, Towne SD, Preston VA, Smith ML. Factors associated with higher hemoglobin A1c and type 2 diabetes-related costs: Secondary data analysis of adults 18 to 64 in Texas with commercial insurance. PLoS One 2023; 18:e0289491. [PMID: 37682942 PMCID: PMC10490838 DOI: 10.1371/journal.pone.0289491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/20/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE This study will identify factors associated with higher hemoglobin A1c (A1c) values and diabetes-related costs among commercially insured adults in Texas diagnosed with type 2 diabetes. RESEARCH DESIGN AND METHODS This secondary data analysis was based on claims data from commercially insured individuals 18-64 years of age residing in Texas with diagnosed type 2 diabetes during the 2018-2019 study period. The final analysis sample after all the exclusions consisted of 34,992 individuals. Measures included hemoglobin A1c, diabetes-related costs, Charlson Comorbidity Index, diabetes-related complications, rurality and other socioeconomic characteristics. Longitudinal A1c measurements were modeled using age, sex, rurality, comorbidity, and diabetes-related complications in generalized linear longitudinal regression models adjusting the observation time, which was one of the 8 quarters in 2018 and 2019. The diabetes-related costs were similarly modeled in both univariable and multivariable generalized linear longitudinal regression models adjusting the observation time by calendar quarters and covariates. RESULTS The median A1c value was 7, and the median quarterly diabetes-related cost was $120. A positive statistically significant relationship (p = < .0001) was found between A1c levels and diabetes-related costs, although this trend slowed down as A1c levels exceeded 8.0%. Higher A1c values were associated with being male, having diabetes-related complications, and living in rural areas. Higher costs were associated with higher A1c values, older age, and higher Charlson Comorbidity Index scores. CONCLUSION The study adds updated analyses of the interrelationships among demographic and geographic factors, clinical indicators, and health-related costs, reinforcing the role of higher A1c values and complications as diabetes-related cost drivers.
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Affiliation(s)
- Marcia G. Ory
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Gang Han
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Sagar N. Jani
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
| | - Lixian Zhong
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
- College of Pharmacy, Texas A&M University, College Station, Texas, United States of America
| | - Elena Andreyeva
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Keri Carpenter
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
| | - Samuel D. Towne
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas, United States of America
- School of Global Health Management and Informatics, University of Central Florida, Orlando, Florida, United States of America
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, Florida, United States of America
- Southwest Rural Health Research Center, Texas A&M University, College Station, Texas, United States of America
| | - Veronica Averhart Preston
- Blue Cross Blue Shield of Texas, a subsidiary of Health Care Service Corporation, Richardson, Texas, United States of America
| | - Matthew Lee Smith
- Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas, United States of America
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12
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Butayeva J, Ratan ZA, Downie S, Hosseinzadeh H. The impact of health literacy interventions on glycemic control and self-management outcomes among type 2 diabetes mellitus: A systematic review. J Diabetes 2023; 15:724-735. [PMID: 37407516 PMCID: PMC10509520 DOI: 10.1111/1753-0407.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/03/2023] [Indexed: 07/07/2023] Open
Abstract
Diabetes imposes an increasing health and economic burden on individuals living with it and their societies worldwide. Glycemic control is necessary to reduce morbidity and mortality of type 2 diabetes mellitus (T2DM). Self-management is the primary tool for managing diabetes. Health literacy (HL) is the primary driver of self-management activities. The aim of this review is to evaluate the impact of HL interventions on glycemic control and self-management outcomes among T2DM. MEDLINE, CINAHL, PubMed, Cochrane, Scopus, and Web of Science were searched for eligible papers. Fifteen randomized controlled trials published in English between 1997 and 2021, used HL-driven intervention, and measured the level of glycohemoglobin A1c (HbA1c) and self-management of T2DM patients were included in this review. The findings showed that HL-driven intervention had a positive impact on glycemic control and improved self-management behaviors. The level of glycemic control and self-management skills were improved through individual and telephone-based intervention respectively. Community worker-led interventions were effective in improvements in diabetes knowledge and self-care behaviors; however, nurse-led interventions were effective in glycemic control. Better glycemic control is achieved in hospital settings compared to outpatient settings. HL interventions yielded better improvement in self-management among people with longer diabetes duration (more than 7 years). It was possible to achieve a large reduction in HbA1c level after a 3-month intervention in hospital settings. HL-driven interventions are effective in glycemic and diabetes self-management outcomes.
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Affiliation(s)
- Jamila Butayeva
- School of Health & Society, Faculty of the Arts, Social Sciences and HumanitiesUniversity of WollongongWollongongNew South WalesAustralia
| | - Zubair Ahmed Ratan
- School of Health & Society, Faculty of the Arts, Social Sciences and HumanitiesUniversity of WollongongWollongongNew South WalesAustralia
| | - Sue Downie
- Discipline of Medical and Exercise Science, Faculty of Science, Medicine and Health, School of MedicineUniversity of WollongongWollongongNew South WalesAustralia
| | - Hassan Hosseinzadeh
- School of Health & Society, Faculty of the Arts, Social Sciences and HumanitiesUniversity of WollongongWollongongNew South WalesAustralia
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13
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Mize TD, Guthrie K, Oprinovich SM. Evaluation of a Diabetes Coaching Program on Clinical Outcomes in a Self-Insured Grocery Chain. J Pharm Pract 2023:8971900231198929. [PMID: 37632146 DOI: 10.1177/08971900231198929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Background: Diabetes is among the most prevalent and costly disease states to treat. Many self-insured employers offer employee wellness programs to decrease healthcare expenditures for chronic illnesses, such as diabetes. Existing literature demonstrates that pharmacists can positively impact treatment of patients with diabetes and assist in lowering costs of care, but no current literature examines pharmacist intervention within an employee wellness program over a prolonged period of time. Objectives: To quantify the hemoglobin A1c (HbA1c) lowering achieved through participation in a pharmacist-led diabetes coaching program within a self-insured company. Methods: A retrospective chart review was conducted at a self-insured grocery store chain in the Kansas City area with an employee wellness program called Start Now. Patients who enrolled in the Start Now Program for Diabetes Care (SN-DM) between July 1, 2008 and July 1, 2021 with at least two documented HbA1c measurements were included in the analysis. Results: A total of 355 charts were included in the analysis. The average HbA1c reduction observed in program patients was 0.61% (P < .001). At baseline, 40% of program patients were considered to have controlled diabetes (A1c <7%) compared with 60% of patients at most recent HbA1c (P < .001). There was no correlation between HbA1c lowering and number of pharmacist coaching visits; however, greater HbA1c lowering was observed in patients with a higher baseline HbA1c. Conclusion: Patients who participated in the SN-DM program achieved a significant decrease in mean HbA1c. More patients were considered controlled at last or most recent HbA1c according to the American Diabetes Association guidelines.
