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Ramadaniati HU, Anggriani Y, Lepeska M, Beran D, Ewen M. Availability, price and affordability of insulin, delivery devices and self-monitoring blood glucose devices in Indonesia. PLoS One 2024; 19:e0309350. [PMID: 39361609 DOI: 10.1371/journal.pone.0309350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 08/09/2024] [Indexed: 10/05/2024] Open
Abstract
Insulin is essential for the survival of people with type 1 diabetes and for better management of people with type 2 diabetes. People with diabetes using insulin also require self-monitoring blood glucose (SMBG) devices (e.g., meters, strips, continuous monitoring systems) for day-to-day management. It is essential to ensure that insulin and these devices are available and affordable. This study aimed to evaluate the availability, price, and affordability of insulin and SMBG devices in Indonesia using an adaptation of the World Health Organization/Health Action International (WHO/HAI) price survey. A total of 34 public health facilities (hospitals, primary healthcare centres/Puskesmas) and 37 private pharmacies were sampled. Information from three major online marketplaces was also collected. Prices were expressed as median patient prices (US$). Affordability was defined as the number of days' wages needed by the lowest paid unskilled government worker (LPGW) to purchase 30 days' supply of insulin, delivery devices and SMBGs. Availability of analogue insulin was slightly higher in public facilities (63.6%) than in the private sector (43.2%), with no human insulin available in both sectors. Conversely, better availability was observed in private facilities for SMBG devices as public sector facilities did not supply devices for self-testing. Median prices for 1000IU analogues varied between the public sector (US$ 5.26) and the private sector (US$11.24). The highest median price of analogues was seen in online marketplaces (US$ 28.65). The least costly median price of SMBG devices were observed in online platforms (meter: US$ 18.37, test strip: US$ 0.27, lancet: US$ 0.02). A low-income person had to work 2-3 days to buy 1000IU of analogues. It required 5-7 days' and 4-5 day's wages to purchase a meter and a month's supply of test strips, respectively. The availability and affordability of insulin and SMBG devices remain important issues in Indonesia requiring holistic approaches for further improvement.
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Affiliation(s)
| | - Yusi Anggriani
- Faculty of Pharmacy, Universitas Pancasila, South Jakarta, Indonesia
| | - Molly Lepeska
- Health Action International, Amsterdam, The Netherlands
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva, Switzerland
| | - Margaret Ewen
- Health Action International, Amsterdam, The Netherlands
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Deressa HD, Abuye H, Adinew A, Ali MK, Kebede T, Habte BM. Access to essential medicines for diabetes care: availability, price, and affordability in central Ethiopia. Glob Health Res Policy 2024; 9:12. [PMID: 38584277 PMCID: PMC10999076 DOI: 10.1186/s41256-024-00352-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/31/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Diabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. This study aimed to assess the accessibility of EMs used for diabetes care in central Ethiopia's public and private medicine outlets with respect to availability and affordability parameters. METHODS A cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days' wages required by the lowest paid government worker (LPGW) to purchase a one month's supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices. RESULTS Across all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5 mg and metformin 500 mg) and two blood pressure-lowering medications (nifedipine 20 mg and hydrochlorothiazide 25 mg) surpassed the WHO's target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets. The cost of one month's supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively. CONCLUSIONS There are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Policy makers should work to improve access to diabetes EMs. It is recommended to increase government attention to availing affordable EMs for diabetes care including at the primary healthcare levels which are more accessible to the majority of the population. Similar studies are also recommended to be conducted in different parts of Ethiopia.
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Affiliation(s)
- Hachalu Dugasa Deressa
- School of Pharmacy, College of Health Sciences, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia
- Addis Ababa City Administration Regional Health Bureau, Addis Ababa, Ethiopia
| | - Habtamu Abuye
- Department of Pharmacy, College of Medicine and Health Sciences, Wachemo University, Hossaena, Ethiopia
| | - Alemayehu Adinew
- School of Pharmacy, College of Health Sciences, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, US
- Emory Global Diabetes Research Center of the Woodruff Health Sciences Center and Emory University, Atlanta, GA, US
| | - Tedla Kebede
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bruck Messele Habte
- School of Pharmacy, College of Health Sciences, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia.
