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Laursen HVB, Jørgensen EP, Vestergaard P, Ehlers LH. A Systematic Review of Cost-Effectiveness Studies of Newer Non-Insulin Antidiabetic Drugs: Trends in Decision-Analytical Models for Modelling of Type 2 Diabetes Mellitus. Pharmacoeconomics 2023; 41:1469-1514. [PMID: 37410277 PMCID: PMC10570198 DOI: 10.1007/s40273-023-01268-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND We performed a systematic overview of the cost-effectiveness analyses (CEAs) comparing Non-insulin antidiabetic drugs (NIADs) with other NIADs for the treatment of type 2 diabetes mellitus (T2DM), using decision-analytical modelling (DAM), focusing on both the economic results and the underlying methodological choices. METHODS Eligible studies were CEAs using DAM to compare NIADs within the glucagon-like peptide-1 (GLP1) receptor agonists, sodium-glucose cotransporter-2 (SGLT2) inhibitors, or dipeptidyl peptidase-4 (DPP4) inhibitor classes with other NIADs within those classes for the treatment of T2DM. The PubMed, Embase and Econlit databases were searched from 1 January 2018 to 15 November 2022. Two reviewers screened the studies for relevance by titles and abstracts and then for eligibility via full-text screening, extracted the data from the full texts and appendices, and then stored the data in a spreadsheet. RESULTS The search yielded 890 records and 50 studies were eligible for inclusion. The studies were mainly based on a European setting (60%). Industry sponsorship was found in 82% of studies. The CORE diabetes model was used in 48% of the studies. GLP1 and SGLT2 products were the main comparators in 31 and 16 studies, respectively, while one study had DPP4 and two had no easily discernible main comparator. Direct comparison between SGLT2 and GLP1 occurred in 19 studies. At a class level, SGLT2 dominated GLP1 in six studies and was cost effective against GLP1 once as part of a treatment pathway. GLP1 was cost effective in nine studies and not cost effective against SGLT2 in three studies. At a product level, oral and injectable semaglutide, and empagliflozin, were cost effective against other within-class products. Injectable and oral semaglutide were more frequently found cost effective in these comparisons, with some conflicting results. Most of the modelled cohorts and treatment effects were sourced from randomised controlled trials. The following model assumptions varied depending on the class of the main comparator: choice of and reasoning behind risk equations, the time until the treatment switch, and how often the comparators were discontinued. Diabetes-related complications were emphasised on par with quality-adjusted life-years as model outputs. The main quality issues were regarding the description of alternatives, the perspective of analysis, the measurement of costs and consequences, and patient subgroups. CONCLUSION The included CEAs using DAMs have limitations that hinder their ability to inform decision makers on the cost-effective choice: lack of updated reasoning behind the choice of key model assumptions, over-reliance on risk equations based on older treatment practices, and sponsorship bias. The question of which NIAD is cost effective for the treatment of which T2DM patient is a pressing one and the answer remains unclear.
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Affiliation(s)
- Henrik Vitus Bering Laursen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
- Steno Diabetes Center North Denmark, Aalborg, Denmark.
| | | | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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Aleppo G, DeSalvo DJ, Lauand F, Huyett LM, Chang A, Vienneau T, Ly TT. Improvements in Glycemic Outcomes in 4738 Children, Adolescents, and Adults with Type 1 Diabetes Initiating a Tubeless Insulin Management System. Diabetes Ther 2023; 14:593-610. [PMID: 36763329 PMCID: PMC9913031 DOI: 10.1007/s13300-023-01366-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Despite recent advances in diabetes technology, most people living with type 1 diabetes mellitus (T1D) are unable to meet glycemic targets. Real-world evidence can provide insight into outcomes achieved with specific treatment devices when used in clinical practice. The aim of this study was to analyze real-world outcomes collected from a large cohort of people living with T1D and initiating treatment with the Omnipod DASH System. METHODS In this retrospective observational study, real-world outcomes were analyzed from a database of information collected from people with T1D initiating the Omnipod DASH System. Information in the database was either taken directly from the patient's medical record or self-reported if medical records were unavailable. The primary outcome was change in glycated hemoglobin (HbA1c) from baseline (before initiation) to 3 months after initiation. Secondary outcomes were changes in total daily dose of insulin (TDD) and self-reported frequency of hypoglycemic events (< 70 mg/dL). Results are separated for the adult (≥ 18 years, N = 3341) and pediatric (< 18 years, N = 1397) cohorts. RESULTS The change in HbA1c from baseline was - 0.9 ± 1.6% ( - 10 ± 18 mmol/mol; p < 0.0001) in adults and - 0.9 ± 2.0% ( - 10 ± 22 mmol/mol; p < 0.0001) in the pediatric cohort. For those previously using multiple daily injections, HbA1c decreased by - 1.0 ± 1.7% ( - 11 ± 19 mmol/mol) in adults and - 1.0 ± 2.1% ( - 11 ± 23 mmol/mol) in the pediatric cohort (both p < 0.0001). Hypoglycemic events decreased in adults from 2.9 to 1.3 episodes per week ( - 1.6 ± 3.2 events/week; p < 0.0001), and in the pediatric cohort from 2.8 to 1.5 episodes per week ( - 1.3 ± 2.7 events/week; p < 0.0001). In adults, TDD decreased by 19.9% (p < 0.0001), and it remained stable in the pediatric cohort (p > 0.05). CONCLUSIONS Real-world outcomes from this large cohort of people initiating therapy with the Omnipod DASH System showed significant improvement in HbA1c and a substantial reduction in hypoglycemic events after 3 months of use.