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Affiliation(s)
- Taylor D Mize
- Clinical Pharmacist, Balls Food Stores, Harrisonville, MO, USA
| | - Kendall Guthrie
- Department of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA
| | - Sarah M Oprinovich
- Department of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA
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14
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Wang L, Lauren BN, Hager K, Zhang FF, Wong JB, Kim DD, Mozaffarian D. Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study. J Am Heart Assoc 2023; 12:e029215. [PMID: 37417296 PMCID: PMC10492976 DOI: 10.1161/jaha.122.029215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/31/2023] [Indexed: 07/08/2023]
Abstract
Background Produce prescription programs, providing free or discounted produce and nutrition education to patients with diet-related conditions within health care systems, have been shown to improve dietary quality and cardiometabolic risk factors. The potential impact of implementing produce prescription programs for patients with diabetes on long-term health gains, costs, and cost-effectiveness in the United States has not been established. Methods and Results We used a validated state-transition microsimulation model (Diabetes, Obesity, Cardiovascular Disease Microsimulation model), populated with national data of eligible individuals from the National Health and Nutrition Examination Survey 2013 to 2018, further incorporating estimated intervention effects and diet-disease effects from meta-analyses, and policy- and health-related costs from published literature. The model estimated that over a lifetime (mean=25 years), implementing produce prescriptions in 6.5 million US adults with both diabetes and food insecurity (lifetime treatment) would prevent 292 000 (95% uncertainty interval, 143 000-440 000) cardiovascular disease events, generate 260 000 (110000-411 000) quality-adjusted life-years, cost $44.3 billion in implementation costs, and save $39.6 billion ($20.5-58.6 billion) in health care costs and $4.8 billion ($1.84-$7.70 billion) in productivity costs. The program was highly cost effective from a health care perspective (incremental cost-effectiveness ratio: $18 100/quality-adjusted life-years) and cost saving from a societal perspective (net savings: $-0.05 billion). The intervention remained cost effective at shorter time horizons of 5 and 10 years. Results were similar in population subgroups by age, race or ethnicity, education, and baseline insurance status. Conclusions Our model suggests that implementing produce prescriptions among US adults with diabetes and food insecurity would generate substantial health gains and be highly cost effective.
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Affiliation(s)
- Lu Wang
- The Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMAUSA
| | - Brianna N. Lauren
- The Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMAUSA
| | - Kurt Hager
- The Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMAUSA
| | - Fang Fang Zhang
- The Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMAUSA
| | - John B. Wong
- Division of Clinical Decision MakingTufts Medical CenterBostonMAUSA
| | - David D. Kim
- Division of Hospital Medicine, Department of MedicineUniversity of ChicagoILUSA
| | - Dariush Mozaffarian
- The Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMAUSA
- Division of CardiologyTufts Medical CenterBostonMAUSA
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15
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Palacios A, Rodriguez-Cairoli F, Balan D, Rojas-Roque C, Moreno-López C, Braun B, Augustovski F, Pichon-Riviere A, Bardach A. Budget Impact Analysis of the FreeStyle Libre Flash Continuous Glucose Monitoring System ® in Patients with Type 1 Diabetes Mellitus and Type 2 Diabetes Mellitus with Multiple Daily Insulin Injections in Argentina. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:637-650. [PMID: 37062046 DOI: 10.1007/s40258-023-00800-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To estimate the budget impact of the potential coverage of FreeStyle Libre Flash Continuous Glucose Monitoring System (FSL) for glycemia monitoring in all type 1 diabetes mellitus (T1DM) patients and in those with type 2 diabetes mellitus (T2DM) with multiple daily insulin injections, from the social security and the private third-party payer's perspective in Argentina. METHODS A budget impact model was developed to estimate the cost difference between the self-monitoring of blood glucose (standard of care) and FSL over 5 years. Input parameters were retrieved from local literature complemented by expert opinion. Health care costs were estimated by a micro-costing approach and reported in USD as of April 2022 (1 USD = 113.34 Argentine pesos). One-way sensitivity and scenario analyses were conducted. RESULTS From a social security third-party payer perspective, the incorporation of FSL was associated with net savings per member per month (PMPM) of $0.026 (Year 1) to $0.097 (Year 5) and net savings PMPM of $0.002 (Year 1) to $0.008 (Year 5) for T1DM and T2DM patients, respectively. Similar findings are reported from the private third-party payer perspective. The budget impact results were more sensitive to the acquisition costs of the FSL and test strips. CONCLUSION The potential coverage of FSL in patients with T1DM and T2DM with multiple daily insulin injections could be associated with small financial savings considering current technology acquisition costs (FSL and test strips) for social security and the private sector third-party payers in Argentina.
