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Marchesini G, Gibertoni D, Giansante C, Perlangeli V, Grilli R, Scudeller L, Descovich C, Pandolfi P. Impact of migration on diabetes burden: audit in the metropolitan area of Bologna, Italy. J Endocrinol Invest 2024; 47:411-420. [PMID: 37474878 PMCID: PMC10859330 DOI: 10.1007/s40618-023-02157-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE To investigate the impact of diabetes in immigrants on the Italian healthcare system, as well as their compliance with standard protocols of control and treatment. METHODS The prevalence of immigrants with diabetes living in the metropolitan area of Bologna (about 1 million inhabitants) in 2019 was investigated using a database containing all subjects in active follow-up for diabetes, based on antidiabetic drug use, disease-specific copayment exemption, ICD-9 codes, continuous care in diabetes units. Country of origin was derived from fiscal code. RESULTS The overall prevalence of diabetes (n = 53,941; 51.8% males, median age 64) was 6.1% in both Italy-born and immigrant cohorts. Immigrant prevalence was 12.4%, moderately higher than that observed in the total population (12.2%). Diabetes risk was increased in the whole immigrant cohort (odds ratio (OR) 1.74; 95% Confidence Interval (CI) 1.69-1.79). Among cases with incident diabetes, the proportion of immigrants (median age, 49 vs. 65 in Italy-born individuals) increased progressively from 11.7% to 26.5% from 2011 to 2019 (males, 8.9-21.0%; females, 14.9-32.8%) in all age groups, particularly in young adults, but also in older subjects. Metabolic control was lower in immigrants, as was adherence to shared diagnostic and therapeutic protocols, without systematic differences in antidiabetic drug use, but much lower use of drugs for comorbid conditions. CONCLUSIONS The population with diabetes in the metropolitan area of Bologna is rapidly changing. Quality improvement initiatives are needed to reduce the burden for the universalistic Italian health care system generated by the rapidly-growing high-risk immigrant population.
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Affiliation(s)
- G Marchesini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - D Gibertoni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - C Giansante
- Department of Public Health, Local Health Authority of Bologna, Bologna, Italy
| | - V Perlangeli
- Department of Public Health, Local Health Authority of Bologna, Bologna, Italy
| | - R Grilli
- Evaluation and Policy Unit, U.O. Health Services Research, Local Health Authority of Romagna, Ravenna, Italy
| | - L Scudeller
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - C Descovich
- Department of Public Health, Local Health Authority of Bologna, Bologna, Italy
| | - P Pandolfi
- Department of Public Health, Local Health Authority of Bologna, Bologna, Italy
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Airoldi C, Pagnoni F, Cena T, Ceriotti D, De Ambrosi D, De Vito M, Faggiano F. Estimate of the prevalence of subjects with chronic diseases in a province of Northern Italy: a retrospective study based on administrative databases. BMJ Open 2023; 13:e070820. [PMID: 37336537 DOI: 10.1136/bmjopen-2022-070820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE To find a definition of chronic disease based on literature review and to estimate the population-based prevalence rate of chronicity in a province in Northern Italy. DESIGN Retrospective observational study based on administrative databases. DATA SOURCES/SETTING Archives of the National Health Service that contain demographic and administrative information linked with the archives of ticket exemptions (2000-2019), the hospital discharge and drug prescriptions (2016-2019). PARTICIPANTS Subjects who lived in Vercelli Local Health Authority, a Northern Italian province (Piedmont region), and were alive in December 2019. MAIN OUTCOME MEASURES Prevalence of subjects with at least one chronic disease identified by administrative sources and stratification of population according to the number of comorbidities. The pathologies considered were: chronic ischaemic heart disease, congestive heart failure, cardiac arrhythmias, hypertension, stroke, neoplasm, asthma, chronic obstructive pulmonary disease, diabetes, thyroid disorders, osteoporosis, rheumatoid arthritis, chronic kidney disease, dementia, autism spectrum disorder, depression, schizophrenia, hepatitis, HIV and substance use disorders. RESULTS Our target population was about 164 344 subjects. The overall prevalence of subjects with at least one chronic condition was 21.43% (n=35 212): 19 541 were female and 15 671 were male with a raw prevalence of 22.96% and 19.77%, respectively. The overall prevalence increases with age until 85 years old, then a decrease is observed. Moreover, 16.39% had only one pathology, 4.30% two diseases and 0.74% had a more complex clinical condition (more than three diseases). CONCLUSIONS Despite the difficulty of having a unique definition of chronic disease, the prevalence obtained was coherent with the estimates reported by other national surveillance systems such as Passi and Passi d'Argento. Underestimates were observed when international comparisons were done; however, when we used less stringent definitions of chronic diseases, similar results were obtained.
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Affiliation(s)
- Chiara Airoldi
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Federico Pagnoni
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Tiziana Cena
- Epidemiologic Unit of the Local Health Authority of Vercelli, Osservatorio Epidemiologico ASL, Vercelli, Italy
| | - Daniele Ceriotti
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Damiano De Ambrosi
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Marta De Vito
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Fabrizio Faggiano
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
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Seghieri C, Ferrè F, Foresi E, Borghini A. Healthcare costs of diabetic foot disease in Italy: estimates for event and state costs. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:169-177. [PMID: 35511310 PMCID: PMC9985574 DOI: 10.1007/s10198-022-01462-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aimed to estimate healthcare costs of diabetic foot disease (DFD) in a large population-based cohort of people with type-2 diabetes (T2D) in the Tuscany region (Italy). DATA SOURCES/STUDY SETTING Administrative healthcare data of Tuscany region, with 2018 as the base year. STUDY DESIGN Retrospective study assessing a longitudinal cohort of patients with T2D. DATA COLLECTION/EXTRACTION METHODS Using administrative healthcare data, DFD were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. METHODS We examined the annual healthcare costs of these clinical problems in patients with T2D between 2015 and 2018; moreover, we used a generalized linear model to estimate the total healthcare costs. PRINCIPAL FINDINGS Between 2015 and 2018, patients with T2D experiencing DFD showed significantly higher average direct costs than patients with T2D without DFD (p < 0.0001). Among patients with T2D experiencing DFD, those who experienced complications either in 2015-2017 and in 2018 incurred the highest incremental costs (incremental cost of € 16,702) followed by those with complications in 2018 only (incremental cost of € 9,536) and from 2015 to 2017 (incremental cost of € 800). CONCLUSIONS DFD significantly increase healthcare utilization and costs among patients with TD2. Healthcare costs of DFD among patients with T2D are associated with the timing and frequency of DFD. These findings should increase awareness among policymakers regarding resource reallocation toward preventive strategies among patients with T2D.
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Affiliation(s)
- Chiara Seghieri
- Department EMbeDS, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Ferrè
- Department EMbeDS, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Elisa Foresi
- Department EMbeDS, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alice Borghini
- Department EMbeDS, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
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Investigation of the Effects of Stress Hyperglycemia Ratio and Preoperative Computed Tomographic Angiography on the Occurrence of Acute Kidney Injury in Diabetic Patients following Surgical Thromboembolectomy. Tomography 2023; 9:255-263. [PMID: 36828372 PMCID: PMC9967571 DOI: 10.3390/tomography9010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Acute lower extremity ischemia (ALI) is a cardiovascular emergency resulting from embolic and thrombotic causes. Although endovascular techniques have advanced, surgical thromboembolectomy is still the gold standard. Emergency thromboembolectomy surgery involves an ischemia-reperfusion injury, which also poses a risk for acute renal injury (AKI). The stress hyperglycemia rate (SHR) has recently emerged as an important prognostic value in emergency cardiovascular events. In the present study, we aimed to analyze the impact of preoperative contrast-enhanced tomographic angiography (CTA) and the SHR value on postoperative AKI in emergency thromboembolectomy procedures in patients with insulin-dependent diabetes mellitus (DM). In this retrospective analysis, patients with DM who received emergency surgical thromboembolectomy after being hospitalized at our hospital with ALI between 20 October 2015, and 10 September 2022, were included. Patients were classified into two groups: Group 1 (N = 159), who did not develop AKI, and Group 2 (N = 45), who did. The 45 patients in Group 2 and the 159 patients in Group 1 had median ages of 59 (39-90) and 66 (37-93), respectively (p = 0.008). The percentage of patients in Group 2 with Rutherford class IIB and admission times longer than 6 h was higher (p = 0.003, p = 0.027, respectively). To determine the variables affecting AKI after surgical embolectomy procedures, multivariate logistic regression analysis was used. In multivariate analysis Model 1, age > 65 years (odds ratio [OR]: 1.425, 95% confidence interval [CI]: 1.230-1.980, p < 0.001), preoperative high creatinine (OR: 4.194, 95% CI: 2.890-6.156, p = 0.003), and Rutherford class (OR: 0.874, 95% CI: 0.692-0.990, p = 0.036) were determined as independent predictors for AKI. In Model 2, age > 65 years (OR: 1.224 CI: 1.090-1.679, p = 0.014), preoperative high creatinine (OR: 3.975, 95% CI: 2.660-5.486, p = 0.007), and SHR (OR: 2.142, CI: 1.134-3.968, p = 0.003), were determined as independent predictors for amputation. In conclusion, when an emergency thromboembolectomy operation is planned in insulin-dependent DM patients, renal risky groups can be identified, and renal protective measures can be taken. In addition, to reduce the renal risk, according to the suitability of the clinical conditions of the patients, the decision to perform a CTA with contrast can be taken by looking at the SHR value.
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Listorti E, Torbica A, Cella SG, Fiorini G, Corrao G, Franchi M. Healthcare Services for Undocumented Migrants: Organisation and Costs from the Italian NHS Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16447. [PMID: 36554329 PMCID: PMC9778250 DOI: 10.3390/ijerph192416447] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Based on the principle of health equity, the Italian National Health Service is known worldwide for being a universalistic system that guarantees healthcare services for all its population, among which there are undocumented migrants. A commitment for their health needs is further motivated by their lower utilisation rates of healthcare services, which becomes even more crucial when considering chronic conditions such as diabetes that require adherence and continuity of care. However, the need for more official data has resulted in little research documenting these healthcare usage patterns. For this reason, our objective has been to deepen, from the Italian NHS perspective, the quantity, costs, type, preventability and organisation of healthcare services directed to undocumented migrants. We used official healthcare data from the Lombardy Region, which enable the identification of people receiving the STP code (undocumented migrants) and of people with foreign citizenship (documented migrants). After quantifying the average annual amount and expenditure for healthcare services grouped by Italian citizens, documented migrants and undocumented migrants for all clinical conditions (quantity and costs), we performed three primary investigations where we enlightened differences between the three mentioned groups focusing on the diagnosis of diabetes: (i) mapping the types of healthcare services used and their characteristics (type); (ii) quantifying the impact of preventable hospital admissions (preventability); (iii) examining the healthcare patterns linking pharmaceutical prescriptions with hospital accesses (organisation). Our results reveal significant differences among the three groups, such as more urgent hospital admissions, more preventable complications, and a higher recurrence in terms of access and costs to hospital services rather than pharmaceutical prescriptions for undocumented migrants. These findings can represent the leverage to raise awareness toward the emerging challenges of the migrant health burden.