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Affiliation(s)
- Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, 645 North Michigan Ave, Suite 530, Chicago, IL, 60611, USA
| | - Daniel J DeSalvo
- Baylor College of Medicine, 1 Moursund St., Houston, TX, 77030, USA
| | - Felipe Lauand
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
| | | | - Albert Chang
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
| | - Todd Vienneau
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
| | - Trang T Ly
- Insulet Corporation, 100 Nagog Park, Acton, MA, 01720, USA
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Ucieklak D, Mrozińska S, Wojnarska A, Małecki MT, Klupa T, Matejko B. Type 1 Diabetes Mellitus and Lipohypertrophy - Impact of the Intervention on Glycemic Control via Patient's Examination and Retraining on Change of Infusion Set. Endocr Pract 2023; 29:174-178. [PMID: 36581082 DOI: 10.1016/j.eprac.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Lipohypertrophy (LH) is a common complication of insulin therapy in type 1 diabetes mellitus (T1DM). We examined whether an intervention consisting of LH assessment and retraining on insulin infusion set use improves glycemic control on subcutaneous insulin infusion (CSII) in patients with T1DM. METHODS The intervention was conducted in 79 consecutive patients with T1DM. Data on glucose levels, glycated hemoglobin (HbA1c), and insulin doses were collected at baseline and after a median of 22 weeks (20-31.75 weeks). RESULTS A total of 46 patients with T1DM (23 [50%] women) participating in the follow-up were characterized by a median age of 29 years (25-33.8 years), body mass index of 24.6 ± 3.3 kg/m2, T1DM duration of 16.5 years (8.3-20 years), and subcutaneous insulin infusion duration of 7 years (4-10.8 years). Patients' median HbA1c fell from 7.4% (6.7%-8.2%) to 7.05% (6.4%-7.6%) (P < .001), daily insulin dose/kg decreased (0.7 ± 0.20 vs 0.68 ± 0.15 IU/kg; P = .017) together with the total daily insulin dose (50.3 [40.5-62.7] vs 47.6 [39.8-62.1] IU; P = .019]. Furthermore, the percentage of basal insulin dose increased (43.0% [36-50] vs 44.0% [39.0-50.0]; P = .010], whereas the percentage of bolus dose decreased (57% [50-64] vs 56% [50-61], P = .010). CONCLUSIONS The structured LH-related intervention in patients with T1DM on insulin pumps resulted in better glycemic control and a decrease in total daily insulin dose.
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Affiliation(s)
- Damian Ucieklak
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland; Department of Metabolic Diseases, University Hospital, Krakow, Poland
| | - Sandra Mrozińska
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland; Department of Metabolic Diseases, University Hospital, Krakow, Poland; Department of Pathophysiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Aleksandra Wojnarska
- Department of Metabolic Diseases, University Hospital, Krakow, Poland; Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland; Department of Metabolic Diseases, University Hospital, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland; Department of Metabolic Diseases, University Hospital, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland; Department of Metabolic Diseases, University Hospital, Krakow, Poland.
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Bruttomesso D, Irace C, Pozzilli P. A sub-analysis of the SAGE study in Italy indicates good glycemic control in type 1 diabetes. Nutr Metab Cardiovasc Dis 2023; 33:631-639. [PMID: 36670006 DOI: 10.1016/j.numecd.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Intensive glycemic control minimizes the risk of micro- and macrovascular complications in patients with type 1 diabetes (T1D). We report glycemic control in Italian participants (age groups: 26-44, 45-64, and ≥65 years) of the global SAGE study. METHODS AND RESULTS The primary endpoint was proportion of participants who achieved an HbA1c <7% in predefined age groups. In the 523 patients with T1D, mean age was 44.6 years and mean body mass index (BMI) was 25 kg/m2. Mean HbA1c was 7.5% and 29.4% had HbA1c <7.0%, with the highest percentage in those 26-45 years (31.7%) and the lowest in those ≥65 years (20%). Altogether, 22.9% of patients achieved their physician-established individualized HbA1c target. Most patients had ≥1 symptomatic hypoglycemic episode in the previous 3 months (≤70 mg/dL 82.5%; ≤54 mg/dL 61%). Severe hypo- and hyperglycemia were experienced by 16.3% and 12% of patients, of which 7.1 and 9.5%, respectively, required hospitalization/emergency visits. More patients achieved HbA1c <7% with CSII (30%) than with multiple daily insulin injections (27.9%). In multivariate analysis, BMI (OR 0.94, 95% CI 0.89-0.99, p = 0.032) and adherence to diet (OR 0.36, 95% CI 0.18-0.70, p = 0.0028) were significantly associated with HbA1c <7.0%. CONCLUSIONS Glycemic control can be considered good in the Italian SAGE cohort, especially in younger patients, who more frequently use pumps/continuous glucose monitoring. Greater patient education and use of technology may further support this achievement. Patients should be encouraged to maintain a low BMI and adhere to their diet.
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Affiliation(s)
- D Bruttomesso
- University of Padova, Department of Medicine (DIMED), Italy; University Hospital of Padova, Division of Metabolic Diseases, Italy.
| | - C Irace
- Department of Health Science, University Magna Graecia Catanzaro, Italy
| | - P Pozzilli
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
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Wirkkala J, Kubin AM, Ohtonen P, Falck A, Hautala N. Outcomes of 35-year duration of type 1 diabetes and proliferative diabetic retinopathy on functional vision and quality of life: Benefits of good glycemic control. J Diabetes Complications 2023; 37:108408. [PMID: 36708699 DOI: 10.1016/j.jdiacomp.2023.108408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
AIMS To evaluate clinical outcomes, functional vision and quality of life (QoL) after 35-year duration of type 1 diabetes (T1D) and proliferative diabetic retinopathy (PDR). METHODS A population-based cohort study of T1D. Data from laboratory tests, ophthalmic examinations, multifunctional vision-test, and 15D-QoL measurements were analysed. RESULTS 35 % of the original cohort (n = 216) had PDR, and 48 % of them were re-evaluated. They were 41 ± 3 [34-46] years old and 62 % were males. The duration of T1D was 35 ± 4 [29-41] years. 76 % had transdermal glucose monitoring. HbA1c had decreased from 80.1 mmol/mol to 63.6 mmol/mol (p < 0.001). Visual acuity was 73-77 ETDRS-letters. Two patients had visual impairment. Visual field sensitivities were lower in PDR vs. healthy controls (23.2 ± 3.9 dB vs. 26.9 ± 1.0 dB, and 14.9 ± 5.6 dB vs. 21.0 ± 2.0 dB, respectively, p < 0.001). Contrast sensitivity was similar, but the reaction time was longer in the PDR group (490.5 ms vs. 462.8 ms, p = 0.004). QoL-parameters concerning sleeping, usual activities, discomfort and symptoms, and sexual activity had decreased, but improved for mobility and distress. CONCLUSIONS Long-term visual prognosis and QoL remained good despite the declined functional vision caused by PDR.
