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Mitchell BD, Rentz AM, Kummer S, Yan Y, Heidenreich S, Krucien N, Artime E, Osumili B, Rubio M, Gelhorn HL. People With Diabetes and Caregivers Prefer Rescue Glucagon Treatment With a Wider Storage Temperature Range and a Nasal Administration, When Efficacy is Similar: A Discrete Choice Experiment in Spain. J Diabetes Sci Technol 2023; 17:1623-1633. [PMID: 35533142 PMCID: PMC10658678 DOI: 10.1177/19322968221095882] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Conventional injectable glucagon (IG) and nasal glucagon (NG), both having similar efficacy, are two options for the emergency treatment of severe hypoglycemia in Spain. This study elicited the effect of changes in key attributes on preferences for NG and IG medication profiles of people with diabetes and caregivers in Spain. METHODS The relative attribute importance (RAI) that participants placed on glucagon preparation, preparation and administration time, delivery method, recovery time, device size, storage temperature, and headache risk was estimated from an online discrete choice experiment. In addition, patients and caregivers were presented with NG and IG profiles that included rates of successful administration; the proportion of participants choosing each profile was summarized. RESULTS The analysis included 276 adults with diabetes (65% type 1) and 270 caregivers (49% type 1). Overall mean age was 40 years; 51% were female. The most important attributes were storage temperature (RAI [95% confidence interval] = 27.3% [22.9-32.2]) and delivery method (17.4% [13.1-21.9]). Headache risk (16.2% [11.8-20.7]), time to prepare and administer (14.5% [10.1-18.8]), glucagon preparation (11.4% [6.8-15.8]), recovery time (8.9% [4.3-13.3]), and device size (4.3% [0.3-8.8]) were also relevant. When comparing medication profiles, significantly more participants (78%) preferred NG over IG profiles (P < .001). CONCLUSION Adults with diabetes and caregivers prefer a glucagon treatment with a higher rate of successful administration, wider storage temperature, and nasal delivery method, when efficacy is similar. Participants favored NG over conventional IG as a rescue medication for severe hypoglycemia. This information may help decision-making by payers and treatment discussions between health care professionals and patients.
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Affiliation(s)
| | | | | | - Yu Yan
- Eli Lilly and Company, Indianapolis, IN, USA
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Oyagüez I, Gómez-Peralta F, Artola S, Carrasco FJ, Carretero-Gómez J, García-Soidan J, Gómez-Huelgas R, Merino-Torres JF, Pérez A. Cost Analysis of FreeStyle Libre ® 2 System in Type 2 Diabetes Mellitus Population. Diabetes Ther 2021; 12:2329-2342. [PMID: 33948909 PMCID: PMC8096131 DOI: 10.1007/s13300-021-01064-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/20/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION FreeStyle Libre® 2 system is a sensor-based flash-monitoring system that measures interstitial fluid glucose. The study aimed to compare cost of FreeStyle Libre 2 system and self-monitoring of blood glucose (SMBG) in the type 2 diabetes mellitus (T2DM) population from the Spanish Health System perspective. METHODS On the basis of data collected from a literature review, the cost of glucose monitoring was modelled for patients with T2DM on a basal-bolus insulin regimen. The cost estimate included annual consumption for glucose monitoring (strips, lancets and sensors) and severe hypoglycaemic events (SHE) management. A published rate of SHE (2.5 episodes/patient-year) was considered. A reduction of SHE (- 48.8%) associated with FreeStyle Libre 2 system, derived from the REPLACE trial, was applied. Hospital attendance for 20.5% of SHEs (with subsequent hospitalization in 16.0%) was applied. Consumption of strips and lancets was set at 6/day for SMBG (derived from national monitoring recommendations), and 0.2/day for FreeStyle Libre 2 system users, with 26 FreeStyle Libre 2 sensors/year. Unitary costs (€, year 2020 excluding VAT) were derived from literature (€0.28/strip; €0.09/lancet; €3.09/daily FM sensor; €3804/hospitalized SHE; €1794/hospital-attended non-admitted SHE; €389/community-attended SHE). RESULTS Costs were €2700 and €2120/year/patient using SMBG or FreeStyle Libre 2 system, respectively. For 1000 patients with T2DM using basal-bolus insulin, 1220 SHEs/year (with 48 hospitalizations) could be prevented and FreeSytle Libre 2 system could generate cost savings of up to €580,953/year versus SMBG (- 21.5%). CONCLUSION FreeStyle Libre 2 system is a potential cost-saving strategy in patients with T2DM in Spain on a basal-bolus insulin regimen.