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Affiliation(s)
- Elisabetta Listorti
- Centre for Healthcare and Social Care Management (CERGAS), SDA Bocconi, 20136 Milan, Italy
| | - Aleksandra Torbica
- Centre for Healthcare and Social Care Management (CERGAS), SDA Bocconi, 20136 Milan, Italy
| | - Silvano G. Cella
- Laboratory of Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milan, via Vanvitelli 32, 20129 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Gianfrancesco Fiorini
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
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Baccolini L, Centis E, Malaguti A, Forlani G, Marchesini G, Petroni ML. A psycho-educational intervention for the prevention of foot lesions in people with diabetes: Report of a clinical audit. Nutr Metab Cardiovasc Dis 2022; 32:2264-2272. [PMID: 35843798 DOI: 10.1016/j.numecd.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS Motivational approaches may help target the psychological aspects of self-care, improving adherence to good practices in individuals with diabetes. The present study was designed to test the feasibility and effectiveness of a psychoeducational program for diabetic foot prevention or disease progression. METHODS AND RESULTS Eighty-one subjects with or at high risk of foot ulcer development entered a program consisting of six 120-min group sessions, conducted by a podiatrist and an expert in psycho-education. Occurrence/recurrence of lesions in a 3-year follow-up was compared with 172 cases with similar risk score (IWGDF score 2019), receiving education at any 6-month podiatric visit (standard-of-care). Motivation to self-care and competence were assessed by specific questionnaires. The experimental program increased adherence to follow-up. The prevalence of foot lesions was higher at baseline and was remarkably reduced at any time-point in patients attending the psychoeducational program, whereas it remained relatively stable in standard care (around 10% of cases). The cumulative incidence was lower in the psychoeducational program (13.2, 95% CI 9.2-18.0 per 100 patient-year vs. 26.1; 95% CI 22.1-30.2); time to new lesions was increased (P = 0.022). Cox proportional hazard analysis confirmed an overall reduction of lesions in the psychoeducational program (HR 0.34; 95% CI 0.18-0.66; P < 0.001), after adjustment for confounders. The program was associated with significant changes in competence and motivation to self-care. CONCLUSION A psychoeducational approach is both feasible and effective to support patients with diabetes at high risk of first or recurrent foot lesions, increasing their adherence to self-care practices.
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Affiliation(s)
- Luca Baccolini
- IRCCS Sant'Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, Alma Mater University, Bologna, Italy
| | - Elena Centis
- IRCCS Sant'Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, Alma Mater University, Bologna, Italy
| | - Anna Malaguti
- IRCCS Sant'Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, Alma Mater University, Bologna, Italy
| | - Gabriele Forlani
- IRCCS Sant'Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, Alma Mater University, Bologna, Italy
| | - Giulio Marchesini
- IRCCS Sant'Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, Alma Mater University, Bologna, Italy.
| | - Maria L Petroni
- IRCCS Sant'Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, Alma Mater University, Bologna, Italy
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Mortality and Conversion Rates to Below-Knee or Above-Knee Amputation After Transmetatarsal Amputation. J Am Acad Orthop Surg 2022; 30:767-779. [PMID: 35442927 DOI: 10.5435/jaaos-d-21-00872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/08/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The purpose of this study was to identify associated risk factors for complications, need for a higher level of amputation such as below-knee amputation (BKA) or above-knee amputation (AKA), and mortality after transmetatarsal amputation (TMA). METHODS We identified 265 patients who underwent 286 TMA procedures between June 2002 and July 2016. Medical records were reviewed for revision surgery and amputation. Mortality was verified using the National Death Index. We identified and documented potential risk factors including diabetes, hemoglobin A1c level, end-stage renal disease, cardiovascular disease, peripheral vascular disease, history of revascularization, contralateral amputation, and neuropathy. Sixty-eight percent were male, the mean age was 56.9 years (SD 12.8; range 24.1 to 92.1), and the median body mass index was 28.6 (interquartile range, 24.5 to 33.1). RESULTS Twenty-seven percent of the patients required a subsequent BKA or AKA after the index TMA surgery. The results of a multivariable model indicated that women (odds ratio [OR], 3.63; 95% confidence interval [CI], 1.716 to 7.672), patients aged 57 to 64 years (OR, 0.17; 95% CI, 0.06 to 0.51), and patients with a history of revascularization (OR, 7.06, 95% CI, 2.86 to 17.44) had markedly higher odds than the relevant comparison groups. Forty percent of the patients died after the index TMA at a median of 27 months. After adjusting for all patient factors, history of end-stage renal disease (OR, 2.2; 95% CI, 1.206 to 4.014) and cardiovascular disease (OR, 2.879; 95% CI, 1.615 to 5.131) remained markedly associated with mortality after TMA. DISCUSSION There are high rates of additional amputation after nontraumatic TMA and a high mortality rate. Surgeons should set realistic expectations with patients considered for TMA and identify risk factors, which may guide treatment. Treatment is multidisciplinary, requiring attention to surgical details, correction of vascular deficiency or contracture when present, and perioperative medical optimization. LEVEL OF EVIDENCE IV.
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Bellia A, Meloni M, Andreadi A, Uccioli L, Lauro D. Geographic and Ethnic Inequalities in Diabetes-Related Amputations. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:855168. [PMID: 36992760 PMCID: PMC10012100 DOI: 10.3389/fcdhc.2022.855168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022]
Abstract
Individuals with diabetes mellitus are at increasing risk for major lower-extremity amputations (LEAs). Poor quality of life and remarkable disabilities are associated with LEAs, determining a high economic burden for the healthcare systems. Reducing LEAs is therefore a primary marker of quality of care of the diabetic foot. At global level, between-countries comparisons of LEAs rates are basically hampered by differences in criteria used for data collection and analysis among studies. Significant variability in amputation rates exists between geographic areas, and also within specific regions of a country. Overall 5-year mortality rate after major amputations is reported to vary substantially across countries, from 50 to 80%. The odds of LEAs are substantially higher for Black, Native American and Hispanic ethnicities compared with White groups, with similar figures observed in the economically disadvantaged areas compared to more developed ones. Such discrepancies may reflect differences in diabetes prevalence as well as in financial resources, health-care system organization and management strategies of patients with diabetic foot ulcers. Looking at the experience of countries with lower rates of hospitalization and LEAs worldwide, a number of initiatives should be introduced to overcome these barriers. These include education and prevention programs for the early detection of diabetic foot at primary care levels, and the multidisciplinary team approach with established expertise in the treatment of the more advanced stage of disease. Such a coordinated system of support for both patients and physicians is highly required to reduce inequalities in the odd of diabetes-related amputations worldwide.
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Affiliation(s)
- Alfonso Bellia
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Endocrinology and Diabetes, University Hospital Policlinico Tor Vergata, Rome, Italy
- *Correspondence: Alfonso Bellia,
| | - Marco Meloni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Endocrinology and Diabetes, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Aikaterini Andreadi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Endocrinology and Diabetes, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Luigi Uccioli
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Endocrinology and Diabetes, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Endocrinology and Diabetes, University Hospital Policlinico Tor Vergata, Rome, Italy
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Geurten RJ, Struijs JN, Elissen AMJ, Bilo HJG, van Tilburg C, Ruwaard D. Delineating the Type 2 Diabetes Population in the Netherlands Using an All-Payer Claims Database: Specialist Care, Medication Utilization and Expenditures 2016-2018. PHARMACOECONOMICS - OPEN 2022; 6:219-229. [PMID: 34862962 PMCID: PMC8864033 DOI: 10.1007/s41669-021-00308-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aim of this study was to describe the healthcare utilization and expenditures related to medical specialist care and medication of the entire type 2 diabetes population in the Netherlands in detail. METHODS For this retrospective, observational study, we used an all-payer claims database. Comprehensive data on specialist care and medication utilization and expenditures of the type 2 diabetes population (n = 900,522 in 2018) were obtained and analyzed descriptively. Data were analyzed across medical specialties and for various types of diabetes medication (or glucose-lowering drugs [GLDs]) and other medication. RESULTS Specialist care utilization was diverse: different medical specialties were visited by a considerable fraction of the type 2 diabetes population. Total expenditures on specialist care were €2498 million in 2018 (i.e., 10.6% of the national specialist care expenditures). In total, 97.8% of patients used other medication (not GLDs) and 81.8% used GLDs; 25.6% of medication expenditures were for GLDs. For both specialist care and medication, mean expenditures per treated patient were higher than median expenditures, indicating a skewed distribution of spending. CONCLUSION Use of and expenditures on specialist care and medication of the type 2 diabetes population is diverse. These heterogeneous healthcare use patterns are likely caused by the presence of comorbidities. Additionally, we found that a small fraction of the population is responsible for a large share of the expenditures. A shift towards more patient-centered care could lead to health improvements and a reduction in overall costs, subsequently promoting the sustainability of healthcare systems.
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Affiliation(s)
- Rose J Geurten
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Campus The Hague, The Hague, The Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Geurten RJ, Elissen AMJ, Bilo HJG, Struijs JN, van Tilburg C, Ruwaard D. Identifying and delineating the type 2 diabetes population in the Netherlands using an all-payer claims database: characteristics, healthcare utilisation and expenditures. BMJ Open 2021; 11:e049487. [PMID: 34876422 PMCID: PMC8655569 DOI: 10.1136/bmjopen-2021-049487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to identify and delineate the Dutch type 2 diabetes population and the distribution of healthcare utilisation and expenditures across the health system from 2016 to 2018 using an all-payer claims database. DESIGN Retrospective observational cohort study based on an all-payer claims database of the Dutch population. SETTING The Netherlands. PARTICIPANTS The whole Dutch type 2 diabetes population (n=900 522 in 2018), determined based on bundled payment codes for integrated diabetes care and medication use indicating type 2 diabetes. OUTCOME MEASURES Annual prevalence of type 2 diabetes, comorbidities and characteristics of the type 2 diabetes population, as well as the distribution of healthcare utilisation and expenditures were analysed descriptively. RESULTS In 2018, 900 522 people (6.5% of adults) were identified as having type 2 diabetes. The most common comorbidity in the population was heart disease (12.1%). Additionally, 16.2% and 5.6% of patients received specialised care for microvascular and macrovascular diabetes-related complications, respectively. Most patients with type 2 diabetes received pharmaceutical care (99.1%), medical specialist care (97.0%) and general practitioner consultations (90.5%). In total, €8173 million, 9.4% of total healthcare expenditures, was reimbursed for the type 2 diabetes population. Medical specialist care accounted for the largest share of spending (38.1%), followed by district nursing (12.4%), and pharmaceutical care (11.5%). CONCLUSIONS All-payer claims databases can be used to delineate healthcare use: this insight can inform health policy and practice and, thereby, support better decisions to promote long-term sustainability of healthcare systems. The healthcare utilisation of the Dutch type 2 diabetes population is distributed across the health system and utilisation of medical specialist care is high. This is likely to be due to presence of concurrent morbidities and complications. Therefore, a shift from a disease-specific approach to a person-centred and integrated care approach could be beneficial in the treatment of type 2 diabetes.