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Hadid S, Zhang E, Frishman WH, Brutsaert E. Insulin's Legacy: A Century of Breakthroughs and Innovation. Cardiol Rev 2024:00045415-990000000-00229. [PMID: 38477588 DOI: 10.1097/crd.0000000000000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
The clinical use of insulin to treat diabetes started just over 100 years ago. The past century has witnessed remarkable innovations in insulin therapy, evolving from animal organ extracts to bioengineered human insulins with ultra-rapid onset or prolonged action. Insulin delivery systems have also progressed to current automated insulin delivery systems. In this review, we discuss the history of insulin and the pharmacology and therapeutic indications for a variety of available insulins, especially newer analog insulins. We highlight recent advances in insulin pump therapy and review evidence on the therapeutic benefits of automated insulin delivery. As with any form of progress, there have been setbacks, and insulin has recently faced an affordability crisis. We address the challenges of insulin accessibility, along with recent progress to improve insulin affordability. Finally, we mention research on glucose-responsive insulins and hepato-preferential insulins that are likely to shape the future of insulin therapy.
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Affiliation(s)
- Somar Hadid
- From the School of Medicine, New York Medical College, Valhalla NY
| | - Emily Zhang
- From the School of Medicine, New York Medical College, Valhalla NY
| | - William H Frishman
- From the School of Medicine, New York Medical College, Valhalla NY
- Department of Cardiology, Westchester Medical Center, Valhalla NY
| | - Erika Brutsaert
- From the School of Medicine, New York Medical College, Valhalla NY
- Department of Endocrinology, Westchester Medical Center, Hawthorne NY
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Barber MJ, Gotham D, Bygrave H, Cepuch C. Estimated Sustainable Cost-Based Prices for Diabetes Medicines. JAMA Netw Open 2024; 7:e243474. [PMID: 38536176 PMCID: PMC10973901 DOI: 10.1001/jamanetworkopen.2024.3474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/29/2024] [Indexed: 04/23/2024] Open
Abstract
Importance The burden of diabetes is growing worldwide. The costs associated with diabetes put substantial pressure on patients and health budgets, especially in low- and middle-income countries. The prices of diabetes medicines are a key determinant for access, yet little is known about the association between manufacturing costs and current market prices. Objectives To estimate the cost of manufacturing insulins, sodium-glucose cotransporter 2 inhibitors (SGLT2Is), and glucagonlike peptide 1 agonists (GLP1As), derive sustainable cost-based prices (CBPs), and compare these with current market prices. Design, Setting, and Participants In this economic evaluation, the cost of manufacturing insulins, SGLT2Is, and GLP1As was modeled. Active pharmaceutical ingredient cost per unit (weighted least-squares regression model using data from a commercial database of trade shipments, data from January 1, 2016, to March 31, 2023) was combined with costs of formulation and other operating expenses, plus a profit margin with an allowance for tax, to estimate CBPs. Cost-based prices were compared with current prices in 13 countries, collected in January 2023 from public databases. Countries were selected to provide representation of different income levels and geographic regions based on the availability of public databases. Main Outcomes and Measures Estimated CBPs; lowest current market prices (2023 US dollars). Results In this economic evaluation of manufacturing costs, estimated CBPs for treatment with insulin in a reusable pen device could be as low as $96 (human insulin) or $111 (insulin analogues) per year for a basal-bolus regimen, $61 per year using twice-daily injections of mixed human insulin, and $50 (human insulin) or $72 (insulin analogues) per year for a once-daily basal insulin injection (for type 2 diabetes), including the cost of injection devices and needles. Cost-based prices ranged from $1.30 to $3.45 per month for SGLT2Is (except canagliflozin: $25.00-$46.79) and from $0.75 to $72.49 per month for GLP1As. These CBPs were substantially lower than current prices in the 13 countries surveyed. Conclusions and Relevance High prices limit access to newer diabetes medicines in many countries. The findings of this study suggest that robust generic and biosimilar competition could reduce prices to more affordable levels and enable expansion of diabetes treatment globally.