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Affiliation(s)
- Itziar Oyagüez
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo 4 - letra I, Pozuelo de Alarcón, 28224, Madrid, Spain.
| | | | | | | | | | | | - Ricardo Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga; and Ciber Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan F Merino-Torres
- Endocrinología y Nutrición, Departamento Medicina, Hospital Universitario y Politécnico La Fe, Universitat de València, Valencia, Spain
| | - Antonio Pérez
- Servicio de Endocrinología y Nutrición. Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERDEM, Universitat Autònoma de Barcelona, Barcelona, Spain
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Jude EB, Trescoli C, Emral R, Ali A, Lubwama R, Palmer K, Shaunik A, Nanda N, Raskin P, Gomez‐Peralta F. Effectiveness of premixed insulin to achieve glycaemic control in type 2 diabetes: A retrospective UK cohort study. Diabetes Obes Metab 2021; 23:929-937. [PMID: 33319424 PMCID: PMC8048616 DOI: 10.1111/dom.14298] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022]
Abstract
AIM To investigate the effectiveness of premixed insulin for achieving glycaemic outcomes in clinical practice in the UK. MATERIALS AND METHODS Electronic medical record data from The Health Improvement Network database were captured for adults with type 2 diabetes (T2D) uncontrolled (HbA1c ≥9%) on two or more oral antihyperglycaemic drugs (OADs) initiating premixed insulin. Effectiveness of premixed insulin was assessed by the probability and incidence of achieving glycaemic outcomes (target HbA1c <7.5% [<58 mmol/mol] and a ≥1% or ≥2% HbA1c reduction) over 24 months. RESULTS Data from 974 participants (mean age 62 years; 56% male; 52% obese or extremely obese; mean HbA1c 11.3% [100 mmol/mol]; hypertension 64%, dyslipidaemia 23% and nephropathy 21%) were analysed. The probability of achieving HbA1c <7.5% was highest during months 3-6 (18.2%), while the cumulative probability of achieving this target plateaued between months 15-24 (15.7%-16.0%). Incidence of achieving all glycaemic outcomes plateaued after 12 months and differed by baseline HbA1c, but not OAD use. Factors affecting some glycaemic outcomes included a body mass index >40 kg/m2 and co-morbidities including nephropathy and stroke. CONCLUSIONS In people with uncontrolled T2D (HbA1c ≥9%), glycaemic outcome achievement on premixed insulin was low at 6 months with little additional clinical benefit beyond 12 months, suggesting a high unmet need for early, timely treatment changes with more effective, simpler therapies.
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Affiliation(s)
- Edward B. Jude
- Tameside and Glossop Integrated Care NHS Foundation TrustAshton‐under‐LyneUK
| | | | - Rifat Emral
- Department of Endocrinology and Metabolic Diseases, Faculty of MedicineAnkara UniversityAnkaraTurkey
| | - Amar Ali
- Oakenhurst Medical PracticeBlackburnUK
| | | | | | | | | | - Philip Raskin
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTexas
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Carrillo Algarra AJ, Beltrán KM, Bolivar Castro DM, Hernández Zambrano SM, Henao Carrillo DC. Cuidados de enfermería para la persona adulta, diabética con hipoglucemia: revisión integrativa. REPERTORIO DE MEDICINA Y CIRUGÍA 2021. [DOI: 10.31260/repertmedcir.01217372.1001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introducción: La hipoglucemia es la complicación más frecuente del tratamiento con insulina en adultos. Los eventos de hipoglucemia severa se asocian con complicaciones a corto, mediano y largo plazo en pacientes con diabetes ellmitus. Una de las estrategias para reducir la frecuencia de hipoglucemia son las intervenciones de enfermería y aunque hay pocos estudios que las enuncian de manera explícita, se ha publicado respecto a las necesidades de dichos pacientes, que permiten determinar características definitorias de diagnósticos enfermeros y a partir de ellos establecer metas e intervenciones enfermeras, para el cuidado de dichos pacientes. Objetivo: identificar los cuidados de enfermería para prevenir y controlar los eventos de hipoglucemia en pacientes adultos diagnosticados con diabetes mellitus. Metodología: revisión integrativa, se realizó en seis fases: planteamiento de la pregunta PICO; búsqueda en bases de datos y metabuscadores; lectura crítica; análisis, clasificación, validación por nivel de evidencia y grado de recomendación, y presentación de la información. Resultados: la revisión reportó cinco categorías: factores de riesgo y protectores, miedo a la hipoglucemia, atención brindada al paciente, disminución de la hipoglucemia y descripción del impacto de la hipoglucemia en los pacientes. Conclusiones: a partir de las necesidades reportadas en las 5 categorías de los resultados se determinaron características definitorias y factores relacionados que permitieron formular diagnósticos de enfermería y determinar como principales intervenciones: enseñanza del proceso de enfermedad, medicamentos prescritos, entrenamiento de asertividad, manejo de la hipoglicemia, nutricional y de la medicación, mejorar el afrontamiento, enseñanza individual, facilitar el aprendizaje y potenciación de la disposición de aprendizaje.