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Affiliation(s)
- Rose J Geurten
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department Public Health and Primary Care, Leiden University Medical Center Campus The Hague, The Hague, The Netherlands
| | - Chantal van Tilburg
- Department Intelligence, Vektis Healthcare Information Center, Zeist, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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11
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Riandini T, Pang D, Toh MPHS, Tan CS, Liu DYK, Choong AMTL, Chandrasekar S, Tai ES, Tan KB, Venkataraman K. Diabetes-related lower extremity complications in a multi-ethnic Asian population: a 10 year observational study in Singapore. Diabetologia 2021; 64:1538-1549. [PMID: 33885933 PMCID: PMC8187215 DOI: 10.1007/s00125-021-05441-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Diabetes progression and complication risk are different in Asian people compared with those of European ancestry. In this study, we sought to understand the epidemiology of diabetes-related lower extremity complications (DRLECs: symptomatic peripheral arterial disease, ulceration, infection, gangrene) and amputations in a multi-ethnic Asian population. METHODS This was a retrospective observational study using data obtained from one of three integrated public healthcare clusters in Singapore. The population consisted of individuals with incident type 2 diabetes who were of Chinese, Malay, Indian or Other ethnicity. We examined incidence, time to event and risk factors of DRLECs and amputation. RESULTS Between 2007 and 2017, of the 156,593 individuals with incident type 2 diabetes, 20,744 developed a DRLEC, of whom 1208 underwent amputation. Age- and sex-standardised incidence of first DRLEC and first amputation was 28.29/1000 person-years of diabetes and 8.18/1000 person-years of DRLEC, respectively. Incidence of both was highest in individuals of Malay ethnicity (DRLEC, 36.09/1000 person-years of diabetes; amputation, 12.96/1000 person-years of DRLEC). Median time from diabetes diagnosis in the public healthcare system to first DRLEC was 30.5 months for those without subsequent amputation and 10.9 months for those with subsequent amputation. Median time from DRLEC to first amputation was 2.3 months. Older age (p < 0.001), male sex (p < 0.001), Malay ethnicity (p < 0.001), Indian ethnicity (p = 0.014), chronic comorbidities (nephropathy [p < 0.001], heart disease [p < 0.001], stroke [p < 0.001], retinopathy [p < 0.001], neuropathy [p < 0.001]), poorer or missing HbA1c (p < 0.001), lower (p < 0.001) or missing (p = 0.002) eGFR, greater or missing BMI (p < 0.001), missing LDL-cholesterol (p < 0.001) at diagnosis, and ever-smoking (p < 0.001) were associated with higher hazard of DRLEC. Retinopathy (p < 0.001), peripheral vascular disease (p < 0.001), poorer HbA1c (p < 0.001), higher (p = 0.009) or missing (p < 0.001) LDL-cholesterol and missing BMI (p = 0.008) were associated with higher hazard of amputation in those with DRLEC. Indian ethnicity (p = 0.007) was associated with significantly lower hazard of amputation. CONCLUSIONS/INTERPRETATION This study has revealed important ethnic differences in risk of diabetes-related lower limb complications, with Malays most likely to progress to DRLEC. Greater research efforts are needed to understand the aetiopathological and sociocultural processes that contribute to the higher risk of lower extremity complications among these ethnic groups.
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Affiliation(s)
- Tessa Riandini
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Deanette Pang
- Policy Research & Evaluation Division, Ministry of Health, Singapore, Republic of Singapore
| | - Matthias P H S Toh
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Daveon Y K Liu
- Information Management, Group Health Informatics, National Healthcare Group, Singapore, Republic of Singapore
| | - Andrew M T L Choong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore, Republic of Singapore
| | - Sadhana Chandrasekar
- Department of Vascular Surgery, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Kelvin B Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
- Policy Research & Evaluation Division, Ministry of Health, Singapore, Republic of Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore.
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12
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Meloni M, Acquati S, Licciardello C, Ludovico O, Sepe M, Vermigli C, Da Ros R. Barriers to diabetic foot management in Italy: A multicentre survey in diabetic foot centres of the Diabetic Foot Study Group of the Italian Society of Diabetes (SID) and Association of Medical Diabetologists (AMD). Nutr Metab Cardiovasc Dis 2021; 31:776-781. [PMID: 33549455 DOI: 10.1016/j.numecd.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Diabetic foot (DF) disease is a current health and social burden. The authors aimed to identify the barriers to the DF management across Italy. METHODS AND RESULTS A questionnaire was submitted to Italian centres dedicated to DF care. The questionnaire was composed of 12 questions focused on the barriers to the DF management including timing of referral, hospital management, and community follow-up. Each centre could answer by choosing a score from 1 to 5 for every item with the following numerical variables: 1 = never; 2 = rarely; 3 = sometimes; 4 = often; 5 = always. Accordingly, for each item a national and regional score was reported and a comparison between regions was carried out. National and regional scores were estimated using the total score for each item as a numerator and the number of national centres included as a denominator. Among 102 centres, 99 were included and 3 were excluded due to missing data. The 99 centres belonged to 16 regions with the following distribution: Calabria 4, Campania 5, Emilia-Romagna 14, Friuli-Venezia-Giulia 4, Lazio 12, Liguria 4, Lombardy 10, Marche 1, Molise 1, Piedmont 5, Apulia 5, Sardinia 5, Sicily 4, Tuscany 11, Veneto 9, Umbria 5. The items with the highest score were late referral (3.3) and urgent surgery (3.2). The regions with the highest score were Molise (3.9) and Calabria (3.5). CONCLUSION The main issues across Italy were late referral and the requirement for urgent surgery for acute DF. In the regional scenario, the southern central areas showed more barriers than northern regions.
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Affiliation(s)
- Marco Meloni
- Diabetic Foot Unit, Department of Systems Medicine, University of Rome Tor Vergata, Italy.
| | - Silvia Acquati
- Unit of Endocrinology, Pierantoni-Morgagni Hospital, Forlì AUSL Romagna, Italy
| | - Carmelo Licciardello
- UFC Malattie disendocrine e dismetaboliche, Centro Catanese di Medicina e Chirurgia, Catania, Italy
| | - Ornella Ludovico
- Unit of Endocrinology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Cristiana Vermigli
- Unit of Endocrinology, Diabetic Foot Centre, University Hospital Santa Maria della Misericordia, Perugia, Italy
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13
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Muraca E, Ciardullo S, Perra S, Zerbini F, Oltolini A, Cannistraci R, Bianconi E, Villa M, Pizzi M, Pizzi P, Manzoni G, Lattuada G, Perseghin G. Hypercortisolism and altered glucose homeostasis in obese patients in the pre-bariatric surgery assessment. Diabetes Metab Res Rev 2021; 37:e3389. [PMID: 32738094 DOI: 10.1002/dmrr.3389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 01/20/2023]
Abstract
AIMS Hypothalamus-pituitary-adrenal (HPA) axis hyperactivity was suggested to be associated with the metabolic syndrome (MS), obesity and diabetes. The aim of this study was to test whether hypercortisolism was associated with altered glucose homeostasis and insulin resistance, hypertension and dyslipidemia in a homogeneous population of obese patients. MATERIALS/METHODS In retrospective analysis of a set of data about obese patients attending the outpatient service of a single obesity centre between January 2013 and January 2020, 884 patients with BMI >30 kg/m2 were segregated in two subgroups: patients with urinary free cortisol (UFC) higher than normal (UFC+; n = 129) or within the normal range (UFC-; n = 755). RESULTS The overall prevalence of UFC+ was 14.6% and double test positivity (morning cortisol >1.8 mcg/dL following overnight dexamethasone suppression test, ODST) was detected in 1.0% of patients. Prediabetes (OR 1.74; 95%CI 1.13-2.69; p = 0.012) and diabetes (OR 2.03; 95%CI 1.21-3.42; p = 0.008) were associated with higher risk of UFC+ when analysis was adjusted for confounding variables. Conversely, hypertension and dyslipidemia were not related to UFC+. Within the individuals with normal FPG and HbA1c, those with higher estimated insulin resistance (HOMA2-IR) maintained a higher risk of UFC+ (OR 2.84, 95%CI 1.06-7.63; p = 0.039) and this relationship was weakened only when the body fat percentage was included into the model. CONCLUSIONS In obese patients, hypercortisolism was more frequent across the entire spectrum of altered glucose homeostasis including the very early stages; this relation could not be detected for the other criteria of the MS, as waist, hypertension and atherogenic dyslipidemia.
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Affiliation(s)
- Emanuele Muraca
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Stefano Ciardullo
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Monza, Italy
| | - Silvia Perra
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Francesca Zerbini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Alice Oltolini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Rosa Cannistraci
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Monza, Italy
| | - Eleonora Bianconi
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Matteo Villa
- Clinical Psychology, Policlinico di Monza, Monza, Italy
| | - Mattia Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, Monza, Italy
| | - Pietro Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, Monza, Italy
| | - Giuseppina Manzoni
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Guido Lattuada
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Gianluca Perseghin
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Monza, Italy
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14
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Bonora E, Dauriz M, Rinaldi E, Mantovani A, Boscari F, Mazzuccato M, Vedovato M, Gallo A, Toffanin E, Lapolla A, Fadini GP, Avogaro A. Assessment of simple strategies for identifying undiagnosed diabetes and prediabetes in the general population. J Endocrinol Invest 2021; 44:75-81. [PMID: 32342446 DOI: 10.1007/s40618-020-01270-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS The rising tide of diabetes mellitus (DM) and prediabetes (PDM) is urgently calling for strategies easily applicable to anticipate diagnosis. We assessed the effectiveness of random capillary blood glucose (RCBG), administration of a validated DM risk questionnaire, or the combination of both. MATERIALS AND METHODS RCBG measurement and/or questionnaire administration were offered to all individuals presenting at gazebos organized during the World Diabetes Day or similar public initiatives on diabetes awareness. Subjects with suspicious DM or PDM were invited to the Diabetes Center (DC) for laboratory confirmation (fasting plasma glucose and HbA1c). RESULTS Among 8563 individuals without known diabetes undergoing RCBG measurement, 341 (4%) had suspicious values. Diagnosis of DM was confirmed in 36 (41.9%) of the 86 subjects who came to the DC and PDM was found in 40 (46.5%). Among 3351 subjects to whom the questionnaire was administered, 480 (14.3%) had suspicious scores. Diagnosis of DM was confirmed in 40 (10.1%) of the 397 who came to the DC and PDM was found in 214 (53.9%). These 3351 subjects also had RCBG measurement and 30 out of them had both tests positive. Among them, 27 subjects came to DC and DM was diagnosed in 17 (63.0%) and PDM was found in 9 (33.3%). CONCLUSIONS These data suggest that RCBG definitely outperforms the questionnaire to identify unknown DM and PDM. RCBG measurement, with questionnaire as an adjunctive tool, appears to be a simple, fast, and feasible opportunistic strategy in detecting undiagnosed DM and PDM.