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Affiliation(s)
- Joonas Wirkkala
- Department of Ophthalmology, Research Unit of Clinical Medicine and Medical Research Centre, University of Oulu, Finland; Oulu University Hospital, Oulu, Finland
| | - Anna-Maria Kubin
- Department of Ophthalmology, Research Unit of Clinical Medicine and Medical Research Centre, University of Oulu, Finland; Oulu University Hospital, Oulu, Finland
| | - Pasi Ohtonen
- Research Service Unit, Oulu, Finland; The Research Unit of Surgery, Anaesthesia and Intensive Care, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Aura Falck
- Department of Ophthalmology, Research Unit of Clinical Medicine and Medical Research Centre, University of Oulu, Finland; Oulu University Hospital, Oulu, Finland
| | - Nina Hautala
- Department of Ophthalmology, Research Unit of Clinical Medicine and Medical Research Centre, University of Oulu, Finland; Oulu University Hospital, Oulu, Finland.
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Ichikawa M, Yamakawa T, Sakamoto R, Takahashi K, Suzuki J, Matsuura-Shinoda M, Shigematsu E, Tanaka S, Kaneshiro M, Asakura T, Kawata T, Yamada Y, Nezu Osada U, Isozaki T, Takahashi A, Kadonosono K, Terauchi Y. A cross-sectional study of the relationship between quality of life and sleep quality in Japanese patients with type 1 diabetes mellitus. Endocr J 2022; 69:399-406. [PMID: 34853196 DOI: 10.1507/endocrj.ej21-0408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study aimed to reveal the relationship between quality of life (QOL) and sleep quality in patients with type 1 diabetes mellitus (T1DM). Overall, 202 patients with T1DM were registered in our study, and 192 were eligible for analysis. Baseline characteristics and laboratory values were determined. Patients completed the Japanese versions of the Pittsburgh Sleep Quality Index (PSQI) and Diabetes Therapy-Related QOL (DTR-QOL) questionnaires. We investigated the relationship between the global PSQI and DTR-QOL total scores by using linear regression analysis. In univariate regression analysis, DTR-QOL total scores were associated with body mass index, alcohol consumption, hypertension, hemoglobin A1c (HbA1c), and global PSQI score (all p-value <0.05) but not with sleep duration. When the association between PSQI subscales and DTR-QOL total scores was examined, DTR-QOL total scores were significantly related to subjective sleep quality and daytime dysfunction. In a multivariate regression analysis, the global PSQI score was negatively related to DTR-QOL total scores. Patients with an HbA1c concentration ≥8.0% had significantly lower DTR-QOL total scores. We revealed a relationship between QOL and sleep quality in T1DM patients and showed that the relationship between QOL and PSQI subscales in T1DM patients may be different from that in patients with type 2 diabetes mellitus. Assessing and managing sleep quality may be necessary for patients with diabetes to improve QOL.
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Affiliation(s)
- Masahiro Ichikawa
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Tadashi Yamakawa
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Rika Sakamoto
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Kenichiro Takahashi
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun Suzuki
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Minori Matsuura-Shinoda
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Erina Shigematsu
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | | | | | | | | | - Yoshihiko Yamada
- International University of Health and Welfare, Atami Hospital, Atami, Japan
| | | | | | | | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Yokohama City University School of Medicine, Yokohama, Japan
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Maffeis C, Rabbone I. Insulin Glargine 300 U/mL Therapy in Children and Adolescents with Type 1 Diabetes. Paediatr Drugs 2022; 24:499-512. [PMID: 35881330 PMCID: PMC9439977 DOI: 10.1007/s40272-022-00520-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/14/2022]
Abstract
The pharmacokinetic and pharmacodynamic properties of the second-generation basal insulin glargine 300 Units/mL (Gla-300) may be of benefit in the treatment of type 1 diabetes mellitus (T1DM). Gla-300 provides a stable and sustained time-action profile, which is associated with glycaemic control and flexible dosing schedule. This review summarises the available evidence on the safety and efficacy of Gla-300 in children and adolescents with T1DM. Gla-300 is as effective as the first-generation basal insulin glargine 100 Units/mL (Gla-100), a standard of care for patients with diabetes in reducing HbA1c, and shows a lower risk of severe hypoglycaemia and hyperglycaemia in children and adolescents with T1DM. However, Gla-300 and Gla-100 are not bioequivalent and are not directly interchangeable. Real-world studies on patients aged 6-17 years are limited. To date, only one small study assessed the effectiveness and safety of Gla-300 versus Gla-100 in newly diagnosed T1DM paediatric patients, confirming the treatment safety and effectiveness of Gla-300 in clinical practice. Gla-300 is a longer-acting basal insulin alternative in the management of children (aged ≥ 6 years) and adolescents with T1DM.
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Affiliation(s)
- Claudio Maffeis
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy.
| | - Ivana Rabbone
- grid.16563.370000000121663741Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
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van Dover TJ, Kim DD. Do Centers for Medicare and Medicaid Services Quality Measures Reflect Cost-Effectiveness Evidence? Value Health 2021; 24:1586-1591. [PMID: 34711358 DOI: 10.1016/j.jval.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/22/2021] [Accepted: 03/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Despite its importance of quality measures used by the Centers for Medicare and Medicaid Services, the underlying cost-effectiveness evidence has not been examined. This study aimed to analyze cost-effectiveness evidence associated with the Centers for Medicare and Medicaid Services quality measures. METHODS After classifying 23 quality measures with the Donabedian's structure-process-outcome quality of care model, we identified cost-effectiveness analyses (CEAs) relevant to these measures from the Tufts Medical Center CEA Registry based on the PICOTS (population, intervention, comparator, outcome, time horizon, and setting) framework. We then summarized available incremental cost-effectiveness ratios (ICERs) to determine the cost-effectiveness of the quality measures. RESULTS The 23 quality measures were categorized into 14 process, 7 outcome, and 2 structure measures. Cost-effectiveness evidence was only available for 8 of 14 process measures. Two measures (Tobacco Screening and Hemoglobin bA1c Control) were cost-saving and quality-adjusted life-years (QALYs) improving, and 5 (Depression Screening, Influenza Immunization, Colon Cancer Screening, Breast Cancer Screening, and Statin Therapy) were highly cost-effective (median ICER ≤ $50 000/QALY). The remaining measure (Fall Screening) had a median ICER of $120 000/QALY. No CEAs were available for 15 measures: 10 defined by subjective patient ratings and 5 employed outcome measures without specifying an intervention or process. CONCLUSIONS When relevant CEAs were available, cost-effectiveness evidence was consistent with quality measures (measures were cost-effective). Nevertheless, most quality measures were based on subjective ratings or outcome measures, posing a challenge in identifying supporting economic evidence. Refining and aligning quality measures with cost-effectiveness evidence can help further improve healthcare efficiency by demonstrating that they are good indicators of both quality and cost-effectiveness of care.