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Oyagüez I, Merino-Torres JF, Brito M, Bellido V, Cardona-Hernandez R, Gomez-Peralta F, Morales-Perez F. Cost analysis of the flash monitoring system (FreeStyle Libre 2) in adults with type 1 diabetes mellitus. BMJ Open Diabetes Res Care 2020; 8:e001330. [PMID: 32699114 PMCID: PMC7375427 DOI: 10.1136/bmjdrc-2020-001330] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Compare cost of the interstitial liquid glucose flash monitoring (FM) system (FreeStyle Libre 2) versus self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes mellitus (T1DM) in Spain. RESEARCH DESIGN AND METHODS A model was developed to estimate, with the perspective of the Spanish health system, the annual costs associated with glucose monitoring and hypoglycemic events management in T1DM population, with multiple insulin daily doses (MDI). According to published evidence, rate of severe hypoglycemia (SHE) of 4.90 episodes per patient-year was applied. Reduction of SHE (58.6%) was modeled associated with FM use. Published rates of hospital care (20.2%) and subsequent admission (16%) were assumed for SHE. The daily consumption of strips and lancets was 9 in patients with SMBG (before and after 4 daily intakes and at bedtime) and 0.5 for FM users (according to IMPACT trial findings). Annual consumption of 26 FM sensors was considered (1 every 14 days). Unit costs (in € of 2019, excluding VAT) were obtained from literature and national databases. Sensitivity analyses (SA) were carried out to evaluate the model robustness. RESULTS The total annual cost/patient was €4437 for SMBG and €2526 for FM. The use of FM would be associated with an annual savings in the costs of monitoring and managing hypoglycemic events of €1911 per patient-year. In a hypothetical cohort of 1000 patients with T1DM MDI, FM could avoid in 1 year 4900 SHE, 93 hospitalizations for SHE. In addition, the use of FM would generate total savings of up to €1 910 000 per year. In the SA with alternative hypoglycemia events rates and use of strips and lancets, and including non-SHE episodes, savings from €370 000 to €1 760 000 were observed with FM. CONCLUSIONS The use of the FM system to monitor glucose in adults with T1DM treated with MDI, would reduce hypoglycemic events and would result in cost savings for the health system.