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Affiliation(s)
- E Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy.
| | - M Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
- Department of Internal Medicine, Section of Endocrinology and Diabetes, Bolzano General Hospital, Bolzano, Italy
| | - E Rinaldi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - A Mantovani
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - F Boscari
- Department of Medicine, University of Padua, Padua, Italy
| | - M Mazzuccato
- Department of Medicine, University of Padua, Padua, Italy
| | - M Vedovato
- Department of Medicine, University of Padua, Padua, Italy
| | - A Gallo
- Department of Medicine, University of Padua, Padua, Italy
| | - E Toffanin
- Department of Medicine, University of Padua, Padua, Italy
| | - A Lapolla
- Department of Medicine, University of Padua, Padua, Italy
| | - G P Fadini
- Department of Medicine, University of Padua, Padua, Italy
| | - A Avogaro
- Department of Medicine, University of Padua, Padua, Italy
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15
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Guerrero-Fernández de Alba I, Orlando V, Monetti VM, Mucherino S, Gimeno-Miguel A, Vaccaro O, Forjaz MJ, Poblador Plou B, Prados-Torres A, Riccardi G, Menditto E. Comorbidity in an Older Population with Type-2 Diabetes Mellitus: Identification of the Characteristics and Healthcare Utilization of High-Cost Patients. Front Pharmacol 2020; 11:586187. [PMID: 33746740 PMCID: PMC7970761 DOI: 10.3389/fphar.2020.586187] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/29/2020] [Indexed: 01/11/2023] Open
Abstract
Objectives: Little is known about the specific comorbidities contributing to higher costs in patients with type-2 diabetes mellitus (T2DM), particularly in older cases. We aimed to evaluate the prevalence, type, and cost of comorbidities occurring in older T2DM patients versus older non-T2DM patients, and the factors associated with high cost (HC) T2DM patients. Methods: Retrospective cohort study using information from the Campania Region healthcare database. People aged ≥65 years who received ≥2 prescriptions for antidiabetic drugs were identified as "T2DM patients." Comorbidities among T2DM and non-T2DM groups were assessed through the RxRiskV Index (modified version). T2DM individuals were classified according to the total cost distribution as HC or "non-high cost." Two sub-cohorts of HC T2DM patients were assessed: above 90th and 80th percentile of the total cost. Age- and sex-adjusted logistic regression models were created. Results: Among the T2DM cohort, concordant and discordant comorbidities occurred significantly more frequently than in the non-T2DM cohort. Total mean annual cost per T2DM patient due to comorbidities was €7,627 versus €4,401 per non-T2DM patient. Among T2DM patients identified as being above 90th and 80th percentiles of cost distribution, the total annual costs were >€19,577 and >€2,563, respectively. The hospitalization cost was higher for T2DM cases. Strongest predictors of being a HC T2DM patient were having ≥5 comorbidities and renal impairment. Conclusion: HC patients accrued >80% of the total comorbidities cost in older T2DM patients. Integrated care models, with holistic and patient-tailored foci, could achieve more effective T2DM care.
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Affiliation(s)
- Inmaculada Guerrero-Fernández de Alba
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
| | - Valentina Orlando
- CIRFF, Center of Pharmacoeconomics and Drug utilization Research, Department of Pharmacy, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Valeria M. Monetti
- CIRFF, Center of Pharmacoeconomics and Drug utilization Research, Department of Pharmacy, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Sara Mucherino
- CIRFF, Center of Pharmacoeconomics and Drug utilization Research, Department of Pharmacy, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
| | - Olga Vaccaro
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria João Forjaz
- National Centre of Epidemiology, Institute of Health Carlos III and REDISSEC, Madrid, Spain
| | - Beatriz Poblador Plou
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics and Drug utilization Research, Department of Pharmacy, University of Naples Federico II, Naples, Italy
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
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16
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Pöhlmann J, Norrbacka K, Boye KS, Valentine WJ, Sapin H. Costs and where to find them: identifying unit costs for health economic evaluations of diabetes in France, Germany and Italy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1179-1196. [PMID: 33025257 PMCID: PMC7561572 DOI: 10.1007/s10198-020-01229-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Health economic evaluations require cost data as key inputs. Many countries do not have standardized reference costs so costs used often vary between studies, thereby reducing transparency and transferability. The present review provided a comprehensive overview of cost sources and suggested unit costs for France, Germany and Italy, to support health economic evaluations in these countries, particularly in the field of diabetes. METHODS A literature review was conducted across multiple databases to identify published unit costs and cost data sources for resource items commonly used in health economic evaluations of antidiabetic therapies. The quality of unit cost reporting was assessed with regard to comprehensiveness of cost reporting and referencing as well as accessibility of cost sources from published cost-effectiveness analyses (CEA) of antidiabetic medications. RESULTS An overview of cost sources, including tariff and fee schedules as well as published estimates, was developed for France, Germany and Italy, covering primary and specialist outpatient care, emergency care, hospital treatment, pharmacy costs and lost productivity. Based on these sources, unit cost datasets were suggested for each country. The assessment of unit cost reporting showed that only 60% and 40% of CEAs reported unit costs and referenced them for all pharmacy items, respectively. Less than 20% of CEAs obtained all pharmacy costs from publicly available sources. CONCLUSIONS This review provides a comprehensive account of available costs and cost sources in France, Germany and Italy to support health economists and increase transparency in health economic evaluations in diabetes.
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Affiliation(s)
- J Pöhlmann
- Ossian Health Economics and Communications, Basel, Switzerland
| | | | - K S Boye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - W J Valentine
- Ossian Health Economics and Communications, Basel, Switzerland
| | - H Sapin
- Lilly France, 24 Bd Vital Bouhot, CS 50004, 92521, Neuilly-sur-Seine Cedex, France.
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17
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Bonora E, Cataudella S, Marchesini G, Miccoli R, Vaccaro O, Fadini GP, Martini N, Rossi E. A view on the quality of diabetes care in Italy and the role of Diabetes Clinics from the 2018 ARNO Diabetes Observatory. Nutr Metab Cardiovasc Dis 2020; 30:1945-1953. [PMID: 32998821 DOI: 10.1016/j.numecd.2020.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUNDS AND AIMS To investigate relevant indicators of quality of care in a large population-based sample of people with diabetes representative of clinical practice in Italy in 2018. METHODS AND RESULTS We analyzed data from 11,300,750 subjects. All administrative healthcare claims collected in 2018 were scrutinized to identify subjects with diabetes and investigate several indicators of quality of care. Subjects with diabetes were identified by anti-hyperglycemic drug prescriptions, disease-specific co-payment exemption and hospital discharge codes. Indicators of quality of care pertained to monitoring (HbA1c, creatinine, lipid profile, microalbuminuria, eye examination, ECG, ultrasonography of carotid and lower limb arteries) and diabetes treatment (anti-hyperglycemic agents in subjects with cardiovascular disease, CVD). Subjects attending and nonattending Diabetes Clinics were compared. We identified 697,208 individuals with diabetes. HbA1c was assessed at least once in the year in 62.7%, creatinine in 62.3%, total cholesterol in 59.6%, microalbuminuria in 34.3%. Frequency of eye examination was 8.2%, ECG 23.5%, carotid ultrasonography 14.3%, lower limb ultrasonography 7.6%. Among anti-hyperglycemic drugs, SGLT-2 inhibitors were prescribed to ~5% and GLP-1 receptor agonists to ~5% although the proportion of subjects with CVD was ~45%. Subjects attending Diabetes Clinics had higher figures for all these monitoring and treatment indicators. CONCLUSIONS The implementation of national and international guidelines regarding disease monitoring and treatment is far from being satisfactory, especially among subjects nonattending Diabetes Clinics. Further efforts and investments are needed for better disseminating guidelines, more efficaciously engaging healthcare professionals and more strongly empowering the healthcare system to improve diabetes care.
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Affiliation(s)
| | | | | | | | | | | | | | - Elisa Rossi
- CINECA - Interuniversity Consortium, Bologna, Italy
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18
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Derosa G, D'Angelo A, Martinotti C, Valentino MC, Di Matteo S, Bruno GM, Maffioli P. Vitamin D3 supplementation improves glycemic control in type 2 diabetic patients: Results from an Italian clinical trial. INT J VITAM NUTR RES 2020; 92:91-100. [PMID: 32795167 DOI: 10.1024/0300-9831/a000673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: to evaluate the effects of Vitamin D3 on glyco-metabolic control in type 2 diabetic patients with Vitamin D deficiency. Methods: one hundred and seventeen patients were randomized to placebo and 122 patients to Vitamin D3. We evaluated anthropometric parameters, glyco-metabolic control, and parathormone (PTH) value at baseline, after 3, and 6 months. Results: a significant reduction of fasting, and post-prandial glucose was recorded in Vitamin D3 group after 6 months. A significant HbA1c decrease was observed in Vitamin D3 (from 7.6% or 60 mmol/mol to 7.1% or 54 mmol) at 6 months compared to baseline, and to placebo (p < 0.05 for both). At the end of the study period, we noticed a change in the amount in doses of oral or subcutaneous hypoglycemic agents and insulin, respectively. The use of metformin, acarbose, and pioglitazone was significantly lower (p = 0.037, p = 0.048, and p = 0.042, respectively) than at the beginning of the study in the Vitamin D3 therapy group. The units of Lispro, Aspart, and Glargine insulin were lower in the Vitamin D3 group at the end of the study (p = 0.031, p = 0.037, and p = 0.035, respectively) than in the placebo group. Conclusions: in type 2 diabetic patients with Vitamin D deficiency, the restoration of value in the Vitamin D standard has led not only to an improvement in the glyco-metabolic compensation, but also to a reduced posology of some oral hypoglycemic agents and some types of insulin used.
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Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.,Laboratory of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Angela D'Angelo
- Laboratory of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Chiara Martinotti
- S.A.V.E. Studi Analisi Valutazioni Economiche Research Centre, Milan, Italy
| | | | - Sergio Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche Research Centre, Milan, Italy
| | - Giacomo M Bruno
- Department of Management information and production Engineering, University of Bergamo, Bergamo, Italy.,Drug Science Department, University of Pavia, Pavia, Italy
| | - Pamela Maffioli
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
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19
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Di Luzio R, Dusi R, Morigi A, Di Nicolantonio D, Mittermaier P, Marchesini G, Bianchi G. Nurse-managed basal-bolus versus sliding-scale insulin regimen in subjects with hyperglycemia at admission for orthopedic surgery: a propensity score approach. Acta Diabetol 2020; 57:835-842. [PMID: 32100106 DOI: 10.1007/s00592-020-01503-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/11/2020] [Indexed: 12/13/2022]
Abstract
AIMS A sliding-scale (SS) regimen is discouraged to correct hyperglycemia in hospital patients, but there is resistance to adoption of basal-bolus (BB) treatment in surgical units. We tested the feasibility and the effects of a nurse-based BB regimen in orthopedic surgery. METHODS Following an intense training to implement a protocol amenable by nurses, a group of patients admitted with hyperglycemia in an orthopedic institute were prospectively followed according to a basal-bolus insulin regimen (BB, n = 80). They were compared with a hyperglycemic group eventually treated by sliding-scale insulin on demand (SS, n = 122). Diabetes was present in 196 cases. Metabolic control was assessed during the first 3 days of surgery; outcome data were tested by logistic regression, after adjusting for propensity score. RESULT Average blood glucose and glucose variability were lower in BB versus SS (P < 0.001), in the presence of similar 3-day insulin doses. Complications were recorded in 68 cases (16.2% vs. 45.1% in BB and SS, respectively). BB regimen was associated with propensity-adjusted reduction in all adverse events [odds ratio (OR) 0.36; 95% confidence interval (CI) 0.17-0.76] and of systemic infections (OR 0.18; 95% CI 0.07-0.50) and with shorter hospital stay (8.8 ± SD 5.2 days vs. 12.5 ± 7.4; P < 0.01). The superiority of BB regimen was confirmed in the pair-matched analysis. CONCLUSIONS The study proves the feasibility and the superiority of nurse-based BB versus SS treatment in metabolic control and on the risk of adverse events in orthopedic surgery patients with hyperglycemia.