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Affiliation(s)
- Timothy J van Dover
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - David D Kim
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA; Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, USA.
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Renard E, Ikegami H, Daher Vianna AG, Pozzilli P, Brette S, Bosnyak Z, Lauand F, Peters A, Pilorget V, Jurišić‐Eržen D, Kesavadev J, Seufert J, Wilmot EG. The SAGE study: Global observational analysis of glycaemic control, hypoglycaemia and diabetes management in T1DM. Diabetes Metab Res Rev 2021; 37:e3430. [PMID: 33369842 PMCID: PMC8518876 DOI: 10.1002/dmrr.3430] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/20/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022]
Abstract
AIMS To describe glycaemic control and diabetes management in adults with type 1 diabetes (T1DM), in a real-life global setting. MATERIALS AND METHODS Study of Adults' GlycEmia (SAGE) was a multinational, multicentre, single visit, noninterventional, cross-sectional study in adult patients with T1DM. Data were collected at a single visit, analysed according to predefined age groups (26-44, 45-64 and ≥65 years) and reported across different regions. The primary endpoint was the proportion of participants achieving HbA1c less than 7.0 % in each age group. Secondary endpoints included incidence of hypoglycaemia, severe hypoglycaemia and severe hyperglycaemia leading to diabetic ketoacidosis (DKA) and therapeutic management of T1DM. RESULTS Of 3903 included participants, 3858 (98.8%) were eligible for the study. Overall, 24.3% (95% confidence interval [CI]: 22.9-25.6) of participants achieved the glycaemic target of HbA1c less than 7.0 %, with more participants achieving this target in the 26-44 years group (27.6% [95% CI: 25.5-29.8]). Target achievement was highest in Eastern and Western Europe, and lowest in the Middle East. The incidence of hypoglycaemia and of severe hyperglycaemia leading to DKA tended to decrease with age, and varied across regions. Age and regional differences were observed in therapeutic management, including types of device/insulin usage, frequency of insulin dose adjustment and technology usage. CONCLUSIONS Glycaemic control remains poor in adults with T1DM globally. Several areas of treatment may be optimised to improve outcomes, including supporting patient self-management of insulin therapy, increasing use of technologies such as CGM, and greater provision of healthcare support.
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Affiliation(s)
- Eric Renard
- Department of Endocrinology, Diabetes, NutritionMontpellier University HospitalINSERM Clinical Investigation Centre 1411Institute of Functional GenomicsCNRSINSERMUniversity of MontpellierMontpellierFrance
| | - Hiroshi Ikegami
- Department of Endocrinology, Metabolism and DiabetesKindai University Faculty of MedicineOsakaJapan
| | | | - Paolo Pozzilli
- Department of Diabetes and EndocrinologyUnit of Endocrinology and Diabetes, Campus Bio‐Medico University of RomeItaly
- Centre of Immunobiology, Barts and the London School of Medicine and Dentistry, Queen Mary University of LondonUK
| | | | | | | | - Anne Peters
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Dubravka Jurišić‐Eržen
- Department of Endocrinology and DiabetologyFaculty of MedicineUniversity Hospital CentreUniversity of RijekaRijekaCroatia
| | | | - Jochen Seufert
- Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Emma G. Wilmot
- Diabetes DepartmentUniversity Hospitals of Derby and BurtonDerbyUK
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Urina-Jassir M, Herrera-Parra LJ, Hernández Vargas JA, Valbuena-García AM, Acuña-Merchán L, Urina-Triana M. The effect of comorbidities on glycemic control among Colombian adults with diabetes mellitus: a longitudinal approach with real-world data. BMC Endocr Disord 2021; 21:128. [PMID: 34174843 PMCID: PMC8235812 DOI: 10.1186/s12902-021-00791-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/08/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Achieving an optimal glycemic control has been described to reduce the incidence of diabetes mellitus (DM) related complications. The association between comorbidities and glycemic control remains unclear. Our aim is to evaluate the effect of comorbidities on glycemic control in people living with DM. METHODS A retrospective longitudinal study on data from the National Registry of Chronic Kidney Disease from 2014 to 2019 in Colombia. The outcome was poor glycemic control (PGC = HbA1c ≥7.0%). The association between each comorbidity (hypertension (HTN), chronic kidney disease (CKD) or obesity) and PGC was evaluated through multivariate mixed effects logistic regression models. The measures of effect were odds ratios (OR) and their 95% confidence intervals (CI). We also evaluated the main associations stratified by gender, insurance, and early onset diabetes as well as statistical interaction between each comorbidity and ethnicity. RESULTS From 969,531 people at baseline, 85% had at least one comorbidity; they were older and mostly female. In people living with DM and CKD, the odds of having a PGC were 78% (OR: 1.78, CI 95%: 1.55-2.05) higher than those without CKD. Same pattern was observed in obese for whom the odds were 52% (OR: 1.52, CI 95%: 1.31-1.75) higher than in non-obese. Non-significant association was found between HTN and PGC. We found statistical interaction between comorbidities and ethnicity (afro descendant) as well as effect modification by health insurance and early onset DM. CONCLUSIONS Prevalence of comorbidities was high in adults living with DM. Patients with concomitant CKD or obesity had significantly higher odds of having a PGC.
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Affiliation(s)
- Manuel Urina-Jassir
- Fundación del Caribe para la Investigación Biomédica, Carrera 50 # 80 - 216 Office 201, Barranquilla, Atlántico, Colombia
| | - Lina Johana Herrera-Parra
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Carrera 45 # 103 - 34, Bogotá, D.C, Colombia
| | | | - Ana María Valbuena-García
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Carrera 45 # 103 - 34, Bogotá, D.C, Colombia
| | - Lizbeth Acuña-Merchán
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Carrera 45 # 103 - 34, Bogotá, D.C, Colombia
| | - Miguel Urina-Triana
- Fundación del Caribe para la Investigación Biomédica, Carrera 50 # 80 - 216 Office 201, Barranquilla, Atlántico, Colombia.