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Affiliation(s)
- Alfredo Palacios
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
- Department of Economics, Universidad de Buenos Aires, Buenos Aires, Argentina.
- Centre for Health Economics (CHE), University of York, York, UK.
| | - Federico Rodriguez-Cairoli
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Dario Balan
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Carlos Rojas-Roque
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Carolina Moreno-López
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Barbara Braun
- Departamento de Clínica Médica y Diabetología, Sanatorio de la Trinidad Palermo, Buenos Aires, Argentina
| | - Federico Augustovski
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Ariel Bardach
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health (CIESP), Buenos Aires, Argentina
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Chauhan A, Samnaliev M, Ken-Opurum J, Srinivas SSS, Mehta AM, Dex T, Charland S, Revel A, Preblick R. Clinical Benefits of Treating Patients with Type 2 Diabetes Mellitus with iGlarLixi: A Patient-Level Simulation Study. Diabetes Ther 2023:10.1007/s13300-023-01419-z. [PMID: 37289358 PMCID: PMC10299979 DOI: 10.1007/s13300-023-01419-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/28/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION The fixed-ratio combination of insulin glargine (iGlar) plus lixisenatide (iGlarLixi) has proven efficacious in clinical trials; however, there is limited evidence of its benefits in a variety of real-world patients with type 2 diabetes mellitus (T2DM) who present in routine clinical practice. METHODS A large integrated claims and EHR database was used to identify two real-world (RW) cohorts (ages ≥ 18) with T2DM who were eligible for treatment with iGlarLixi. At baseline, the first cohort (insulin cohort) received insulin with or without oral antidiabetic drugs (OADs), and the second cohort (OAD-only cohort) received OADs only. A Monte Carlo patient-level simulation was applied to each cohort based on treatment strategies and efficacies from the LixiLan-L and LixiLan-O trials to estimate reductions in glycated hemoglobin A1C (A1C) and the percentage achieving age-based A1C goals (≤ 7% for ages < 65 and ≤ 8% for ages ≥ 65) at 30 weeks. RESULTS The RW insulin (N = 3797) and OAD-only (N = 17,633) cohorts differed considerably in demographics, age, clinical characteristics, baseline A1C levels, and background OAD therapies compared to the populations in the Lixilan-L and Lixilan-O trials. Regardless of the cohort description, A1C goals were achieved among 52.6% vs. 31.6% (p < 0.001) of patients in the iGlarLixi vs. the iGlar arms in the insulin cohort simulation, while A1C goals were achieved among 59.9% vs. 49.3% and 32.8% (p < 0.001) of patients in the OAD-only cohort simulation in the iGlarLixi vs. the iGlar and lixisenatide arms, respectively. CONCLUSIONS Irrespective of the treatment regimen at baseline (insulin vs. OAD only), this patient-level simulation demonstrated that a greater proportion of patients achieved their A1C goals with iGlarlixi compared to iGlar or lixisenatide alone. These findings suggest that the benefits of iGlarLixi extend to clinically distinct RW populations.
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Shao Y, Stoecker C, Hong D, Nauman E, Fonseca V, Hu G, Bazzano AN, Fort D, Kabagambe EK, Shi L. The Impact of Reimbursement for Non-Face-to-Face Chronic Care Management on Comprehensive Metabolic Biomarkers Among Multimorbid Patients With Type 2 Diabetes. Med Care 2023; 61:157-164. [PMID: 36728398 PMCID: PMC11110110 DOI: 10.1097/mlr.0000000000001816] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS We evaluated the impact of reimbursement for non-face-to-face chronic care management (NFFCCM) on comprehensive metabolic risk factors among multimorbid Medicare beneficiaries with type 2 diabetes in Louisiana. MATERIALS AND METHODS We implemented a propensity score method to obtain comparable treatment (n=1501 with NFFCCM) and control (n=17,524 without NFFCCM) groups. Patients with type 2 diabetes were extracted from the electronic health records stored in REACHnet. The study period was from 2013 to February 2020. The comprehensive metabolic risk factors included the primary outcome of glycated hemoglobin (HbA1c) (as the primary outcome) and the secondary outcomes of body mass index (BMI), systolic blood pressure (BP), and low-density lipoprotein cholesterol. RESULTS Receiving any NFFCCM was associated with improvement in all outcomes measures: a reduction in HbA1c of 0.063% (95% CI: 0.031%-0.094%; P <0.001), a reduction in BMI of 0.155 kg/m 2 (95% CI: 0.029-0.282 kg/m 2 ; P =0.016), a reduction in systolic BP of 0.816 mm Hg (95% CI: 0.469-1.163 mm Hg; P <0.001), and a reduction in low-density lipoprotein cholesterol of 1.779 mg/dL (95% CI: 0.988 2.570 mg/dL; P <0.001). Compared with the control group, the treatment group had 1.6% more patients with HbA1c <7% (95% CI: 0.3%-2.9%; P =0.013). CONCLUSIONS Patients with diabetes in Louisiana receiving NFFCCM experienced better control of HbA1c, BMI, BP, and low-density lipoprotein outcomes.