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Affiliation(s)
| | - Rachele Dusi
- Department of Medical and Surgical Sciences (DIMEC), "Alma Mater" University, 9, Via Massarenti, 40138, Bologna, Italy
| | | | | | | | - Giulio Marchesini
- Department of Medical and Surgical Sciences (DIMEC), "Alma Mater" University, 9, Via Massarenti, 40138, Bologna, Italy.
| | - Giampaolo Bianchi
- Department of Medical and Surgical Sciences (DIMEC), "Alma Mater" University, 9, Via Massarenti, 40138, Bologna, Italy
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Bonora E, Cataudella S, Marchesini G, Miccoli R, Vaccaro O, Fadini GP, Martini N, Rossi E. Clinical burden of diabetes in Italy in 2018: a look at a systemic disease from the ARNO Diabetes Observatory. BMJ Open Diabetes Res Care 2020; 8:8/1/e001191. [PMID: 32713842 PMCID: PMC7383948 DOI: 10.1136/bmjdrc-2020-001191] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/14/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Diabetes is a highly prevalent disease worldwide and represents a challenge for patients and healthcare systems. This population-based study evaluated diabetes burden in Italy in 2018 by assessing all aspects of outpatient and hospital care. RESEARCH DESIGN AND METHODS We investigated data of 11 300 750 residents in local health districts contributing to ARNO Diabetes Observatory (~20% of Italian inhabitants). All administrative healthcare claims were analyzed to gather information on access to medical resources. Subjects with diabetes, identified by antihyperglycemic drug prescriptions, disease-specific copayment exemption and hospital discharge codes, were compared with age, sex and residency-matched non-diabetic individuals. RESULTS We identified 697 208 subjects with ascertained diabetes, yielding a prevalence of 6.2% (6.5% in men vs 5.9% in women, p<0.001). Age was 69±15 (mean±SD). As compared with non-diabetic subjects, patients with diabetes received more prescriptions of any drugs (+30%, p<0.001), laboratory tests, radiologic exams and outpatient specialist consultations (+20%, p<0.001) and were hospitalized more frequently (+86%, p<0.001), with a longer stay (+1.4 days, p<0.001). Although cardiovascular diseases accounted for many hospital discharge diagnoses, virtually all diseases contributed to the higher rate of hospital admissions in diabetic subjects (235 vs 99 per 1000 person-years, p<0.001). Healthcare costs were >2-fold higher in subjects with diabetes, mainly driven by hospitalizations and outpatient care related to chronic complications rather than to glucose-lowering drugs, diabetes-specific devices, or metabolic monitoring. CONCLUSIONS The burden of diabetes in Italy is particularly heavy and, as a systemic disease, it includes all aspects of clinical medicine, with consequent high expenses in all areas of healthcare.
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Affiliation(s)
- Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | | | - Giulio Marchesini
- Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
| | | | - Olga Vaccaro
- Department of Clinical and Experimental Medicine, University of Naples Federico II, Napoli, Italy
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21
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Lee H, Lee H, Lim Y. Vitamin D 3 improves lipophagy-associated renal lipid metabolism and tissue damage in diabetic mice. Nutr Res 2020; 80:55-65. [PMID: 32693268 DOI: 10.1016/j.nutres.2020.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 05/20/2020] [Accepted: 06/04/2020] [Indexed: 12/16/2022]
Abstract
Oxidative stress and abnormal lipid metabolism in diabetes can trigger renal lipotoxicity, extending to diabetic nephropathy. Vitamin D3 has been known to be involved in lipid metabolism as well as insulin secretion or inflammation. Therefore, we hypothesized that vitamin D3 supplementation attenuated hyperglycemia-induced renal damage in diabetic mice. Diabetes was induced by a 40% kJ high-fat diet with 30 mg/kg body weight of streptozotocin by intraperitoneal injection twice in male C57BL/6J mice. Among diabetic mice (fasting blood glucose > 140 mg/dL), mice were supplemented with 300 ng/kg body weight of vitamin D3 dissolved in olive oil for 12 weeks. Normal control and diabetic control mice were orally administrated with olive oil as a vehicle. Normal control mice were fed with an AIN-93G diet during the experiment. Vitamin D3 supplementation in diabetic mice improved glucose intolerance and kidney function, demonstrated by diminishing glomerular areas. Vitamin D3 supplementation in diabetic mice significantly reduced triglycerides and low-density lipoprotein cholesterol in plasma as well as triglycerides and total cholesterol in the kidney. Furthermore, vitamin D3 supplementation attenuated lipid synthesis, oxidative stress, and apoptosis, accompanied by activation of β-oxidation, antioxidant defense enzymes, and autophagy in diabetic mice. In conclusion, vitamin D3 supplementation ameliorates hyperglycemia-induced renal damage through the regulation of lipid metabolisms, oxidative stress, apoptosis, and autophagy in diabetes. Vitamin D3 could be a promising nutrient to weaken diabetic nephropathy.
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Affiliation(s)
- Heeseung Lee
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea.
| | - Heaji Lee
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea.
| | - Yunsook Lim
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea.
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22
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Elshahat S, Cockwell P, Maxwell AP, Griffin M, O’Brien T, O’Neill C. The impact of chronic kidney disease on developed countries from a health economics perspective: A systematic scoping review. PLoS One 2020; 15:e0230512. [PMID: 32208435 PMCID: PMC7092970 DOI: 10.1371/journal.pone.0230512] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/02/2020] [Indexed: 11/18/2022] Open
Abstract
Chronic kidney disease (CKD) affects over 10% of the global population and poses significant challenges for societies and health care systems worldwide. To illustrate these challenges and inform cost-effectiveness analyses, we undertook a comprehensive systematic scoping review that explored costs, health-related quality of life (HRQoL) and life expectancy (LE) amongst individuals with CKD. Costs were examined from a health system and societal perspective, and HRQoL was assessed from a societal and patient perspective. Papers published in English from 2015 onward found through a systematic search strategy formed the basis of the review. All costs were adjusted for inflation and expressed in US$ after correcting for purchasing power parity. From the health system perspective, progression from CKD stages 1-2 to CKD stages 3a-3b was associated with a 1.1-1.7 fold increase in per patient mean annual health care cost. The progression from CKD stage 3 to CKD stages 4-5 was associated with a 1.3-4.2 fold increase in costs, with the highest costs associated with end-stage renal disease at $20,110 to $100,593 per patient. Mean EuroQol-5D index scores ranged from 0.80 to 0.86 for CKD stages 1-3, and decreased to 0.73-0.79 for CKD stages 4-5. For treatment with renal replacement therapy, transplant recipients incurred lower costs and demonstrated higher HRQoL scores with longer LE compared to dialysis patients. The study has provided a comprehensive updated overview of the burden associated with different CKD stages and renal replacement therapy modalities across developed countries. These data will be useful for the assessment of new renal services/therapies in terms of cost-effectiveness.
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Affiliation(s)
- Sarah Elshahat
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Paul Cockwell
- University Hospitals Birmingham, Birmingham, England, United Kingdom
| | - Alexander P. Maxwell
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | | | | | - Ciaran O’Neill
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
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Anichini R, Brocco E, Caravaggi CM, Da Ros R, Giurato L, Izzo V, Meloni M, Uccioli L. Physician experts in diabetes are natural team leaders for managing diabetic patients with foot complications. A position statement from the Italian diabetic foot study group. Nutr Metab Cardiovasc Dis 2020; 30:167-178. [PMID: 31848052 DOI: 10.1016/j.numecd.2019.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 12/16/2022]
Abstract
Diabetic foot syndrome (DFS) is a complex disease. The best outcomes are reported with the multi-disciplinary team (MDT) approach, where each member works collaboratively according to his/her expertise. However, which health provider should act as the team leader (TL) has not been determined. The TL should be familiar with the management of diabetes, related complications and comorbidities. He/she should be able to diagnose and manage foot infections, including prompt surgical treatment of local lesions, such as abscesses or phlegmons, in an emergent way in the first meeting with the patient. According to the Organization for Economic Co-operation and Development (OECD) reports, Italy is one of countries with a low amputation rate in diabetic patients. Many factors might have contributed to this result, including 1)the special attention directed to diabetes by the public health system, which has defined diabetes as a "protected disease", and accordingly, offers diabetic patients, at no charge, the best specialist care, including specific devices, and 2)the presence of a network of diabetic foot (DF) clinics managed by diabetologists with medical and surgical expertise. The health care providers all share a "patient centred model" of care, for which they use their internal medicine background and skills in podiatric surgery to manage acute or chronic needs in a timely manner. Therefore, according to Italian experiences, which are fully reported in this document, we believe that only a skilled diabetologist/endocrinologist should act as a TL. Courses and university master's degree programmes focused on DF should guarantee specific training for physicians to become a TL.
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Affiliation(s)
- R Anichini
- Diabetes Unit and Diabetic Foot Unit, Area Pistoiese, AUSL Centro Toscana, Italy
| | - E Brocco
- Diabetic Foot Unit, Foot and Ankle Clinic, Abano Terme Polyclinic, Abano Terme, Italy
| | - C M Caravaggi
- Diabetic Foot Department, IRCCS Multimedica Milan, Italy
| | - R Da Ros
- Diabetes Center AAS2 Monfalcone-Gorizia, Italy
| | - L Giurato
- Diabetic Foot Unit, Department of Medicine Systems, University of Tor Vergata, Rome, Italy
| | - V Izzo
- Diabetic Foot Unit, Department of Medicine Systems, University of Tor Vergata, Rome, Italy
| | - M Meloni
- Diabetic Foot Unit, Department of Medicine Systems, University of Tor Vergata, Rome, Italy
| | - L Uccioli
- Diabetic Foot Unit, Department of Medicine Systems, University of Tor Vergata, Rome, Italy.