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Affiliation(s)
- Itziar Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia, Pozuelo de Alarcon, Madrid, Spain
| | - Juan Francisco Merino-Torres
- Department of Medicine, Universitat de València Facultat de Medicina i Odontologia, Valencia, Comunitat Valenciana, Spain
- Endocrinology and Nutrition, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Miguel Brito
- Endocrinology and Nutrition, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain
| | - Virginia Bellido
- Endocrinology and Nutrition, Cruces University Hospital, Barakaldo, País Vasco, Spain
| | | | | | - Francisco Morales-Perez
- Department of Endocrinology and Nutrition, University Hospital Complex Badajoz, Badajoz, Extremadura, Spain
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Gebremichael GB, Mariye Zemicheal T. Hypoglycemia Prevention Practice and Associated Factors among Diabetic Patients on Follow-Up at Public Hospitals of Central Zone, Tigray, Ethiopia, 2018. Int J Endocrinol 2020; 2020:8743531. [PMID: 32256577 PMCID: PMC7093907 DOI: 10.1155/2020/8743531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/13/2020] [Accepted: 02/19/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hypoglycemia is an acute medical situation that occurs when blood glucose level falls below 70 mg/dl. Although prevention of hypoglycemia is one cornerstone in the management of diabetes mellitus, its prevention practice among patients with diabetes mellitus is insufficiently studied. Moreover, the existed scarce literature in Ethiopia revealed hypoglycemia prevention practice is inadequate. Thus, this study tried to assess hypoglycemia prevention practices and associated factors among diabetic patients. METHODS Hospital-based cross-sectional study design was employed from March 1 to April 1, 2018, in the central zone of Tigray regional state of Ethiopia. A total of 272 diabetes mellitus patients selected by a systematic random sampling method were included in the study. Data were entered into Epi-data version 3.1 and exported to SPSS version 23 for further analysis. The binary logistic regression model (AOR, 95% CI, and p value < 0.05) was used to determine the predictors of hypoglycemia prevention practice. RESULTS The mean age of respondents was 43.62 years, and about 100 (63.2%) participants had good hypoglycemia prevention practice. Good knowledge on hypoglycemia (AOR = 10.34; 95% CI [5.41, 19.89]), having a glucometer at home (AOR = 3.02; 95% CI [1.12, 8.12]), favorable attitude towards diabetes mellitus (AOR = 2.36 CI [1.26, 4.39]), and being governmental employee (AOR = 5.19, 95% CI [1.63, 16.58]) were positive predictors of good hypoglycemia prevention practice. However, being divorced (AOR = 0.13, 95% CI [0.32, 0.53]) was found negatively associated with good hypoglycemia prevention practice. CONCLUSION Only two-thirds of the study participants were found to have good hypoglycemia prevention practices. Healthcare personnel and Ethiopian diabetic association should promote patients' attitude towards DM and knowledge on hypoglycemia by strengthening information, education, and communication program. Stakeholders should also try to provide glucometers to diabetic patients.
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Núñez M, Díaz S, Dilla T, Reviriego J, Pérez A. Epidemiology, Quality of Life, and Costs Associated with Hypoglycemia in Patients with Diabetes in Spain: A Systematic Literature Review. Diabetes Ther 2019; 10:375-392. [PMID: 30661221 PMCID: PMC6437233 DOI: 10.1007/s13300-019-0563-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To assess the burden of hypoglycemia in patients with diabetes mellitus (DM) in Spain, including epidemiological data and information relating to healthcare resource utilization (HRU) and costs, and patients' quality of life (QoL). METHODS A systematic literature review (SLR) was conducted to identify studies that included original information on epidemiology, HRU and costs, and/or QoL associated with hypoglycemia in patients with DM in Spain, published in either Spanish or English, between January 2007 and April 2017. RESULTS Fifteen articles, involving 14 studies, were identified in the SLR and included in the analysis. The estimated rate of severe hypoglycemia (SH) events per patient per year ranged from 0.90 to 1.50 in patients with type 1 DM (T1DM) and from 0.30 to 0.63 in patients with type 2 DM (T2DM). The data on HRU differed extensively between studies, making it difficult to draw a conclusion. Total costs per SH event ranged from €409.97 in patients with T1DM to €713.10 in patients with DM. Work absence was reported in 11.80-18% of the working patients. Further, patients who experienced hypoglycemic events expressed a higher fear and had a poorer QoL than those who did not report these events. CONCLUSION Although the data included in the SLR were difficult to synthesize due to heterogeneity of the study designs and patient characteristics in the 14 studies, our search identified a high burden associated with hypoglycemic events in terms of HRU and costs, and patients' QoL. Further research is recommended to reach a consensus on hypoglycemia definition and study design to provide robust evidence on the burden of hypoglycemia and to accurately weigh the impact of this acute complication in Spain. FUNDING Eli Lilly and Company.