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Affiliation(s)
- Yixue Shao
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University
| | - Charles Stoecker
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University
| | - Dongzhe Hong
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University
| | | | - Vivian Fonseca
- Section of Endocrinology, Tulane University Health Sciences Center, New Orleans
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge
| | - Alessandra N. Bazzano
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University
| | | | | | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University
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18
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Palacios A, Rodriguez Cairoli F, Balan D, Balmaceda C, Augustovski F, Pichon-Riviere A, Bardach A. Budget impact analysis of the freestyle libre flash continuous glucose monitoring system® in patients with diabetes mellitus type 1 in Chile. Expert Rev Pharmacoecon Outcomes Res 2023; 23:353-363. [PMID: 36701814 DOI: 10.1080/14737167.2023.2171989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To estimate the budget impact of covering the FreeStyle Libre Flash Continuous Glucose Monitoring System (FSL) for type 1 Diabetes Mellitus patients (T1DM), compared to self-monitoring of blood glucose (SMBG), from the perspective of public and private third-party payers in Chile. METHODS A budget impact model was developed to estimate the cost difference between SMBG and FSL over five years. Two FSL coverage schemes were assessed. Input parameters were retrieved from the literature review and complemented by expert opinion. Healthcare costs were estimated by a micro-costing approach and reported in USD. RESULTS For a public sector third-party payer, incorporating FSL implied a cost increase up to USD 0.013 per member per month (PMPM) for the fifth year under the broad coverage scheme and a net saving of 0.0001 PMPM (all years) under the restricted coverage scheme. From a private sector third-party payer, incorporating FSL implied savings up to USD 0.028 PMPM (fifth year) for the broad coverage scheme and up to USD 0.012 PMPM (fifth year) for the restricted scheme. CONCLUSION Incorporating the FSL for T1DM patients was associated with a marginal incremental cost for the public sector third-party payer and cost savings in Chile's private healthcare sector.
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Affiliation(s)
- Alfredo Palacios
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.,Centre for Health Economics, University of York, York, UK.,Department of Economics, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Federico Rodriguez Cairoli
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Dario Balan
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Carlos Balmaceda
- Centre for Health Economics, University of York, York, UK.,Unidad de Evaluación de Tecnologías Sanitarias, Centro de Investigación Clínica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Federico Augustovski
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andres Pichon-Riviere
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Ariel Bardach
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Zhang X, McAdam Marx C. Short-term cost-effectiveness analysis of tirzepatide for the treatment of type 2 diabetes in the United States. J Manag Care Spec Pharm 2023; 29:276-284. [PMID: 36840958 PMCID: PMC10388019 DOI: 10.18553/jmcp.2023.29.3.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND: Tirzepatide is a novel once-a-week dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist that is used as an addition to diet and exercise to improve blood glucose in adults with type 2 diabetes. It is the first dual glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide receptor agonist that has been approved by the US Food and Drug Administration. The SURPASS-2 clinical trial demonstrated superiority of tirzepatide 10 mg and 15 mg over semaglutide 1 mg in glycated hemoglobin A1c reduction and weight loss from baseline to week 40. Economic analyses to support coverage and access decision-making for tirzepatide are limited. OBJECTIVES: To evaluate the cost-effectiveness of tirzepatide 10 mg vs semaglutide 1 mg injection over 52 weeks of treatment regarding A1c reduction and weight loss from the perspective of the US health care payer. METHODS: A decision tree model over a 52-week time horizon was developed to identify incremental treatment-related costs of once-weekly tirzepatide 10 mg vs semaglutide 1 mg injection. Costs were divided by mean reduction in A1c and change in body weight from baseline to week 52 observed in the SURPASS-2 clinical trial. In addition to efficacy, probabilities of adverse events, discontinuation, and need for rescue therapy were derived from the SURPASS-2 study. Drug costs in 2022 US dollars were based on wholesale acquisition cost. Costs associated with adverse events were sourced from the published literature. One-way sensitivity analyses were conducted. RESULTS: Treatment with once-weekly tirzepatide 10 mg injection was associated with a higher cost and larger reduction in A1c and body weight after 52 weeks, compared with once-weekly semaglutide 1 mg injection. The incremental cost-effectiveness ratio for tirzepatide vs semaglutide was $2,247 per 1% reduction in A1c and $237 per 1 kg weight loss. One-way sensitivity analysis suggested that incremental cost-effectiveness ratios were most sensitive to the drug costs and treatment effect on A1c and weight. CONCLUSIONS: Once-weekly tirzepatide 10 mg was associated with higher cost and greater reduction in A1c and weight vs semaglutide. Tirzepatide 10 mg is cost-effective compared with semaglutide 1 mg if payers' willingness-to-pay threshold exceeds $2,247 for 1% reduction in A1c level and $237 for 1 kg weight loss.
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Affiliation(s)
- Xiaotong Zhang
- University of Nebraska Medical Center, Department of Pharmacy Practice and Science, College of Pharmacy, Omaha
| | - Carrie McAdam Marx
- University of Nebraska Medical Center, Department of Pharmacy Practice and Science, College of Pharmacy, Omaha
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Hirosaki M, Ohira T, Wu Y, Eguchi E, Shirai K, Imano H, Funakubo N, Nishizawa H, Katakami N, Shimomura I, Iso H. Laughter yoga as an enjoyable therapeutic approach for glycemic control in individuals with type 2 diabetes: A randomized controlled trial. Front Endocrinol (Lausanne) 2023; 14:1148468. [PMID: 37065750 PMCID: PMC10102335 DOI: 10.3389/fendo.2023.1148468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Laughter has been reported to have various health benefits. However, data on the long-term effects of laughter interventions on diabetes are limited. This study aimed to investigate whether laughter yoga can improve glycemic control among individuals with type 2 diabetes. METHODS In a single-center, randomized controlled trial, 42 participants with type 2 diabetes were randomly assigned to either the intervention or the control group. The intervention consisted of a 12-week laughter yoga program. Hemoglobin A1c (HbA1c), body weight, waist circumference, psychological factors, and sleep duration were evaluated at baseline and week 12. RESULTS Intention-to-treat analysis showed that participants in the laughter yoga group experienced significant improvements in HbA1c levels (between-group difference: -0.31%; 95% CI -0.54, -0.09) and positive affect scores (between-group difference: 0.62 points; 95% CI 0.003, 1.23). Sleep duration tended to increase in the laughter yoga group with a between-group difference of 0.4 hours (95% CI -0.05, 0.86; P = 0.080). The mean attendance rate for laughter yoga program was high (92.9%). CONCLUSIONS A 12-week laughter yoga program is feasible for individuals with type 2 diabetes and improves glycemic control. These findings suggest that having fun could be a self-care intervention. Further studies with larger numbers of participants are warranted to better evaluate the effects of laughter yoga. CLINICAL TRIAL REGISTRATION http://www.chinadrugtrials.org.cn, identifier UMIN000047164.