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Di Luzio R, Dusi R, Mazzotti A, Petroni ML, Marchesini G, Bianchi G. Stress Hyperglycemia and Complications Following Traumatic Injuries in Individuals With/Without Diabetes: The Case of Orthopedic Surgery. Diabetes Metab Syndr Obes 2020; 13:9-17. [PMID: 32021347 PMCID: PMC6954837 DOI: 10.2147/dmso.s225796] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/19/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Hyperglycemia in trauma patients may stem from metabolic response to stress, both in the presence and the absence of underlying diabetes. We aimed to test the association of stress hyperglycemia with risks of adverse events subjects undergoing orthopedic surgery. PATIENTS AND METHODS In a prospective observational study, we enrolled 202 consecutive patients with hyperglycemia at hospital admission for trauma injuries requiring orthopedic surgery. Based on history, diabetes was present in 183, and 13 more were defined as unknown diabetes on the basis of HbA1c ≥48mmol/mol. Stress hyperglycemia was defined in subjects with/without diabetes by a stress hyperglycemia ratio (SHR) >1.14, calculated as admission glucose/average glucose, estimated from glycosylated hemoglobin. Logistic regression analysis was used to calculate the risk of post-surgery adverse events associated with different states of hyperglycemia, after correction for demographic and clinical confounders. RESULTS Stress hyperglycemia was diagnosed, either as superimposed to diabetes (54/196 cases, 27.6%) as well as in the 6 cases without diabetes. At least one complication was recorded in 68 cases (33.7%), the most common being systemic infection (22.8% of cases). In the total cohort, stress hyperglycemia, irrespective of the presence of diabetes, increased the risk of adverse events (any events, odds ratio [OR], 4.43; 95% confidence interval [CI], 2.11-9.30), cardiovascular events (OR, 7.09; 95% CI, 2.47-19.91), systemic infections (OR, 4.21; 95% CI, 1.97-9.03) and other adverse events (OR, 6.30; 95% CI, 1.41-28.03), after adjustment for confounders; hospital stay was much longer. The same was true when the analysis was limited to the diabetes cohort or by comparing pure stress hyperglycemia vs diabetes without stress hyperglycemia. CONCLUSION The study highlights the importance of stress hyperglycemia for adverse events in the setting of orthopedic surgery following trauma injuries. This condition requires stricter management, considering the much longer length of hospital stay and higher costs.
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Affiliation(s)
| | - Rachele Dusi
- Department of Medical and Surgical Sciences (DIMEC), “Alma Mater” University, Bologna, Italy
| | - Arianna Mazzotti
- Department of Medical and Surgical Sciences (DIMEC), “Alma Mater” University, Bologna, Italy
- Diabetes Unit, AUSL Romagna, Ravenna, Italy
| | - Maria Letizia Petroni
- Department of Medical and Surgical Sciences (DIMEC), “Alma Mater” University, Bologna, Italy
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences (DIMEC), “Alma Mater” University, Bologna, Italy
- Correspondence: Giulio Marchesini Department of Medical and Surgical Sciences (DIMEC), “Alma Mater” University, Sant’Orsola-Malpighi Hospital, BolognaI-40138, ItalyTel +39 051 2144889Fax +39 051 6364502 Email
| | - Giampaolo Bianchi
- Department of Medical and Surgical Sciences (DIMEC), “Alma Mater” University, Bologna, Italy
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Saini M, Kulandaivelan S, Bansal VK, Saini V, Sharma S, Kaur J, Sondh A. Pulmonary Pathology Among Patients with Type 2 Diabetes Mellitus: An Updated Systematic Review and Meta-analysis. Curr Diabetes Rev 2020; 16:759-769. [PMID: 31333139 DOI: 10.2174/1573399815666190716130324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/18/2019] [Accepted: 06/26/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Restrictive lung pathology was reported in the previous meta-analysis among patients with Type 2 Diabetes mellitus (T2DM) which is date back to 2010. OBJECTIVE To see the effect of T2DM on pulmonary functions through updated systematic review and meta-analysis. DATA SOURCE PubMed. STUDY ELIGIBILITY CRITERIA English language case-control or cross-sectional studies, published between 1 January 2010 to 31 August 2018. PARTICIPANTS AND INTERVENTION T2DM and non-diabetic subjects were compared for at least one of the pulmonary function variables i.e. Forced expiratory volume in 1st second (FEV1), % FEV1, Forced vital capacity (FVC), % FVC and % FEV1/FVC. STUDY APPRAISAL AND SYNTHESIS METHODS Methodological quality of the study was assessed using Newcastle-Ottawa Quality Assessment Scale. Meta-analysis was done using Review Manager 5.3 (RevMan 5.3) and meta-regression was conducted using R statistical software. RESULTS We selected 22 articles that met our inclusion and exclusion criteria. Results reveal that among patients with T2DM all variables were reduced except %FEV1/FVC which shows statistically nonsignificant results with P=0.46. This confirms that T2DM patients have a restrictive type of lung pathology. LIMITATION Only articles from the PubMed database were included. Conclusion and Implications of Key Findings: This review affirms the existing evidence of restrictive pathology among patients with T2DM. The future study could be conducted to see the effect of various rehabilitation protocols on pulmonary function among patients with T2DM.
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Affiliation(s)
- Minaxi Saini
- Mother Teresa Saket College of Physiotherapy, Chandimandir, Panchkula, India
| | | | | | - Vikram Saini
- Maharaja Agrasen Medical College, Agroha, Haryana, India
| | - Suresh Sharma
- Department of Statistics, Panjab University, Chandigarh, India
| | - Jaspreet Kaur
- Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India
| | - Aparajita Sondh
- Mother Teresa Haryana Saket Council, Panchkula, Haryana, India
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Rognoni C, Armeni P, Tarricone R, Donin G. Cost–benefit Analysis in Health Care: The Case of Bariatric Surgery Compared With Diet. Clin Ther 2020; 42:60-75.e7. [DOI: 10.1016/j.clinthera.2019.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 01/27/2023]
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Estimating the Impact of Diabetes Mellitus on Worker Productivity Using Self-Report, Electronic Health Record and Human Resource Data. J Occup Environ Med 2019; 60:e569-e574. [PMID: 30188491 DOI: 10.1097/jom.0000000000001441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We assessed the relationship between diabetes mellitus (DM) and measures of worker productivity, direct health care costs, and costs associated with lost productivity (LP) among health care industry workers across two integrated health care systems. METHODS We used data from the Value Based Benefit Design Health and Wellness Study Phase II (VBD), a prospective study of employees surveyed across health systems. Survey and health care utilization data were linked to estimate LP and health care utilization costs. RESULTS Mean marginal lost productive time per week was 0.56 hours higher for respondents with DM. Mean adjusted monthly total health care utilization costs were $467 higher for respondents with DM. CONCLUSION The impact of DM is reflected in higher rates of LP and higher indirect costs for employers related to LP and higher health care resource use.
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Pöhlmann J, Montagnoli R, Lastoria G, Parekh W, Markert M, Hunt B. Value For Money In The Treatment Of Patients With Type 2 Diabetes Mellitus: Assessing The Long-Term Cost-Effectiveness Of IDegLira Versus iGlarLixi In Italy. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:605-614. [PMID: 31632108 PMCID: PMC6789179 DOI: 10.2147/ceor.s218746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/06/2019] [Indexed: 11/23/2022] Open
Abstract
Objective Italian treatment guidelines for type 2 diabetes mellitus (T2DM) target good glycemic control but acknowledge the associated risk of hypoglycemia. Unlike traditional antidiabetic therapies, modern treatment options such as fixed-ratio combinations of basal insulin and glucagon-like peptide 1 receptor agonists are associated with improved glycemic control, reduced body weight and low risk of hypoglycemia. The cost-effectiveness of the fixed-ratio combinations of basal insulin and glucagon-like peptide 1 receptor agonists IDegLira and iGlarLixi was assessed for Italy in patients with T2DM uncontrolled on basal insulin, to evaluate how short-term clinical benefits translate into long-term health economic outcomes. Methods The IQVIA CORE Diabetes Model was used to project clinical and economic outcomes over patient lifetimes. Treatment effects were sourced from an indirect treatment comparison. The analysis captured direct medical costs (expressed in 2017 Euros) from the perspective of the Italian National Health Service (NHS) and patient-related quality of life. Sensitivity analyses were performed. Results IDegLira was associated with gains of 0.09 life years and 0.13 quality-adjusted life years (QALYs) relative to iGlarLixi, due to a lower cumulative incidence and delayed onset of diabetes-related complications. IDegLira was associated with an incremental cost of EUR 930 over patient lifetimes, leading to an incremental cost-effectiveness ratio of EUR 7,386 per QALY gained. Conclusion Over the lifetime of patients with T2DM uncontrolled on basal insulin, IDegLira was associated with improved clinical outcomes at higher costs relative to iGlarLixi. At a willingness-to-pay threshold of EUR 30,000 per QALY gained, IDegLira was considered to be cost-effective versus iGlarLixi from the perspective of the Italian NHS.
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Affiliation(s)
- Johannes Pöhlmann
- Health Economics, Ossian Health Economics and Communications, Basel 4051, Switzerland
| | | | | | - Witesh Parekh
- European HEOR, Nova Nordisk Ltd, West Sussex RH6 0PA, UK
| | - Marie Markert
- Global Market Access, Novo Nordisk A/S, Søborg DK-2860, Denmark
| | - Barnaby Hunt
- Health Economics, Ossian Health Economics and Communications, Basel 4051, Switzerland
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Lee H, Lim Y. Gamma-tocopherol ameliorates hyperglycemia-induced hepatic inflammation associated with NLRP3 inflammasome in alloxan-induced diabetic mice. Nutr Res Pract 2019; 13:377-383. [PMID: 31583056 PMCID: PMC6760984 DOI: 10.4162/nrp.2019.13.5.377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/27/2019] [Accepted: 05/28/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/OBJECTIVES Hyperglycemia-induced hepatic damage has been recognized as one of the major cause of complications in diabetes. Hepatic complications are associated with inflammation and oxidative stress in diabetes. In this study, we investigated the hypothesis that gamma-tocopherol (GT) supplementation ameliorates NLRP3 inflammasome associated hepatic inflammation in diabetes. MATERIALS/METHODS Diabetes was induced by the intraperitoneal injection of alloxan (150 mg/kg. BW) in ICR mice. All mice were fed with a control diet (AIN-76A). After diabetes was induced (fasting glucose level ≥ 250 mg/dL), the mice were treated with tocopherol-stripped corn oil or GT-supplemented (35 mg/kg) corn oil, respectively, by gavage for 2 weeks. RESULTS GT supplementation reduced fasting blood glucose levels in diabetic mice relative to non-treated diabetic mice. Moreover, GT supplementation ameliorated hyperglycemia-induced hepatic damage by regulation of NOD-like receptor protein 3 (NLRP3)-inflammasome associated inflammation represented by NLRP3, apoptosis-associated speck-like protein containing a caspase-recruitment domain, caspase-1, nuclear factor-κB pathway as well as oxidative stress demonstrated by nuclear factor erythroid 2-related factor 2, NAD(P)H dehydrogenase quinone 1, catalase and glutathione-dependent peroxidase in diabetic mice. CONCLUSION The findings suggested that GT supplementation ameliorated hepatic damage by attenuating inflammation and oxidative stress in alloxan-induced diabetic mice. Taken together, GT could be a beneficial nutrient that can ameliorate inflammatory responses associated with NLRP3 inflammasome in hyperglycemia-induced hepatic damage.