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Carrera 59 # 59 - 65, Barranquilla, 080002, Colombia.
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11
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Carral F, Tomé M, Fernández JJ, Piñero A, Expósito C, Jiménez AI, García C, Ayala C. The presence of microvascular complications is associated with a poor evolution of metabolic control in patients with type 1 diabetes mellitus. ENDOCRINOL DIAB NUTR 2021; 68:389-397. [PMID: 34742472 DOI: 10.1016/j.endien.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/22/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To report the evolution of metabolic control and to assess the clinical and metabolic factors associated with the presence of microvascular complications in patients with type 1 diabetes mellitus (T1DM). MATERIAL AND METHODS This was a retrospective, observational study analysing clinical, laboratory, and therapeutic data from a registry of patients with T1DM created in 2010. RESULTS Data recorded from 586 patients (males: 50.2%; mean age: 36.1±13.5 years; T1DM duration: 18.0±12.1 years) followed for a mean of 6.0±3.1 years were assessed, and 8133 HbA1c levels (13.2±7.6 measurements/patient) were analysed, with a mean evolutionary HbA1c of 7.9%±1.2%. The mean annual HbA1c level gradually improved from 8.6%±1.6% in 2010 to 7.5%±1.4% in 2019, with 34.3% and 69.0% of patients having HbA1c levels ≤7% and ≤8% respectively. Patients with T1DM duration of <10 years and ≥20 years, non-smokers, CSII users, and those using the insulin/carbohydrate ratio had better current and evolutionary HbA1c levels. The presence of microvascular complications was independently associated with T1DM lasting ≥20 years, the presence of HBP, and evolutionary HbA1c≥7.0%. CONCLUSION A progressive but still inadequate improvement in metabolic control over 10 years was seen in patients with T1DM. Poor metabolic control (mean HbA1c over 10 years ≥7%) was independently associated with the presence of microvascular complications.
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Affiliation(s)
- Florentino Carral
- Unidad de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, Spain.
| | - Mariana Tomé
- Unidad de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, Spain
| | - Juan Jesús Fernández
- Unidad de Obstetricia y Ginecología, Hospital Universitario Puerto Real, Cádiz, Spain
| | - Antonia Piñero
- Unidad de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, Spain
| | - Coral Expósito
- Unidad de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, Spain
| | - Ana Isabel Jiménez
- Unidad de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, Spain
| | - Concepción García
- Unidad de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, Spain
| | - Carmen Ayala
- Unidad de Endocrinología y Nutrición, Hospital Universitario Puerto Real, Cádiz, Spain
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12
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Carral F, Tomé M, Fernández JJ, Piñero A, Expósito C, Jiménez AI, García C, Ayala C. La presencia de complicaciones microvasculares se asocia con un mal control metabólico evolutivo en pacientes con diabetes tipo 1. ENDOCRINOL DIAB NUTR 2021. [DOI: 10.1016/j.endinu.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Carral San Laureano F, Tomé Fernández-Ladreda M, Jiménez Millán AI, García Calzado C, Ayala Ortega MDC. Insulin doses requirements in patients with type 1 diabetes using glargine U300 or degludec in routine clinical practice. J Investig Med 2021; 69:983-988. [PMID: 33771843 PMCID: PMC8223633 DOI: 10.1136/jim-2020-001633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/20/2022]
Abstract
There are not many real-world studies evaluating daily insulin doses requirements (DIDR) in patients with type 1 diabetes (T1D) using second-generation basal insulin analogs, and such comparison is necessary. The aim of this study was to compare DIDR in individuals with T1D using glargine 300 UI/mL (IGlar-300) or degludec (IDeg) in real clinical practice. An observational, retrospective study was designed in 412 patients with T1D (males: 52%; median age 37.0±13.4 years, diabetes duration: 18.7±12.3 years) using IDeg and IGla-300 ≥6 months to compare DIDR between groups. Patients using IGla-300 (n=187) were more frequently males (59% vs 45.8%; p=0.004) and had lower glycosylated hemoglobin (HbA1c) (7.6±1.2 vs 8.1%±1.5%; p<0.001) than patients using IDeg (n=225). Total (0.77±0.36 unit/kg/day), basal (0.43±0.20 unit/kg/day) and prandial (0.33±0.23 unit/kg/day) DIDR were similar in IGla-300 and IDeg groups. Patients with HbA1c ≤7% (n=113) used significantly lower basal (p=0.045) and total (p=0.024) DIDR, but not prandial insulin (p=0.241), than patients with HbA1c between 7.1% and 8% and >8%. Patients using IGla-300 and IDeg used similar basal, prandial and total DIDR regardless of metabolic control subgroup. No difference in basal, prandial and total DIDR was observed between patients with T1D using IGla-300 or IDeg during at least 6 months in routine clinical practice.
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14
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Mehta SN, Tinsley LJ, Kruger D, Bode B, Layne JE, Huyett LM, Dryga K, Dumais B, Ly TT, Laffel LM. Improved Glycemic Control Following Transition to Tubeless Insulin Pump Therapy in Adults With Type 1 Diabetes. Clin Diabetes 2021; 39:72-79. [PMID: 33551556 PMCID: PMC7839599 DOI: 10.2337/cd20-0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Continuous subcutaneous insulin infusion (CSII) treatment may improve long-term glycemic outcomes and enhance quality of life compared with a multiple daily injection (MDI) insulin regimen for people with type 1 diabetes. As the number of people treated with CSII via a tubeless insulin pump is increasing, there is growing interest in the long-term glycemic outcomes of this treatment option across diverse populations. This multicenter, retrospective study evaluated glycemic control in 156 adults with type 1 diabetes initiating tubeless insulin pump therapy following transition from either MDI or CSII with a tubed insulin pump. In this study, use of the tubeless insulin pump over 12 months was associated with significant improvement in A1C in adults with type 1 diabetes, most notably in those with an A1C ≥9.0% and those previously treated with MDI.