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Affiliation(s)
- Melissa J. Barber
- Yale Collaboration for Regulatory Rigor, Integrity, and Transparency (CRRIT), New Haven, Connecticut
- Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Dzintars Gotham
- King’s College Hospital, London, United Kingdom
- Médecins Sans Frontières Access Campaign, Geneva, Switzerland
| | - Helen Bygrave
- Médecins Sans Frontières Access Campaign, Geneva, Switzerland
| | - Christa Cepuch
- Médecins Sans Frontières Access Campaign, Geneva, Switzerland
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Ali L, Alhassan M. Challenges in achieving adequate glycemic control among children with type 1 diabetes mellitus in a resource-limited setting: A cross-sectional study from Sudan. Diabetes Res Clin Pract 2024; 208:111113. [PMID: 38266824 DOI: 10.1016/j.diabres.2024.111113] [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: 11/04/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To assess glycemic control and associated factors in children with type 1 diabetes mellitus (T1DM) attending the pediatric diabetes clinic in Wad-Madani City, Sudan. METHODS This cross-sectional observational study was conducted at a referral center in Sudan. The study population consisted of children aged 1-18 years who had been diagnosed with T1DM for more than 1 year and were under regular follow-up in the clinic. Data on their glycemic control and sociodemographic and clinical characteristics were captured. RESULTS Out of 211 enrolled patients, 120 (56.9 %) were females. The mean age was 11.7 years (SD = 4.0), with the mean age at diagnosis of 6.7 years (SD = 4.0). Only 6.2 % achieved adequate glycemic control. Adolescents had particularly poor control (97.8 %). The mean glycosylated hemoglobin (HBA1c) level was 10.4 % (90 mmol/mol). Inferior glycemic control was associated with advancing age, older age at diagnosis, belonging to single-parent households, less frequent self-monitoring of blood glucose (SMBG), and having a greater number of siblings or household members. A third of patients (33.8 %) had had one or more diabetes ketoacidosis (DKA) episodes in the previous year. There was a high prevalence of lipodystrophy (34.1 %) and arthropathy (25.1 %). CONCLUSIONS An exceptionally low proportion of children with T1DM achieved adequate glycemic control, with adolescents particularly struggling. SMBG frequency and family dynamics emerged as potential factors, highlighting the urgent need for tailored interventions and improved diabetes education in resource-limited settings.
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Affiliation(s)
- Lena Ali
- Family Medicine Board, Sudan Medical Specialization Board, Khartoum, Sudan.
| | - Mohammed Alhassan
- College of Medicine, Department of Pediatrics, Prince Sattam Bin Abdulaziz University, Alkharj, Kingdom of Saudi Arabia.
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Yuan J, Li M, Jiang X, Lu ZK. National Volume-Based Procurement (NVBP) exclusively for insulin: towards affordable access in China and beyond. BMJ Glob Health 2024; 9:e014489. [PMID: 38232994 PMCID: PMC10806927 DOI: 10.1136/bmjgh-2023-014489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024] Open
Abstract
Universal access to insulin remains a global public health challenge mainly due to its high price. After unsuccessful healthcare reforms attempting to lower insulin prices over the past several decades, the novel pooled procurement-also known as the national volume-based procurement (NVBP)was initiated exclusively for insulin in China. The NVBP exclusively for insulin represents a unique approach to conquering the challenges in the pooled procurement many low-income and middle-income countries face. In this paper, we described how the pooled procurement mechanism was implemented for insulin in China. Forty-two insulin products from 11 companies were procured, with a median price reduction of 42.08%. The procurement price ranged from US$0.35 to US$1.63 (¥2.35-¥10.97) per defined daily dose (DDD). The median procurement price per DDD was US$$0.54 (¥3.63) for human insulins and US$0.92 (¥6.18) for analogue insulin (p<0.001), respectively. A total of 32 000 medical facilities participated in the procurement, and the pooled demand for insulin was 1.61 billion daily doses, with an estimated saving of US$2.85 billion (¥19 billion) for the first year of the procurement agreement. Insulin affordability and accessibility improved substantially. This study reveals that the NVBP exclusively for insulin could effectively reduce insulin prices and improve access to this essential medicine. Even though the pooled procurement option looks efficient, its long-term impacts on the healthcare system should be closely monitored.