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Affiliation(s)
- Mayumi Hirosaki
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
- *Correspondence: Mayumi Hirosaki, ; Tetsuya Ohira,
| | - Tetsuya Ohira
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
- *Correspondence: Mayumi Hirosaki, ; Tetsuya Ohira,
| | - Yawei Wu
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Eri Eguchi
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kokoro Shirai
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hironori Imano
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Narumi Funakubo
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Naoto Katakami
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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Fujiwara T, Collier A, Al-Attar N. The importance of dietetic input in improving glycaemic control for cardiac surgery. Diabet Med 2023; 40:e14933. [PMID: 35929186 DOI: 10.1111/dme.14933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Tomoyo Fujiwara
- Clinical Nutrition, Golden Jubilee National Hospital, Clydebank, Scotland
| | | | - Nawwar Al-Attar
- Cardiac Surgery, Golden Jubilee National Hospital, Clydebank, Scotland
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Rimawi A, Shah A, Louis H, Scales D, Kheiran JA, Jawabreh N, Yunez S, Horino M, Seita A, Wispelwey B. Community Health Worker Program Outcomes for Diabetes and Hypertension Control in West Bank Refugee Camps: A Retrospective Matched Cohort Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2200168. [PMID: 36316145 PMCID: PMC9622278 DOI: 10.9745/ghsp-d-22-00168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Community health worker (CHW) programs have proven effective in improving diabetes control in many locations and settings, but data on feasibility and efficacy are lacking in the Middle East and settings of chronic violence. A Palestinian CHW program, Health for Palestine (H4P), addresses chronic diseases in West Bank refugee camps. Our study assesses the feasibility and effectiveness of the program's diabetes and hypertension interventions. METHODS Data on home visits, patient retention, and blood pressure were extracted from the CHW records and analyzed. To assess diabetic patient progress, we conducted a retrospective matched cohort study using data obtained from a United Nations (UN) clinical database to analyze the trajectory of hemoglobin A1c (A1c) values. Thirty of the 47 diabetic patients in the H4P CHW program met study inclusion criteria and were each matched with 3 patients from the Bethlehem UN clinic (n=120). We tested for significance using multivariable linear regression with robust standard errors. RESULTS The average number of home visits per patient per month was 7.3 (standard deviation=4.1), and the patient retention rate was 100% over an average of 11.2 months. For hypertension patients in the CHW program (n=33), mean systolic blood pressure decreased by 7.3 mmHg (95% confidence interval [CI]=1.93, 12.25; P=.009) and mean diastolic blood pressure by 4.3 mmHg (95% CI=0.80, 7.91; P=.018) from March 2018 to November 2019. On average, diabetic patients within the CHW group experienced a 1.4 point greater decline in A1c per year compared to those in the non-CHW group, after adjusting for potential confounders (95% CI=-0.66, -2.1; P<.001). DISCUSSION The results suggest that CHW accompaniment may be an effective model for improving diabetes and hypertension control in refugee camps experiencing direct violence and extreme adversity. A low exclusion cut-off for A1c (≤6.4%) may underestimate the program's impact.
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Affiliation(s)
- Asmaa Rimawi
- Harvard T.H. Chan School of Public Health; Harvard Medical School, Boston, MA, USA
| | - Adarsh Shah
- Harvard Kennedy School, Harvard University, Cambridge, MA, USA
| | - Henry Louis
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - David Scales
- New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Jawad Abu Kheiran
- United Nations Relief and Works Agency, Arroub refugee camp, occupied Palestinian territory
| | - Nashat Jawabreh
- Makassad Hospital, East Jerusalem, occupied Palestinian territory
| | - Sofia Yunez
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Masako Horino
- United Nations Relief and Works Agency, Amman, Jordan
| | - Akihiro Seita
- United Nations Relief and Works Agency, Amman, Jordan
| | - Bram Wispelwey
- Brigham and Women's Hospital, Harvard Medical School; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Joshi S, Verma R, Lathia T, Selvan C, Tanna S, Saraf A, Tiwaskar M, Modi A, Kalra S, K V, Chitale M, Malde F, Abdul Khader M, Singal AK. Changes in HbA1c and weight in people with Type 2 Diabetes after continuous glucose monitoring based Diabefly-Pro digital therapeutics program: Analysis of real-world data (Preprint). JMIR Diabetes 2022; 8:e43292. [PMID: 37133922 DOI: 10.2196/43292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/31/2023] [Accepted: 03/07/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Digital therapeutic platforms facilitate health care through patient-centered strategies based on multidisciplinary teams and shared decision-making. Such platforms can be used for developing a dynamic model of diabetes care delivery, which can help in improving glycemic control by promoting long-term behavior changes in people with diabetes. OBJECTIVE This study aims to evaluate the real-world effectiveness of the Fitterfly Diabetes CGM digital therapeutics program for improving glycemic control in people with type 2 diabetes mellitus (T2DM) after the completion of 90 days in the program. METHODS We analyzed deidentified data of 109 participants in the Fitterfly Diabetes CGM program. This program was delivered through the Fitterfly mobile app coupled with continuous glucose monitoring (CGM) technology. This program consists of 3 phases: the first phase is observation, wherein the patient's CGM readings are observed for 7 days (week 1); the second phase is the intervention; and the third phase aims at sustaining the lifestyle modification introduced during the second phase. The primary outcome of our study was the change in the participants' hemoglobin A1c (HbA1c) levels after program completion. We also evaluated the changes in participant weight and BMI after the program, changes in the CGM metrics in the initial 2 weeks of the program, and the effects of participant engagement in the program on improving their clinical outcomes. RESULTS At the end of the 90 days of the program, the mean HbA1c levels, weight, and BMI of the participants were significantly reduced by 1.2% (SD 1.6%), 2.05 (SD 2.84) kg, and 0.74 (SD 1.02) kg/m2 from baseline values of 8.4% (SD 1.7%), 74.45 (SD 14.96) kg, and 27.44 (SD 4.69) kg/m2 in week 1, respectively (P<.001). The average blood glucose levels and time above range values showed a significant mean reduction by 16.44 (SD 32.05) mg/dL and 8.7% (SD 17.1%) in week 2 from week 1 baseline values of 152.90 (SD 51.63) mg/dL and 36.7% (SD 28.4%), respectively (P<.001 for both). Time in range values significantly improved by 7.1% (SD 16.7%) from a baseline value of 57.5% (SD 25%) in week 1 (P<.001). Of all the participants, 46.9% (50/109) showed HbA1c reduction ≥1% and 38.5% (42/109) showed weight loss ≥4%. The average number of times the mobile app was opened by each participant during the program was 108.80 (SD 127.91) times. CONCLUSIONS Our study shows that participants in the Fitterfly Diabetes CGM program showed a significant improvement in their glycemic control and reduction in weight and BMI. They also showed a high level of engagement with the program. Weight reduction was significantly associated with higher participant engagement with the program. Thus, this digital therapeutic program can be considered as an effective tool for improving glycemic control in people with T2DM.