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Affiliation(s)
- Heaji Lee
- Department of Food and Nutrition, Kyung Hee University, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul 02447, Republic of Korea
| | - Yunsook Lim
- Department of Food and Nutrition, Kyung Hee University, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul 02447, Republic of Korea
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Marchesini G, Pasqualetti P, Anichini R, Caputo S, Memoli G, Ponzani P, Resi V, Rizzo M, Serviddio G, Zanette G. Patient preferences for treatment in type 2 diabetes: the Italian discrete-choice experiment analysis. Acta Diabetol 2019; 56:289-299. [PMID: 30306406 DOI: 10.1007/s00592-018-1236-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/26/2018] [Indexed: 12/18/2022]
Abstract
AIMS Several drug classes are now available to achieve a satisfactory metabolic control in patients with type 2 diabetes (T2DM), but patients' preferences may differ. METHODS In a discrete-choice experiment, we tested T2DM patients' preferences for recent antidiabetic drugs, in the event that their treatment might require intensification. The following attributes were considered: (a) route of administration; (b) type of delivery; (c) timing; (d) risk of adverse events; (e) effects on body weight. Twenty-two possible scenarios were built, transferred into 192 paired choices and proposed to 491 cases naïve to injectable treatments and 171 treated by GLP-1 receptor agonists (GLP-1RAs). Analyses were performed by descriptive statistics and random effects logit regression model. RESULTS Preferences according to dosing frequency, risk of nausea and urinary tract infections (UTls) were similar across groups, age, sex and BMI. Administration route and delivery type accounted for 1/3 of relative importance; the risk of UTIs, nausea and dosing frequency for ≈ 20% each, and weight loss for only 6%. Two significant interactions emerged (p < 0.01): type of delivery × group, and weight change × BMI class. Irrespective of previous treatment, the three preferred choices were injectable, coupled with weekly dosing and a ready-to-use device (first two choices). In a regression model, being naïve or non-naïve changed the ranking of preferences (p < 0.001), and the order was systematically shifted towards injectable medications in non-naïve subjects. CONCLUSION Easy-to-deliver, injectable treatment is preferred in T2DM, independently of treatment history, and previous experience with GLP-1RAs strengthens patients' willingness to accept injectable drugs.
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Affiliation(s)
- Giulio Marchesini
- SSD Malattie del Metabolismo e Dietetica Clinica, Università "Alma Mater", Bologna, Italy.
- Department of Medical & Surgical Sciences, "Alma Mater" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Patrizio Pasqualetti
- Fondazione Fatebenefratelli per la Ricerca e la Formazione Sanitaria e Sociale, Rome, Italy
| | - Roberto Anichini
- Sezione Autonoma di Diabetologia e Malattie Metaboliche, Presidio Ospedaliero di Pistoia, Pistoia, Italy
| | - Salvatore Caputo
- Servizio di Diabetologia, Policlinico Gemelli, Università Cattolica, Rome, Italy
| | - Giuseppe Memoli
- Centro di Diabetologia "San Luca", Ariano Irpino (AV), Italy
| | - Paola Ponzani
- UO di Diabetologia, Ospedale La Colletta, Arenzano (GE), Italy
| | - Veronica Resi
- Servizio di Diabetologia, UO Endocrinologia e Malattie Metaboliche, Fondazione IRCCS Ca' Granda-Ospedale Maggiore, Policlinico, Milan, Italy
| | - Manfredi Rizzo
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Gaetano Serviddio
- Dipartimento di Scienze Mediche e Chirurgiche, Centro Universitario per la Ricerca e la Cura delle Epatopatie (CURE), Foggia, Italy
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Canonica GW, Colombo GL, Bruno GM, Di Matteo S, Martinotti C, Blasi F, Bucca C, Crimi N, Paggiaro P, Pelaia G, Passalaqua G, Senna G, Heffler E. Shadow cost of oral corticosteroids-related adverse events: A pharmacoeconomic evaluation applied to real-life data from the Severe Asthma Network in Italy (SANI) registry. World Allergy Organ J 2019; 12:100007. [PMID: 30937132 PMCID: PMC6439414 DOI: 10.1016/j.waojou.2018.12.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/12/2018] [Accepted: 12/09/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Asthma is one of the most common non-communicable respiratory diseases, affecting about 6% of the general population. Severe asthma, even if afflicts a minority of asthmatics, drives the majority of costs of the disease. The aim of this study is to create a pharmacoeconomic model to predict the costs of corticosteroid-related adverse events in severe asthmatics and applying it to the first published epidemiologic data from the Severe Asthma Network in Italy (SANI) registry. METHODS The analysis was conducted from the perspective of the Italian National Healthcare System (INHS). Model inputs, derived from literature, included: asthma epidemiology data, frequency of adverse events, percentage of severe asthma treated with OCS and adverse event cost (Diagnosis-Related Group (DRG) national tariffs). We estimated costs per different patient groups: non-asthma controls, mild/moderate and severe asthmatics. Final results report estimated direct cost per patient and total direct cost for overall target population, showing economic impact related to corticosteroid complication. RESULTS Based on epidemiological data input, in Italy, asthmatic subjects resulted about 3,999,600, of which 199,980 with severe asthma. The number of patients with severe asthma OCS-treated was estimated at 123,988. Compared to the non-asthma control cohort and to that with moderate asthma annual cost per severe asthmatic patient resulted respectively about €892 and €606 higher, showing a corticosteroids shadow cost ranging from 45% to 30%.Applying the cost per patient to the target population identified for Italy, the budget impact model estimated a total annual cost related to OCS-related adverse events of €242.7 million for severe asthmatics. In respect with non-asthmatic and moderate population, an incremental expenditure of about € 110.6 million and €75.2, respectively, were shown. CONCLUSIONS Our study provides the first estimates of additional healthcare costs related to corticosteroid induced adverse events in severe asthma patient. Budget impact model results highlighted the relevant economic impact of OCS-related adverse events in severe asthma patients. The future extrapolation of additional data from SANI registry will support the development of a model to investigate the role of corticosteroids sparing drugs.
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Giorgio Lorenzo Colombo
- Drug Science Department, Pavia University, Italy
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Giacomo Matteo Bruno
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Sergio Di Matteo
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Chiara Martinotti
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Italy
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS “Cà Granda – Ospedale Maggiore Policlinico”, Milan, Italy
| | - Caterina Bucca
- Pneumology Unit, Cardiovascular and Thoracic Department, AOU Molinette “Città della Salute e della Scienza”, Department of Medical Sciences, University of Torino, Italy
| | - Nunzio Crimi
- Allergy and Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Respiratory Unit – University Magna Graecia of Catanzaro, Italy
| | - Giovanni Passalaqua
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI) – University of Genoa, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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Ni Y, Liu S, Li J, Dong T, Tao L, Yuan L, Yang M. The Effects of Nurse-Led Multidisciplinary Team Management on Glycosylated Hemoglobin, Quality of Life, Hospitalization, and Help-Seeking Behavior of People with Diabetes Mellitus. J Diabetes Res 2019; 2019:9325146. [PMID: 31934593 PMCID: PMC6942811 DOI: 10.1155/2019/9325146] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/13/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023] Open
Abstract
AIM To evaluate the effect of community-nurse-led multidisciplinary team management on glycosylated hemoglobin (HbA1c), quality of life (QOL), hospitalization, and help-seeking behavior in people with type 2 diabetes mellitus (DM). METHODS A quasi-experimental trial was conducted among people with type 2 DM from two community centers in China. The intervention group (n = 88) received community-nurse-led multidisciplinary team management for 2 years, while the control group (n = 91) received usual care. Data regarding HbA1c, QOL (assessed by the SF-36), hospitalization, and help-seeking behavior were collected at baseline and at 6, 12, and 24 months. RESULTS During the 24-month project, the intervention group demonstrated 1.08% reduction in HbA1c, whereas the control group achieved an increase of 0.45%. The differences between the two groups were statistically significant (P < 0.001). The intervention group showed greater increased in QOL scores (from 66.43 to 70.47, P < 0.001), more decrease in hospitalization (OR = 2.981, 95% CI: 1.016, 8.752 versus OR = 1.189, 95% CI: 0.411, 3.444; P = 0.028) when compared with the control group. The percentage increase of seeking help from nurses in the intervention group (from 12.5% to 57.3%, P < 0.001) was significantly greater than that in the control group after the intervention. CONCLUSIONS Nurse-led multidisciplinary team management is an effective intervention for improving glycemic control, QOL, hospitalization, and help-seeking behavior for people with DM in a community.
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Affiliation(s)
- Yunxia Ni
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Suzhen Liu
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiping Li
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Ting Dong
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Lin Tao
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Li Yuan
- Department of Endocrinology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Meilan Yang
- Yulin Community Health Service Center, Chengdu, Sichuan Province, China
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Piccinni C, Dondi L, Ronconi G, Pedrini A, Martini N, Marchesini G. Burden of disease, healthcare pathways and costs of cardiovascular high-risk patients with type 2 diabetes: a real world analysis. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2018. [DOI: 10.1177/2284240318756529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Carlo Piccinni
- CORE srl – Collaborative Outcome Research, Casalecchio di Reno, Bologna, Italy
| | - Letizia Dondi
- CORE srl – Collaborative Outcome Research, Casalecchio di Reno, Bologna, Italy
| | - Giulia Ronconi
- CORE srl – Collaborative Outcome Research, Casalecchio di Reno, Bologna, Italy
| | - Antonella Pedrini
- CORE srl – Collaborative Outcome Research, Casalecchio di Reno, Bologna, Italy
| | - Nello Martini
- CORE srl – Collaborative Outcome Research, Casalecchio di Reno, Bologna, Italy
- Drugs & Health – Roma, Italy
| | - Giulio Marchesini
- DIMEC - Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
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Mazzi S, Ravasio R, Forlani G, Veronese G, Fabbri A, Marchesini G. Estimating the risk of severe hypoglycemic event related to glucose-lowering treatment among Italian patients with diabetes: the HYPOTHESIS database. Clinicoecon Outcomes Res 2017; 9:711-720. [PMID: 29200880 PMCID: PMC5701554 DOI: 10.2147/ceor.s148368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The primary objective of this study was to estimate 1) the annual risk of undergoing a severe hypoglycemic event in Italian patients with diabetes and 2) the risk of hospitalization following such event. From the HYPOTHESIS database, powered by 46 emergency departments covering a 12-million-odd population, data were extracted of 1,922 hypoglycemic events occurring in patients with diabetes in 2011. The mean age was 71.5 (standard deviation 16.8) years, 50.1% were men, and blood glucose at the time of the event was 44.2 (26.5) mg/dL. Patients were being treated with insulin alone (55%) or in combination with oral hypoglycemic agents (OHA, 15%), or with OHA alone, either in monotherapy (14%) or in multiple therapy (16%). Comorbidities were recorded in 71.8% of the patients. Based on the rates of glucose-lowering drug use in Italian patients with diabetes, the annual risk of undergoing a serious hypoglycemic event was estimated at 1.27% for subjects treated with insulin alone, the highest (p<0.00001) as compared with insulin + OHA (0.41%) or OHA alone, either in monotherapy or in multiple therapy (0.1% and 0.17%, respectively). The risk of being hospitalized following the hypoglycemic event was the least (27.6%) for subjects treated with insulin alone (p<0.0083). Subjects treated with insulin + OHA showed a lower risk (34.2%) as compared with that for subjects treated with OHA (p<0.02). Death occurs in 7% of hospitalized patients. Older age (p<0.0001) and comorbidities (p<0.0001) were risk factors for hypoglycemia-related hospitalization. Treatments with insulin alone (p<0.005) or in combination (p<0.049) were negatively associated with hospital admission. Severe hypoglycemic events associated with the use of oral glucose-lowering agents carry the highest risk of hospital treatment. As such, they are also likely to generate higher tangible and intangible costs.