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Affiliation(s)
| | | | | | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, GA
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15
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Battelino T, Edelman SV, Nishimura R, Bergenstal RM. Comparison of Second-Generation Basal Insulin Analogs: A Review of the Evidence from Continuous Glucose Monitoring. Diabetes Technol Ther 2021; 23:20-30. [PMID: 32700970 DOI: 10.1089/dia.2020.0180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Many people with insulin-treated diabetes continue to experience inadequate glycemic control and a high incidence of hypoglycemic events, despite improvements in therapeutic strategies. While glycated hemoglobin (HbA1c) is currently recognized as the gold-standard for assessing glycemic control, the measure reflects mean blood glucose levels over a period of time, does not inform on acute glycemic deviations, and can be unreliable in certain populations. Continuous glucose monitoring (CGM) facilitates the acquisition of blood glucose data around the clock and, importantly, predicts and/or captures acute hyper- and hypoglycemic episodes. In light of the recent publication of the Time in Range (TIR) International Consensus Group report on key CGM metrics, we performed a review of current CGM evidence for second-generation basal insulins in both people with type 1 and type 2 diabetes. The identified studies highlight the varied CGM-related metrics used to assess basal insulins, which complicate comparisons. Furthermore, all studies had small sample sizes and typically were of short duration, which may account for the lack of statistically significant between-treatment differences observed. Differences were seen in the titration approaches used and the settings in which participants were observed. These results highlight the need for further studies of second-generation basal insulin analogs that are designed to capture the standard metrics proposed by the TIR consensus group, with additional consideration given to sample size and study duration.
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Affiliation(s)
- Tadej Battelino
- UMC-University Children's Hospital and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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16
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Moulson H, Sanders S, Coppin S, Meyrick J. What psychosocial interventions work to reduce hospital admissions in people with diabetes and elevated HbA 1c : a systematic review of the evidence. Diabet Med 2020; 37:1280-1290. [PMID: 32443172 DOI: 10.1111/dme.14332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diabetes is a chronic condition that can lead to devastating complications if not managed effectively. Individuals with elevated HbA1c are at higher risk of developing complications resulting in diabetes-related hospital admissions, an additional pressure and expense for healthcare systems. AIM To systematically review evidence of the effectiveness of psychosocial interventions among individuals with elevated HbA1c , as indicated by hospital admissions. METHODS Electronic databases (MEDLINE, PsychINFO, CINAHL, AMED, Embase and Scopus) were used to identify studies systematically. Studies were screened against eligibility criteria and included if they evaluated the effectiveness of a psychosocial intervention on diabetes-related hospital admissions in individuals with elevated HbA1c . Risk of bias was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies, and a narrative synthesis was conducted. RESULTS Of 15 362 studies, five were included in the review. Psychosocial interventions were found to significantly reduce diabetes-related hospital admissions in four of these studies and interventions involving psychotherapy in particular were found to reduce admissions. The methodological quality of studies ranged from weak to moderate, due to lack of blinding, weak study design and issues with withdrawals and drop-outs. CONCLUSIONS Psychosocial interventions may reduce diabetes-related hospital admissions in individuals with elevated HbA1c ; however, due to variability in methodological rigour, the conclusion remains tentative. Further research targeting this group, particularly within the adult population, is recommended. (PROSPERO registration number: CRD42019133456).
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Affiliation(s)
- H Moulson
- Department of Psychology, University of West England, Bristol, UK
| | - S Sanders
- Department of Psychology, University of West England, Bristol, UK
| | - S Coppin
- Department of Psychology, University of West England, Bristol, UK
| | - J Meyrick
- Department of Psychology, University of West England, Bristol, UK
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17
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Gregory GA, Guo J, Klatman EL, Ahmadov GA, Besançon S, Gomez ED, Fawwad A, Ramaiya K, Wijesuriya MA, Orchard TJ, Ogle GD. Costs and outcomes of "intermediate" vs "minimal" care for youth-onset type 1 diabetes in six countries. Pediatr Diabetes 2020; 21:628-636. [PMID: 31970828 DOI: 10.1111/pedi.12988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/02/2019] [Accepted: 01/13/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Data are needed to demonstrate that providing an "intermediate" level of type 1 diabetes (T1D) care is cost-effective compared to "minimal" care in less-resourced countries. We studied these care scenarios in six countries. METHODS We modeled the complications/costs/mortality/healthy life years (HLYs) associated with "intermediate" care including two blood glucose tests/day (mean HbA1c 9.0% [75 mmol/mol]) in three lower-gross domestic product (GDP) countries (Mali, Tanzania, Pakistan), or three tests/day (mean HbA1c 8.5% [69 mmol/mol]) in three higher-GDP countries (Bolivia, Sri Lanka, Azerbaijan); and compared findings to "minimal" care (mean HbA1c 12.5% [113 mmol/mol]). A discrete time Markov illness-death model with age and calendar-year-dependent transition probabilities was developed, with inputs of 30 years of complications and Standardized Mortality Rate data from the youth cohort in the Pittsburgh Epidemiology of Diabetes Complications Study, background mortality, and costs determined from international and local prices. RESULTS Cumulative 30 years incidences of complications were much lower for "intermediate care" than "minimal care", for example, for renal failure incidence was 68.1% (HbA1c 12.5%) compared to 3.9% (9%) and 2.4% (8.5%). For Mali, Tanzania, Pakistan, Bolivia, Sri Lanka, and Azerbaijan, 30 years survival was 50.1%/52.7%/76.7%/72.5%/82.8%/89.2% for "intermediate" and 8.5%/10.1%/39.4%/25.8%/45.5%/62.1% for "minimal" care, respectively. The cost of a HLY gained as a % GDP/capita was 141.1%/110.0%/52.3%/41.8%/17.0%/15.6%, respectively. CONCLUSIONS Marked reductions in complications rates and mortality are achievable with "intermediate" T1D care achieving mean clinic HbA1c of 8.5% to 9% (69-75 mmol/mol). This is also "very cost-effective" in four of six countries according to the WHO "Fair Choices" approach which costs HLYs gained against GDP/capita.