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Affiliation(s)
| | | | | | | | - Antonio Pérez
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
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A Component-Based Approach for Securing Indoor Home Care Applications. SENSORS 2017; 18:s18010046. [PMID: 29278370 PMCID: PMC5796285 DOI: 10.3390/s18010046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/05/2017] [Accepted: 12/18/2017] [Indexed: 11/17/2022]
Abstract
eHealth systems have adopted recent advances on sensing technologies together with advances in information and communication technologies (ICT) in order to provide people-centered services that improve the quality of life of an increasingly elderly population. As these eHealth services are founded on the acquisition and processing of sensitive data (e.g., personal details, diagnosis, treatments and medical history), any security threat would damage the public’s confidence in them. This paper proposes a solution for the design and runtime management of indoor eHealth applications with security requirements. The proposal allows applications definition customized to patient particularities, including the early detection of health deterioration and suitable reaction (events) as well as security needs. At runtime, security support is twofold. A secured component-based platform supervises applications execution and provides events management, whilst the security of the communications among application components is also guaranteed. Additionally, the proposed event management scheme adopts the fog computing paradigm to enable local event related data storage and processing, thus saving communication bandwidth when communicating with the cloud. As a proof of concept, this proposal has been validated through the monitoring of the health status in diabetic patients at a nursing home.
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Parekh W, Hoskins N, Baker-Knight J, Ramirez de Arellano A, Mezquita Raya P. The Economic Burden of Insulin-Related Hypoglycemia in Spain. Diabetes Ther 2017; 8:899-913. [PMID: 28653237 PMCID: PMC5544621 DOI: 10.1007/s13300-017-0285-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION An analysis was conducted to estimate the economic burden of insulin-related hypoglycemia in adults in Spain, derived from a novel concept developed for the UK known as the Local Impact of Hypoglycemia Tool. METHODS Costs per severe and non-severe hypoglycemic episode were calculated for patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM). The costs per episode were applied to the population of adults with T1DM and T2DM using insulin in Spain according to the number of severe and non-severe episodes experienced per year. Costs were calculated using Spanish-specific resource costs and published values for resource utilization, including ambulance, accident and emergency (A&E) department, hospitalization, healthcare professional visits, and extra self-monitoring of blood glucose (SMBG) tests used in the week following the episode. A one-way sensitivity analysis on all model inputs was then performed. RESULTS The cost of insulin-related hypoglycemia in Spain is estimated as €662.0 m per year, €292.6 m of which is due to severe episodes and €369.4 m to non-severe episodes. The cost per episode varies from €1.25 for patients with T1DM and €1.48 for patients with T2DM for a non-severe episode where extra SMBG testing after the episode is the only action taken, to €4378.22 for T1DM and €3005.74 for T2DM for a severe episode that was treated in hospital and requires an ambulance, A&E visit, hospitalization, and a diabetes specialist visit. A reduction in severe and non-severe hypoglycemia rates of just 20% could lead to considerable cost savings of €284,925 per 100,000 general population. CONCLUSION This analysis highlights the substantial economic burden of hypoglycemia in Spain, and gives budget holders the ability to assess the costs of new treatments or patient education programs in relation to the potential cost savings due to lower hypoglycemia rates.
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Affiliation(s)
- Witesh Parekh
- European HEOR, Novo Nordisk Ltd., 3 City Place, Beehive Ring Road, Gatwick, UK
| | | | | | - Antonio Ramirez de Arellano
- EU-HEOR Novo Nordisk, Via de los Poblados, 3, Parque Empresarial Cristalia, Edificio 6-4a Planta, Madrid, Spain.