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Affiliation(s)
- Silvio Mazzi
- Department of Health Economics, Health Publishing & Services Srl, Milan
| | - Roberto Ravasio
- Department of Health Economics, Health Publishing & Services Srl, Milan
| | - Gabriele Forlani
- Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University of Bologna, Bologna
| | - Giacomo Veronese
- Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University of Bologna, Bologna
| | - Andrea Fabbri
- Department of Emergency Medicine, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Giulio Marchesini
- Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University of Bologna, Bologna
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Lorenzoni V, Baccetti F, Genovese S, Torre E, Turchetti G. Cost-consequence analysis of sitagliptin versus sulfonylureas as add-on therapy for the treatment of diabetic patients in Italy. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:699-710. [PMID: 29200879 PMCID: PMC5700761 DOI: 10.2147/ceor.s141477] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective Diabetes mellitus is a chronic disease related to a significant impact in both epidemiologic and economic terms. In Italy, around 3.6 million people are affected by diabetes and this number is expected to increase significantly in the next few years. As recommended by current national and international guidelines, metformin (Met) is prescribed as first-line pharmacological treatment, and many pharmacological alternatives are available for patients uncontrolled with Met monotherapy. Despite the availability of many innovative oral antidiabetic drugs (OADs), such as dipeptidyl peptidase 4 inhibitors (DPP4-i) and its first-in-class sitagliptin (SITA), which entered the Italian market in the last 10 years, their usage is consistently lower than traditional drugs such as sulfonylureas (SUs). In fact, due to higher acquisition costs, the prescription of innovative OADs in Italy is restricted to specialist, resulting in a prominent usage of traditional OAD that can be prescribed also by general practitioners (GPs). A cost consequence analysis (CCA) was performed in order to compare SITA with SU, as second-line therapy in add-on to Met, in terms of costs and related clinical events over 36 months. Methods A CCA was conducted on a hypothetical cohort of 100,000 type 2 diabetes mellitus (T2DM) patients uncontrolled with Met monotherapy, from both the Italian National Health Service (INHS) and societal perspective. Therefore, both direct (drugs, self-monitoring, hypoglycemia, major cardiovascular events [MACEs], and switch to insulin) and indirect costs (expressed in terms of productivity losses) were evaluated. Clinical and economic data were collected through Italian national tariffs, literature, and experts' opinions. Three expert clinicians finally validated data inputs. To assess robustness of base case results, a one-way sensitivity analysis (OWSA) and a conservative scenario analysis - excluding MACEs - were carried out. Results In the base case analysis, the higher drug costs related to SITA were offset by other management costs (ie, lower use of devices for glycemia self-monitoring, lower incidence of hypoglycemia and MACE, and delay to insulin switch). As a result, the economic evaluation showed that, compared to SU, SITA was cost saving from both societal (-€61,217,723) and INHS (-€51,846,442) perspectives over 3 years as add-on to Met. The base case results were also confirmed by the scenario analysis and by the OWSA performed on the key parameters. The adoption of SITA, in a cohort of 100,000 diabetes patients, would avoid 26,882 non-severe hypoglycemic events, 6,528 severe hypoglycemic events, and 1,562 MACEs. Conclusion This analysis suggests that, compared to SU, SITA could be a sustainable and cost-saving alternative for the management of T2DM patients uncontrolled with Met monotherapy from both clinical and economic perspectives.
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Affiliation(s)
| | - Fabio Baccetti
- SD Diabetology, ASL Toscana Nordovest, Massa Carrara, Italy
| | - Stefano Genovese
- Cardiovascular and Metabolic Department, IRCCS Multimedica Sesto San Giovanni, Milan, Italy
| | - Enrico Torre
- SSD Endocrinologia, Diabetologia e Malattie metaboliche, ASL 3 Genovese, Genoa, Italy
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Viswanath B, Choi CS, Lee K, Kim S. Recent trends in the development of diagnostic tools for diabetes mellitus using patient saliva. Trends Analyt Chem 2017. [DOI: 10.1016/j.trac.2017.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mazzotti A, Caletti MT, Marchignoli F, Forlani G, Marchesini G. Which treatment for type 2 diabetes associated with non-alcoholic fatty liver disease? Dig Liver Dis 2017; 49:235-240. [PMID: 28089623 DOI: 10.1016/j.dld.2016.12.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes (T2DM) and nonalcoholic fatty liver disease (NAFLD) are highly prevalent in the community, and share common pathogenic mechanisms. There is also evidence that T2DM may be favored by hepatic fat accumulation; in turn the presence of T2DM is a risk factor for liver disease progression. The treatment of T2DM has considerably changed in the past few years; new drug classes, promoting glucose-lowering through mechanisms different from classical insulin-sensitizing or insulin-secreting action, have been added to continuing lifestyle intervention. Metformin and pioglitazone may be safely used in the presence of liver fat, whereas sulfonylureas and insulin itself have been associated with NAFLD progression and adverse outcome. Drugs acting on the incretin axis and on Na-glucose co-transport at renal tubular level offer new hopes for a tailored treatment able to reduce the burden of hepatic triglyceride accumulation and liver disease progression.
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Affiliation(s)
- Arianna Mazzotti
- Department of Medical & Surgical Sciences, Alma Mater University, Bologna, Italy
| | | | | | - Giulia Forlani
- Department of Medical & Surgical Sciences, Alma Mater University, Bologna, Italy
| | - Giulio Marchesini
- Department of Medical & Surgical Sciences, Alma Mater University, Bologna, Italy.
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Mazzuca P, Montesi L, Mazzoni G, Grazzi G, Micheli MM, Piergiovanni S, Pazzini V, Forlani G, Maietta Latessa P, Marchesini G. Supervised vs. self-selected physical activity for individuals with diabetes and obesity: the Lifestyle Gym program. Intern Emerg Med 2017; 12:45-52. [PMID: 27424279 DOI: 10.1007/s11739-016-1506-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 07/11/2016] [Indexed: 12/17/2022]
Abstract
The effectiveness of different programs of physical activity outside randomized studies is difficult to determine. We carried out an audit in two different units where either a supervised physical activity (PA) program or a self-selected PA program was in use in individuals with type 2 diabetes or obesity. The supervised PA cohort (n = 101) received progressive gym training (120 min, twice a week for 13 weeks) by a dedicated team, with nutritional counseling during resting periods. The self-selected PA cohort (n = 69) was enrolled in a 13-week cognitive-behavioral program (120 min/week, in groups of 12-15 individuals), chaired by an expert team. Body weight and physical fitness (6-min walk test) were measured at baseline and after 6 and 12 months. Outcome measures were attrition, weight loss ≥10 % initial body weight, 10 % increase in 6-min walk test; their association with a PA program was tested by logistic regression analysis. Attrition rate was lower in the supervised PA group (28 vs. 45 % than in the self-selected cohort, P = 0.023). After adjustment for confounders, the supervised PA program was associated with a lower risk of attrition at 1 year (odds ratio 0.45; 95 % confidence interval, 0.21-0.98) at logistic regression analysis. Body weight similarly decreased in both groups (more rapidly in the supervised PA cohort); also physical fitness improved in a similar way, and no differences in achieved targets of body weight (supervised, 31 %; self-selected, 18 %; P = 0.118) or fitness (supervised, 62 %; self-selected, 49 %; P = 0.312) were demonstrated. Different PA programs produce very similar health benefits, but an initially supervised program has lower attrition rates, which might translate into better outcomes in the long term.
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Affiliation(s)
- Paolo Mazzuca
- Unit of Internal Medicine, Diabetes and Metabolic Disease Center, Romagna Health District, Rimini, Italy
| | - Luca Montesi
- Department of Medical and Surgical Sciences, "Alma Mater Studiorum" University, Bologna, Italy
| | - Gianni Mazzoni
- Public Health Department and University Center for Sport-Applied Biomedical Studies, Ferrara, Italy
| | - Giovanni Grazzi
- Public Health Department and University Center for Sport-Applied Biomedical Studies, Ferrara, Italy
| | - Maria Maddalena Micheli
- Public Health Department and University Center for Sport-Applied Biomedical Studies, Ferrara, Italy
| | | | | | - Giulia Forlani
- Department of Medical and Surgical Sciences, "Alma Mater Studiorum" University, Bologna, Italy
| | | | - Giulio Marchesini
- Department of Medical and Surgical Sciences, "Alma Mater Studiorum" University, Bologna, Italy.
- Unit of Metabolic Diseases, "Alma Mater Studiorum" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, I-40135, Bologna, Italy.
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Bruno G, Pagano E, Rossi E, Cataudella S, De Rosa M, Marchesini G, Miccoli R, Vaccaro O, Bonora E. Incidence, prevalence, costs and quality of care of type 1 diabetes in Italy, age 0-29 years: The population-based CINECA-SID ARNO Observatory, 2002-2012. Nutr Metab Cardiovasc Dis 2016; 26:1104-1111. [PMID: 27817991 DOI: 10.1016/j.numecd.2016.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/04/2016] [Accepted: 09/02/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS To assess temporal trend in incidence (2003-12) and prevalence (2002-12) of type 1 diabetes in children and young adults, direct costs and selected indicators of quality of care under the coverage of the universalistic Italian National Health System (NHS). METHODS AND RESULTS The ARNO Observatory, a healthcare monitoring system based on administrative data, identified a population-based multiregional cohort of subjects aged 0-29 years. Type 1 diabetes was defined by at least two prescriptions of insulin over 12 months and continuous insulin-treatment in the following year. Indicators of quality of care and directs costs were assessed in persons with diabetes and in people without diabetes, individually matched for age, gender and health unit (1:4 ratio). We identified 2357 incident cases of type 1 diabetes aged 0-29 years (completeness of ascertainment, 99%). Incidence rates were similar in ages 0-14 (15.8, 95% CI 14.9-16.8) and 15-29 years (16.3, 15.4-17.2), with no significant trend. Prevalence increased from 137 to 166.9/100,000, particularly in the age 15-29 years. Direct costs accounted for € 2117 in persons with diabetes and € 292 in control individuals. A statistically significant decreasing trend in hospitalization for acute complications was evident (p < 0.001), which was almost completely due to ketoacidosis. People with at least one HbA1c measurement over the year were 48.5%. CONCLUSION We showed high incidence and increasing prevalence of type 1 diabetes in young adults in Italy, which impact on direct costs under the universalistic coverage of the NHS.
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Affiliation(s)
- G Bruno
- Dept. of Medical Sciences, University of Torino, Italy.
| | - E Pagano
- Unit of Cancer Epidemiology, "Città della Salute e della Scienza" Hospital-University of Turin and CPO Piemonte, Turin, Italy
| | - E Rossi
- CINECA Interuniversity Consortium, Health Department, Bologna, Italy
| | - S Cataudella
- CINECA Interuniversity Consortium, Health Department, Bologna, Italy
| | - M De Rosa
- CINECA Interuniversity Consortium, Health Department, Bologna, Italy
| | - G Marchesini
- Unit of Metabolic Diseases and Clinical Dietetics, Alma Mater Studiorum University, Bologna, Italy
| | - R Miccoli
- Dept. of Endocrinology and Metabolism, Section of Metabolic Diseases and Diabetes, University of Pisa, Italy
| | - O Vaccaro
- Dept. of Clinical Medicine and Surgery, University of Napoli Federico II, Napoli, Italy
| | - E Bonora
- Endocrinology, Diabetes and Metabolism, Dept. of Medicine, University and University Hospital of Verona, Italy
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