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Affiliation(s)
- Gabriel A Gregory
- Life for a Child Program, Diabetes NSW, Glebe, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jingchuan Guo
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emma L Klatman
- Life for a Child Program, Diabetes NSW, Glebe, New South Wales, Australia
| | - Gunduz A Ahmadov
- The Endocrine Center, Baku, Azerbaijan.,Azerbaijan Medical University, Baku, Azerbaijan
| | | | | | - Asher Fawwad
- Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | | | - Mahen A Wijesuriya
- Diabetes Association of Sri Lanka, National Diabetes Centre, Colombo, Sri Lanka
| | - Trevor J Orchard
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Graham D Ogle
- Life for a Child Program, Diabetes NSW, Glebe, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
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18
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MOMENI M, MIRMOHAMMADKHANI M, ZIARI A. Health Literacy in the Population of Diabetic Patients in Iran: A Systematic Review and Meta-Analysis. Iran J Public Health 2020; 49:617-627. [PMID: 32548041 PMCID: PMC7283175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND The present systematic review and meta-analysis were conducted to find the degree by which the Iranian diabetic patients were informed about their disease in term of health literacy. METHODS The search was carried out in databases including the PubMed, MEDLINE (PubMed), Scopus, Embase, Cochrane Library, ProQuest, Web of Science, Science Direct and Wiley and also domestic databases including the Iranian Academic Center for Education Culture and Research (sid.ir), the Iranian Research Institute for Information Science and Technology (IranDoc.ac.ir), Barakat Knowledge Network System (barakatkns.com), the national publications database (magiran.com) and also Google Scholar and Elmnet search engines. All the original studies published by Oct 20, 2018, in Persian or English, to assess the health literacy of adults with diabetes were included in the study. Ultimately, 17 articles were included in the meta-analysis. The meta-analysis was carried out using the fixed-effects method using Stata-11.2. RESULTS The pooled mean score of health literacy was 56.65 out of score of 100, and its 95% CI was estimated as 49.85 to 63.45. No significant heterogeneity could be reported for the articles included in the meta-analysis (I-squared=21.3%, P=0.177). The pooled mean scores with the CI of 95% by gender based on the study population in women and men were estimated as 47.97and 50.06 respectively. CONCLUSION Health literacy is not high in Iranian diabetic patients and is rather inadequate in most of them in both genders. Diabetic women have somewhat lower health literacy compared to diabetic men.
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Affiliation(s)
- Marjan MOMENI
- Department of Health Information Technology, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid MIRMOHAMMADKHANI
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Abbas ZIARI
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran,Corresponding author:
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19
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Zhang YP, Cui QY, Zhang TM, Yi Y, Nie JJ, Xie GH, Wu JH. Chloroquine pretreatment attenuates ischemia-reperfusion injury in the brain of ob/ob diabetic mice as well as wildtype mice. Brain Res 2020; 1726:146518. [PMID: 31647899 DOI: 10.1016/j.brainres.2019.146518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/15/2019] [Accepted: 10/19/2019] [Indexed: 11/28/2022]
Abstract
Chloroquine, a prototype anti-malaria drug, has been reported to possess anti-inflammatory effects. Moreover, chloroquine pretreatment could improve DNA damage repair. It is therefore reasonable to hypothesize that chloroquine pretreatment could attenuate ischemia/reperfusion injury in the brain. Considering the fact that chloroquine could also improve glucose metabolism, we speculated that the potential effects of chloroquine on ischemia/reperfusion injury might be particularly pronounced in diabetic mice. In this study, chloroquine pretreatment protected neurons from Oxygen Glucose Deprivation (OGD) induced cytotoxicity and apoptosis. In vivo, Ob/ob mice and wildtype (WT) mice were pretreated with chloroquine for 3 weeks. Then, ischemic stroke was induced by 60 min Middle Cerebral Artery Occlusion (MCAO). We found that chloroquine pretreatment normalized blood glucose in diabetic ob/ob mice, and reduced cerebral damage after ischemic stroke especially for diabetic mice. In addition, chloroquine pretreatment reduced High-mobility group box 1 (HMGB1) content in the cerebrospinal fluid (CSF) and serum and lowered myeloperoxidase (MPO) activity and inflammatory cytokines gene expression both in the ob/ob diabetic mice and WT mice. Moreover, harmful DNA damage-signaling responses, including PARP activation and p53 activation, were also attenuated by chloroquine pretreatment in these two kinds of mice. In conclusion, chloroquine pretreatment could reduce cerebral damage after ischemic stroke especially in diabetic mice through multiple mechanisms, which include reducing neural cell DNA injury, restoring euglycemia and anti-inflammatory effects. The findings may provide potential for the development of chloroquine in the prevention and treatment of stroke in diabetic high-risk patients.
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Affiliation(s)
- Ying-Pei Zhang
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Qiu-Yan Cui
- Department of Physiology, School of Basic Medicine and Tongji Medical College, Huazhong University of Science and Technology, Wuhan 4030030, China; The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tong-Mei Zhang
- Department of Physiology, School of Basic Medicine and Tongji Medical College, Huazhong University of Science and Technology, Wuhan 4030030, China; The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yao Yi
- Department of Physiology, School of Basic Medicine and Tongji Medical College, Huazhong University of Science and Technology, Wuhan 4030030, China; The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jun-Jie Nie
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Guang-Hui Xie
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jian-Hua Wu
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
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20
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Trento M, Charrier L, Cavallo F, Bertello S, Oleandri S, Donati MC, Rizzo S, Virgili G, Picca G, Bandello F, Lattanzio R, Aragona E, Perilli R, Casati S, Beltramo E, Mazzeo A, Fornengo P, Durando O, Merlo S, Porta M. Vision-related quality of life and locus of control in type 1 diabetes: a multicenter observational study. Acta Diabetol 2019; 56:1209-1216. [PMID: 31313005 DOI: 10.1007/s00592-019-01384-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/22/2019] [Indexed: 10/26/2022]
Abstract
AIMS Diabetic retinopathy remains asymptomatic until its late stages but remains a leading cause of vision impairment and blindness. We studied quality of life and the ability to deal with the discomfort deriving from the presence of a chronic disease in patients with type 1 diabetes and different stages of retinopathy. METHODS Multicenter collaborative observational study involving nine centers screening for retinopathy in different areas of Italy. The National Eye Institute 25-item visual functioning questionnaire and the locus of control tool were administered to 449 people with type 1 diabetes between February 2016 and March 2018. Socio-demographic and clinical data were collected. RESULTS On multivariable analysis, severe retinopathy is associated with worse scores for general vision, ocular pain, near vision activities, distance vision activities, driving, color vision, peripheral vision and lower values of internal control, independently of visual acuity. Women had a perception of worse general health, distance vision activities and driving, and lower internal control and trust in others. Worse scores for visual-specific social functioning, visual-specific mental health, visual-specific role difficulties, visual-specific dependency and peripheral vision were associated with higher HbA1c levels. Fatalism increased with rising HbA1c levels. CONCLUSIONS These results confirm that a gap exists between patients' knowledge and expectations on retinopathy and providers' expertise and assumptions. To bridge this gap, patient-centered education and engaging approaches may be more effective than simple information given during consultations.