| | - Pedro Mezquita Raya
- Clínica San Pedro, Hospital Torrecárdenas, Endocrinology and Nutrition Unit, Almería, Spain
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Mezquita-Raya P, Reyes-Garcia R, Moreno-Perez O, Escalada-San Martin J, Ángel Rubio Herrera M, Lopez de la Torre Casares M. Clinical Effects of Liraglutide in a Real-World Setting in Spain: eDiabetes-Monitor SEEN Diabetes Mellitus Working Group Study. Diabetes Ther 2015; 6:173-85. [PMID: 26055216 PMCID: PMC4478178 DOI: 10.1007/s13300-015-0112-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION A limitation with randomized controlled trials is that, while they provide unbiased evidence of the efficacy of interventions, they do so under unreal conditions and in a very limited and highly selected patient population. Our aim was to provide data about the effectiveness of liraglutide treatment in a real-world and clinical practice setting. METHODS In a retrospective and observational study, data from 753 patients with type 2 diabetes were recorded through an online tool (eDiabetes-Monitor). RESULTS Mean baseline glycated hemoglobin (HbA1c) was 8.4 ± 1.4% and mean body mass index (BMI) was 38.6 ± 5.4 kg/m(2). After 3-6 months of treatment with liraglutide, we observed a change in HbA1c of -1.1 ± 1.2%, -4.6 ± 5.3 kg in weight and -1.7 ± 2.0 kg/m(2) in BMI (p < 0.001 for all). Compared to baseline, there was a significant reduction in systolic blood pressure (-5.9 mmHg, p < 0.001), diastolic blood pressure (-3.2 mmHg, p < 0.001), LDL cholesterol (-0.189 mmol/l, p < 0.001) and triglycerides (-0.09 mmol/l, p = 0.021). In patients switched from DPP-4 inhibitors, liraglutide induced a decrease of -1.0% in HbA1c (p < 0.001) and a reduction in weight (-4.5 kg, p < 0.001). In patients treated with liraglutide as an add-on therapy to insulin a decrease of -1.08% in HbA1c (p < 0.001) and a weight reduction of -4.15 kg (p < 0.001) were observed. CONCLUSION Our study confirms the effectiveness of liraglutide in a real-life and clinical practice setting. FUNDING Spanish Society of Endocrinology and Nutrition.
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Affiliation(s)
- Pedro Mezquita-Raya
- Unidad de Endocrinología, Nutrición y Riesgo Vascular, Complejo Hospitalario Torrecárdenas, Almería, Spain
- Servicio de Endocrinología, Clínica San Pedro, Almería, Spain
| | - Rebeca Reyes-Garcia
- Servicio de Endocrinología, Clínica San Pedro, Almería, Spain
- Unidad de Endocrinología, Hospital General Universitario Rafael Méndez, Lorca, Murcia, Spain
| | - Oscar Moreno-Perez
- Sección de Endocrinología y Nutrición, Hospital General Universitario de Alicante, FISABIO, Universidad Miguel Hernández, Alicante, Spain
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How to prevent and treat pharmacological hypoglycemias. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2013.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Reyes García R, Mezquita Raya P. How to prevent and treat pharmacological hypoglycemias. Rev Clin Esp 2014; 214:202-8. [PMID: 24468002 DOI: 10.1016/j.rce.2013.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/09/2013] [Accepted: 12/14/2013] [Indexed: 11/19/2022]
Abstract
A 58 year-old woman with type 2 diabetes diagnosed 3 years before came to our clinic. Her treatment was metformin 850 mg every 12 hours and glimepiride 4 mg every 24 hours. After the initiation of glimepiride 9 months before her weight has increased 5 kg, and she suffers frequent hypoglycemias which have affected her while driving. Her BMI is 35.5 kg/m². She has a normal eye fund exam. She has hypertension treated with telmisartán and hidroclorotiazide with adequate control, and also hypercholesterolemia treated with atorvastatine 40 mg every 24 hours. Her blood test shows an HbA1c of 7.0%, normal values of microalbuminuria, total cholesterol 149 mg/dl, HDL cholesterol 52 mg/dl, LDL cholesterol 98 mg/dl and triglycerides 123 mg/dl. Her blood pressure is 129/81 mmHg, there was no orthostatic hypotension, and her peripheral neurological examination shows normal results. In summary, our case is a young woman with type 2 diabetes and obesity, without chronic complications and which has frequent hypoglycaemia. How must this woman be evaluated and treated?
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Affiliation(s)
- R Reyes García
- Unidad de Endocrinología, Hospital General Universitario Rafael Méndez, Lorca, Murcia, España; Servicio de Endocrinología, Clínica San Pedro, Almería, España
| | - P Mezquita Raya
- Unidad de Endocrinología, Nutrición y Riesgo Vascular, Complejo Hospitalario Torrecárdenas, Almería, España; Servicio de Endocrinología, Clínica San Pedro, Almería, España.
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