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Affiliation(s)
- Shilpa Joshi
- Department of Metabolic Nutrition, Fitterfly HealthTech Pvt Ltd, Navi Mumbai, India
| | - Ritika Verma
- Department of Scientific writing and Research, Fitterfly HealthTech Pvt Ltd, Navi Mumbai, India
| | - Tejal Lathia
- Department of Endocrinology and Diabetology, Apollo Hospitals, Navi Mumbai, India
| | - Chitra Selvan
- Department of Endocrinology and Diabetology, MS Ramaiah Memorial Hospital, Bangalore, India
| | - Snehal Tanna
- Department of Internal Medicine, Jupiter Hospital, Thane, India
| | - Amit Saraf
- Department of Internal Medicine, Jupiter Hospital, Thane, India
| | - Mangesh Tiwaskar
- Department of Diabetology, Shilpa Medical Research Center, Mumbai, India
| | - Alok Modi
- Department of General Medicine, Kevalya Hospital, Thane, India
| | - Sanjay Kalra
- Department of Endocrinology and Diabetology, Bharti Research Institute of Diabetes and Endocrinology, Haryana, India
| | - Vasudevarao K
- Department of Endocrinology and Diabetology, Hridayam Diabetes World, Thane, India
| | - Manoj Chitale
- Department of General Medicine, Shree Clinic, Nashik, India
| | - Forum Malde
- Department of Metabolic Nutrition, Fitterfly HealthTech Pvt Ltd, Navi Mumbai, India
| | - Mohammed Abdul Khader
- Department of Scientific writing and Research, Fitterfly HealthTech Pvt Ltd, Navi Mumbai, India
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Boye KS, Thieu VT, Lage MJ, Miller H, Paczkowski R. The Association Between Sustained HbA1c Control and Long-Term Complications Among Individuals with Type 2 Diabetes: A Retrospective Study. Adv Ther 2022; 39:2208-2221. [PMID: 35316502 PMCID: PMC9056490 DOI: 10.1007/s12325-022-02106-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/24/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The prevalence of type 2 diabetes (T2D) represents a rising burden in the US and worldwide, with the condition shown to be associated with relatively large human and economic costs. Part of the reason for such high costs associated with T2D is that the condition is often accompanied by additional health-related complications. The goal of this research is to examine the association between glycemic control and diabetes-related complications for individuals with T2D. METHODS The Optum Clinformatics® Data Mart (CDM) database from 2007 to 2020 was used to identify adults with T2D. Individuals were classified as having sustained glycemic control (all hemoglobin A1c [HbA1c] < 7%) or poor glycemic control (all HbA1c ≥ 7%) over the 5-year post-period, and diabetes-related complications were identified based upon the Diabetes Complications Severity Index. Multivariable analyses examined the association between sustained glycemic control and diagnosis of a diabetes-related complication in the post-period. RESULTS Maintaining HbA1c < 7% over the 5-year post-period, compared to maintaining HbA1c ≥ 7%, was associated with reduced odds of the diabetes-related complications of cardiovascular disease (odds ratio [OR] = 0.76, 95% confidence interval [CI] 0.61-0.94), metabolic disease (OR = 0.37, 95% CI 0.22-0.600), neuropathy (OR = 0.62, 95% CI 0.45-0.84), nephropathy (OR = 0.81, 95% CI 0.69-0.94), and peripheral vascular disease (OR = 0.52, 95% CI 0.33-0.83). There was no statistically significant association between sustained glycemic control and cerebrovascular disease. CONCLUSIONS Sustained glycemic control was found to be associated with significant reductions in the odds of being diagnosed with diabetes-related complications over a 5-year post-period.