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Affiliation(s)
- Marina Trento
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy.
| | - Lorena Charrier
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Franco Cavallo
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Stefania Bertello
- Endocrinology and Diabetology Unit, Health Unit 1, Savigliano, Italy
| | | | - Maria Carla Donati
- Eye Clinic, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Salvatore Rizzo
- Eye Clinic, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Gianni Virgili
- Eye Clinic, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giuseppe Picca
- Endocrinology and Metabolic Diseases Unit, Hospital of Foggia, Foggia, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Elena Aragona
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Roberto Perilli
- Department of Ophthalmology, Territorial Ophthalmology, Pescara, Italy
| | - Stefano Casati
- Eye Clinic, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elena Beltramo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Aurora Mazzeo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Fornengo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Olga Durando
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Stefano Merlo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
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21
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Affiliation(s)
- Vivien Swanson
- Centre for Health and Behaviour Change, Psychology DivisionUniversity of Stirling Stirling UK
| | - Wendy Maltinsky
- Centre for Health and Behaviour Change, Psychology DivisionUniversity of Stirling Stirling UK
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22
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Uysal C, Arslan D, Buyukinan M, Gederet YT, Vatansev H, Ozcelik HS. Growth Differentiation Factor-15 Level and Tissue Doppler Echocardiography as a Tool in Identification of Cardiac Effects in the Children with Type 1 Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2019; 129:574-580. [PMID: 31426113 DOI: 10.1055/a-0983-1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the importance of growth-differentiation factor-15 level and tissue Doppler imaging in the detection of cardiomyopathy in children who have type 1 diabetes mellitus. MATERIALS AND METHODS Thirty-eight patients (11 males and 27 females) with type 1 diabetes mellitus were included in this study. The control group consisted of 40 age- and gender-matched healthy volunteers. All children underwent a detailed echocardiography, which contained an m-mode, pulse Doppler and tissue Doppler imaging; and growth-differentiation factor-15 level was measured. RESULTS In this study, there were significant differences between diastolic function parameters of the heart. The mitral isovolumic contraction time, contraction time, and isovolumic relaxation time values were different in the patients than in the controls (p<0.01, p<0.01, p<0.01, respectively). Also, the tricuspid isovolumic contraction time, contraction time, and isovolumic relaxation time values were different in the patients than in the controls (p<0.01, p=0.01, p<0.01, respectively). No statistically significant difference was found between the other M-mode parameters. Mean plasma growth-differentiation factor-15 level was significantly higher in patients than in healthy controls (p<0.01). CONCLUSION The follow-up of children with type 1 diabetes mellitus in terms of cardiomyopathy and the use of tissue Doppler imaging and growth differentiation factor-15 levels may be useful.
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Affiliation(s)
- Celil Uysal
- Department of Pediatrics, Patnos State Hospital, Agri, Turkey
| | - Derya Arslan
- Department of Pediatric Cardiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Muammer Buyukinan
- Department of Pediatric Endocrinology, Konya Training and Research Hospital, Konya, Turkey
| | | | - Husamettin Vatansev
- Department of Biochemistry, Selcuk University Medical Faculty, Konya, Turkey
| | - Huseyin Samet Ozcelik
- Department of Pediatrics, Dr. Ali Kemal Belviranli Obstetrics and Gynecology Hospital, Konya, Turkey
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23
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Herman WH, Braffett BH, Kuo S, Lee JM, Brandle M, Jacobson AM, Prosser LA, Lachin JM. The 30-year cost-effectiveness of alternative strategies to achieve excellent glycemic control in type 1 diabetes: An economic simulation informed by the results of the diabetes control and complications trial/epidemiology of diabetes interventions and complications (DCCT/EDIC). J Diabetes Complications 2018; 32:934-939. [PMID: 30064713 PMCID: PMC6481926 DOI: 10.1016/j.jdiacomp.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To simulate the cost-effectiveness of historical and modern treatment scenarios that achieve excellent vs. poor glycemic control in type 1 diabetes (T1DM). RESEARCH DESIGN AND METHODS We describe and compare the costs of intensive and conventional therapies for T1DM as performed during DCCT, and modern intensive and basic therapy scenarios using insulin analogs, pens, pumps, and continuous glucose monitoring (CGM) to achieve excellent or poor glycemic control. We then assess the differences in treatment costs and the costs of outcomes over 30 years and report incremental cost-effectiveness ratios. RESULTS Over 30 years, DCCT intensive therapy cost $127,500 to $181,600 more per participant than DCCT conventional therapy, and modern intensive therapy cost $87,700 to $409,000 more per individual than modern basic therapy. Excellent glycemic control averted as much as $90,900 in costs from complications and added ~1.62 quality-adjusted life-years (QALYs) per participant over 30 years. When costs and QALYs were discounted at 3% annually, DCCT intensive therapy and modern intensive therapies that use multiple daily injections (MDI) or pumps are cost-saving or cost-effective (<$100,000/QALY-gained). If applied to all patients with T1DM, modern intensive therapy using pumps and CGM is not cost-effective (>$250,000/QALY-gained) but would be more cost-effective if associated with less hypoglycemia, better glycemic control, fewer complications, or improved health-related quality-of-life. CONCLUSIONS Use of the least expensive intensive therapy needed to safely achieve treatment goals for patients with T1DM represents a good value for money. TRIAL REGISTRATION clinicaltrials.govNCT00360815 and NCT00360893.
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Affiliation(s)
- William H Herman
- Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI, United States of America.
| | - Barbara H Braffett
- The Biostatistics Center, George Washington University, Washington, DC, United States of America
| | - Shihchen Kuo
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Joyce M Lee
- Pediatric Endocrinology, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, MI, United States of America
| | - Michael Brandle
- Division of Endocrinology and Diabetes, Kantonsspital St. Gallen, Sankt Gallen, SG, Switzerland
| | - Alan M Jacobson
- Winthrop-University Hospital, Mineola, NY, United States of America
| | - Lisa A Prosser
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States of America
| | - John M Lachin
- The Biostatistics Center, George Washington University, Washington, DC, United States of America
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