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Affiliation(s)
- Jing Yuan
- Minhang Hospital, School of Pharmacy, Fudan University, Shanghai, China
| | - Minghui Li
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Xiangxiang Jiang
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Zhiqiang Kevin Lu
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
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Deressa HD, Abuye H, Adinew A, Ali MK, Kebede T, Habte BM. Access to Essential Medicines for Diabetes Care: Availability, Price, and Affordability in Central Ethiopia. RESEARCH SQUARE 2023:rs.3.rs-3694051. [PMID: 38106116 PMCID: PMC10723550 DOI: 10.21203/rs.3.rs-3694051/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background Diabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. Methods A cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days' wages required by the lowest paid government worker (LPGW) to purchase a one month's supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices. Results Across all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5mg, metformin 500mg) and two blood pressure-lowering medications (nifedipine 20mg and hydrochlorothiazide 25mg) surpassed the WHO's target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets, respectively. The cost of one month's supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively. Conclusion There are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Relevant stakeholders should work to improve access to EMs.
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Affiliation(s)
- Hachalu Dugasa Deressa
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Habtamu Abuye
- Department of Pharmacy, College of Medicine and Health Sciences, Wachemo University, Hossaena, Ethiopia
| | - Alemayehu Adinew
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Tedla Kebede
- School of Medicine, College of Health Sciences, Addis Ababa University
| | - Bruck Messele Habte
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Xie D, Ma T, Cui H, Li J, Zhang A, Sheng Z, Xie Y. Global burden and influencing factors of chronic kidney disease due to type 2 diabetes in adults aged 20-59 years, 1990-2019. Sci Rep 2023; 13:20234. [PMID: 37981642 PMCID: PMC10658077 DOI: 10.1038/s41598-023-47091-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023] Open
Abstract
Population structure and lifestyles may have contributed to the epidemiological status of Chronic Kidney Disease due to Type 2 Diabetes (CKD-T2D). This study is a secondary data analysis. Using data from the Global Burden of Disease Study, we describe the changes in CKD-T2D burden and its influencing factors in the population aged 20-59 years from 1990 to 2019. Globally, the incidence, death, and Disability Adjusted Life Years (DALYs) rate of CKD-T2D showed an upward trend and increased with age, and the burden in males was higher than that in females. Population growth and aging were important driving factors for the increase of CKD-T2D DALY burden, while high systolic blood pressure and high body-mass index were the primary attributable risk factors. High body-mass index exhibited higher contributions to high Socioeconomic Development Index (SDI) countries, whereas low SDI countries were more impacted by high systolic blood pressure. The population attributable fraction of CKD-T2D DALY caused by high body-mass index was positively correlated with SDI, while high temperature and lead exposure were negatively correlated. Therefore, strengthening disease screening for people aged 20-59 years and formulating early intervention measures based on the level of socioeconomic development may effectively alleviate the burden of CKD-T2D.
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Affiliation(s)
- Dandan Xie
- College of Traditional Chinese Medicine, International Advanced Functional Omics Platform, Scientific Experiment Center, Hainan Medical University, No. 3, Xueyuan Road, Haikou, 571199, Hainan, China
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Road, Changsha, 410011, Hunan, China
- Department of Clinical Nutrition, The First Affiliated Hospital of Hainan Medical University, No. 31, Longhua Road, Haikou, 570102, Hainan, China
| | - Tianpeng Ma
- College of Traditional Chinese Medicine, International Advanced Functional Omics Platform, Scientific Experiment Center, Hainan Medical University, No. 3, Xueyuan Road, Haikou, 571199, Hainan, China
| | - Haoliang Cui
- School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Jing Li
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Road, Changsha, 410011, Hunan, China
| | - Aihua Zhang
- College of Traditional Chinese Medicine, International Advanced Functional Omics Platform, Scientific Experiment Center, Hainan Medical University, No. 3, Xueyuan Road, Haikou, 571199, Hainan, China.
| | - Zhifeng Sheng
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Road, Changsha, 410011, Hunan, China.
| | - Yiqiang Xie
- College of Traditional Chinese Medicine, International Advanced Functional Omics Platform, Scientific Experiment Center, Hainan Medical University, No. 3, Xueyuan Road, Haikou, 571199, Hainan, China.