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Affiliation(s)
- Kristina S. Boye
- Eli Lilly and Company, 893 Delaware Street, Indianapolis, IN 46225 USA
| | - Vivian T. Thieu
- Eli Lilly and Company, 893 Delaware Street, Indianapolis, IN 46225 USA
| | - Maureen J. Lage
- HealthMetrics Outcomes Research, 17 Benton’s Knoll, Guilford, CT 06437 USA
| | - Heather Miller
- The Pennsylvania State University, 535 North Midlothian Road, Mundelein, IL 60060 USA
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Boye KS, Lage MJ, Thieu VT. The Association Between HbA1c and 1-Year Diabetes-Related Medical Costs: A Retrospective Claims Database Analysis. Diabetes Ther 2022; 13:367-377. [PMID: 35129822 PMCID: PMC8873294 DOI: 10.1007/s13300-022-01212-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The American Diabetes Association (ADA) has identified a target hemoglobin A1c (HbA1c) < 7% as appropriate for most adults with type 2 diabetes (T2D). This research examines US diabetes-related healthcare costs for adults with T2D for individuals with glycemic control (HbA1c < 7%) compared to poor glycemic control (HbA1c ≥ 7%). METHODS The Optum Clinformatics® Data Mart database from 2016 to 2020 was used to identify a cohort of adults with T2D who had a recorded HbA1c test (with first such date identified as the index date) and continuous insurance from 1 year prior through 1 year post index date. Patients with glycemic control were propensity matched to patients with poor glycemic control. Generalized linear models and two-part models examined diabetes-related outpatient, drug, acute care, and total costs over the 1-year post-period. RESULTS There were 34,538 propensity matched individuals included in the study. Results indicate that glycemic control (HbA1c < 7%), compared to poor glycemic control (HbA1c ≥ 7%) ,was associated with statistically significantly lower annual diabetes-related acute ($5671 ± $4216 vs $6138 ± $4211), outpatient ($6051 ± $4216 vs $7259 ± $7771), drug ($3739 ± $4581 vs $4288 ± $4788), and total costs care ($13,704 ± $10,635 vs $16,460 ± $10,885) (all P < 0.0001). Sensitivity analyses also examined results based upon alternative HbA1c thresholds which were chosen on the basis of expert guidelines and prior clinical trial thresholds (< 6%, ≤ 6.5%, < 8%, and ≤ 9%). In all cases, being below threshold was associated with statistically significantly lower diabetes-related total costs and component costs. Results also illustrate that, in general, higher HbA1c thresholds are associated with higher diabetes-related costs. CONCLUSION Glycemic control was found to be associated with significantly lower annual diabetes-related component and total costs. Results suggest economic benefits associated with having HbA1c at or below target.
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Affiliation(s)
- Kristina S. Boye
- Eli Lilly and Company, 893 Delaware Street, Indianapolis, IN 46225 USA
| | - Maureen J. Lage
- HealthMetrics Outcomes Research, 17 Benton’s Knoll, Guilford, CT 06437 USA
| | - Vivian T. Thieu
- Eli Lilly and Company, 893 Delaware Street, Indianapolis, IN 46225 USA
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26
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Boye KS, Lage MJ, Thieu V, Shinde S, Dhamija S, Bae JP. Obesity and glycemic control among people with type 2 diabetes in the United States: A retrospective cohort study using insurance claims data. J Diabetes Complications 2021; 35:107975. [PMID: 34176723 DOI: 10.1016/j.jdiacomp.2021.107975] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/26/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022]
Abstract
AIMS To examine body mass index (BMI) and HbA1c for individuals with type 2 diabetes (T2D) in the United States. METHODS The retrospective study utilized data from IBM® MarketScan® Explorys® Claims-EMR Data for the years 2012-2019. Individuals with T2D and a recorded HbA1c laboratory result and BMI were included. The relationship between BMI and HbA1c was assessed descriptively and logistic regressions examined the relationship between benchmark BMI and the probability of having HbA1c above targets of 7% or 8% in the 1year post-period. RESULTS In our sample of 44,723 patients, results indicated that compared to individuals of normal weight, those classified as obese class I or obese class II were 24% more likely to have a last HbA1c≥7% (Odds Ratio [OR]=1.24; 95% Confidence Interval [CI] 1.14-1.35 for both obese class I and obese class II), while those classified as obese class III were 16% more likely (OR=1.16; 95% CI 1.06-1.27). Results were similar when using a HbA1c threshold of 8%. CONCLUSIONS Given the importance of glycemic control for people with T2D, these results suggest that treatments which reduce rates of obesity may help to improve health outcomes.
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Affiliation(s)
- Kristina S Boye
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, United States of America.
| | - Maureen J Lage
- HealthMetrics Outcomes Research, 27576 River Reach Drive, Bonita Springs, FL 34134, United States of America.
| | - Vivian Thieu
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, United States of America.
| | - Shraddha Shinde
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, United States of America.
| | - Shivanie Dhamija
- HealthMetrics Outcomes Research and The Pennsylvania State University, 9303 Shore Road, Apt 2F, Brooklyn, NY 11209, United States of America
| | - Jay Patrick Bae
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, United States of America.
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Au XY, Kola S, Mohan V. The Effect of Diabetes Self-Management Education on Glycemic Control in Minority Patients With Diabetes Mellitus. Cureus 2021; 13:e16888. [PMID: 34367841 PMCID: PMC8341211 DOI: 10.7759/cureus.16888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/05/2022] Open
Abstract
Background Diabetes self-management education (DSME) plays a vital role in diabetes control yet is highly underutilized, especially in the minority population. The efficacy of DSME on glycemic control among the Hispanic and non-Hispanic black population is not as well established as it is compared to the non-Hispanic White population. Methodology In this retrospective cohort study, patients who participated in both group and one-to-one DSME classes at Saint Francis Medical Center, Trenton, New Jersey, from 2017 to 2019 were identified. Mean hemoglobin A1c levels before DSME and after DSME were compared using paired t-test. Results A total of 344 patients were included in the study. Out of 344 patients, 200 (58%) patients were Hispanic and 97 (28%) were non-Hispanic black, 42 (12%) were Caucasian, and five (2%) were from other races. The mean hemoglobin A1c was reduced by an average of 1.08% among patients who participated in group DSME (DSME done in group settings) and by an average of 1.95% among patients who participated in one-to-one DSME (DSME done in individualized settings). Conclusion DSME is effective in reducing hemoglobin A1c levels in Hispanic and non-Hispanic black majority patients. One-to-one DSME is more effective than group DSME in reducing hemoglobin A1c in this patient population.
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Affiliation(s)
- Xiu Ying Au
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
| | - Sneha Kola
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
| | - Vinuta Mohan
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
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28
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Chauhan S, Kerr A, Keogh B, Nolan S, Casey R, Adelfio A, Murphy N, Doherty A, Davis H, Wall AM, Khaldi N. An Artificial-Intelligence-Discovered Functional Ingredient, NRT_N0G5IJ, Derived from Pisum sativum, Decreases HbA1c in a Prediabetic Population. Nutrients 2021; 13:1635. [PMID: 34068000 PMCID: PMC8152294 DOI: 10.3390/nu13051635] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 12/20/2022] Open
Abstract
The prevalence of prediabetes is rapidly increasing, and this can lead to an increased risk for individuals to develop type 2 diabetes and associated diseases. Therefore, it is necessary to develop nutritional strategies to maintain healthy glucose levels and prevent glucose metabolism dysregulation in the general population. Functional ingredients offer great potential for the prevention of various health conditions, including blood glucose regulation, in a cost-effective manner. Using an artificial intelligence (AI) approach, a functional ingredient, NRT_N0G5IJ, was predicted and produced from Pisum sativum (pea) protein by hydrolysis and then validated. Treatment of human skeletal muscle cells with NRT_N0G5IJ significantly increased glucose uptake, indicating efficacy of this ingredient in vitro. When db/db diabetic mice were treated with NRT_N0G5IJ, we observed a significant reduction in glycated haemoglobin (HbA1c) levels and a concomitant benefit on fasting glucose. A pilot double-blinded, placebo controlled human trial in a population of healthy individuals with elevated HbA1c (5.6% to 6.4%) showed that HbA1c percentage was significantly reduced when NRT_N0G5IJ was supplemented in the diet over a 12-week period. Here, we provide evidence of an AI approach to discovery and demonstrate that a functional ingredient identified using this technology could be used as a supplement to maintain healthy glucose regulation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Audrey M. Wall
- Nuritas Ltd., Joshua Dawson House, Dawson St, Dublin 2, Ireland; (S.C.); (A.K.); (B.K.); (S.N.); (R.C.); (A.A.); (N.M.); (A.D.); (H.D.); (N.K.)
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Mynhier M, Nwoku K, Krishna P, Siemers K, Fassett R. Core services that power AI-driven transformation in cancer research and care. Biochim Biophys Acta Rev Cancer 2021; 1876:188535. [PMID: 33848616 DOI: 10.1016/j.bbcan.2021.188535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
This review captures some key lessons learned in the course of helping some of America's leading healthcare AI innovators achieve scale and sustained impact in complex research and care delivery ecosystems. AI innovators may find it useful to access core services to form effective collaborations, find and manage the right data and technology, incentivize and regulate partnerships, demonstrate they can improve lives, and create self-sustaining networks by redistributing realized value.
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Affiliation(s)
- Mark Mynhier
- PricewaterhouseCoopers, LLP US, 300 Madison Avenue, New York, NY 10017, United States of America.
| | - Kelechi Nwoku
- PricewaterhouseCoopers, LLP US, 300 Madison Avenue, New York, NY 10017, United States of America.
| | - Praveen Krishna
- PricewaterhouseCoopers, LLP US, 300 Madison Avenue, New York, NY 10017, United States of America.
| | - Kyle Siemers
- PricewaterhouseCoopers, LLP US, 300 Madison Avenue, New York, NY 10017, United States of America.
| | - Robert Fassett
- PricewaterhouseCoopers, LLP US, 300 Madison Avenue, New York, NY 10017, United States of America.
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30
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Casey R, Adelfio A, Connolly M, Wall A, Holyer I, Khaldi N. Discovery through Machine Learning and Preclinical Validation of Novel Anti-Diabetic Peptides. Biomedicines 2021; 9:276. [PMID: 33803471 PMCID: PMC8000967 DOI: 10.3390/biomedicines9030276] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 12/19/2022] Open
Abstract
While there have been significant advances in drug discovery for diabetes mellitus over the past couple of decades, there is an opportunity and need for improved therapies. While type 2 diabetic patients better manage their illness, many of the therapeutics in this area are peptide hormones with lengthy sequences and a molecular structure that makes them challenging and expensive to produce. Using machine learning, we present novel anti-diabetic peptides which are less than 16 amino acids in length, distinct from human signalling peptides. We validate the capacity of these peptides to stimulate glucose uptake and Glucose transporter type 4 (GLUT4) translocation in vitro. In obese insulin-resistant mice, predicted peptides significantly lower plasma glucose, reduce glycated haemoglobin and even improve hepatic steatosis when compared to treatments currently in use in a clinical setting. These unoptimised, linear peptides represent promising candidates for blood glucose regulation which require further evaluation. Further, this indicates that perhaps we have overlooked the class of natural short linear peptides, which usually come with an excellent safety profile, as therapeutic modalities.
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Affiliation(s)
| | | | | | - Audrey Wall
- Nuritas Ltd., Joshua Dawson House, D02 RY95 Dublin, Ireland; (R.C.); (A.A.); (M.C.); (I.H.); (N.K.)
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Xiang W, Fang B, Xiang X, Liu C, Zhang Y. Predictive modeling of 30-day readmission risk of diabetes patients by logistic regression, artificial neural network, and EasyEnsemble. ASIAN PAC J TROP MED 2021. [DOI: 10.4103/1995-7645.326254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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