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Abstract
BACKGROUND Health authorities stress the temperature sensitivity of human insulin, advising protection from heat and freezing, with manufacturers suggesting low-temperature storage for intact vials, and once opened, storage at room temperature for four to six weeks, though usage time and maximum temperature recommendations vary. For human insulin, the recommendations of current shelf life in use may range from 10 to 45 days, and the maximum temperature in use varies between 25 °C and 37 °C. Optimal cold-chain management of human insulin from manufacturing until the point of delivery to people with diabetes should always be maintained, and people with diabetes and access to reliable refrigeration should follow manufacturers' recommendations. However, a growing segment of the diabetes-affected global population resides in challenging environments, confronting prolonged exposure to extreme heat due to the climate crisis, all while grappling with limited access to refrigeration. OBJECTIVES To analyse the effects of storing human insulin above or below the manufacturers' recommended insulin temperature storage range or advised usage time, or both, after dispensing human insulin to people with diabetes. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 12 July 2023. SELECTION CRITERIA We included clinical and laboratory studies investigating the storage of human insulin above or below manufacturers' recommended temperature storage range, advised usage time, or both. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. We used GRADE to assess the certainty of evidence for the clinical study. Most information emerged from in vitro studies, mainly from pharmaceutical companies. There is no validated risk of bias and certainty of evidence rating for in vitro studies. We thus presented a narrative summary of the results. MAIN RESULTS We included 17 eligible studies (22 articles) and additional information from pharmaceutical companies. Pilot clinical study One pilot clinical study investigated temperature conditions for insulin stored for six weeks in an unglazed clay pot with temperatures ranging between 25 °C and 27 °C. The mean fall in plasma glucose in eight healthy volunteers after clay pot-stored insulin injection was comparable to refrigerator-stored insulin injection (very low-certainty evidence). In-vitro studies Nine, three and four laboratory studies investigated storage conditions for insulin vials, insulin cartridges/pens and prefilled plastic syringes, respectively. The included studies reported numerous methods, laboratory measurements and storage conditions. Three studies on prefilled syringes investigating insulin potency at 4 °C up to 23 °C for up to 28 days showed no clinically relevant loss of insulin activity. Nine studies examined unopened vials and cartridges. In studies with no clinically relevant loss of insulin activity for human short-acting insulin (SAI), intermediate-acting insulin (IAI) and mixed insulin (MI) temperatures ranged between 28.9 °C and 37 °C for up to four months. Two studies reported up to 18% loss of insulin activity after one week to 28 days at 37 °C. Four studies examined opened vials and cartridges at up to 37 °C for up to 12 weeks, indicating no clinically relevant reduction in insulin activity. Two studies analysed storage conditions for oscillating temperatures ranging between 25 °C and 37 °C for up to 12 weeks and observed no loss of insulin activity for SAI, IAI and MI. Four studies, two on vials (including one on opened vials), and two on prefilled syringes, investigated sterility and reported no microbial contamination. Data from pharmaceutical companies Four manufacturers (BIOTON, Eli Lilly and Company, Novo Nordisk and Sanofi) provided previously unreleased human insulin thermostability data mostly referring to unopened containers (vials, cartridges). We could not include the data from Sanofi because the company announced the permanent discontinuation of the production of human insulins Insuman Rapid, Basal and Comb 25. BIOTON provided data on SAI after one, three and six months at 25 °C: all investigated parameters were within reference values, and, compared to baseline, loss of insulin activity was 1.1%, 1.0% and 1.7%, respectively. Eli Lilly and Company provided summary data: at below 25 °C or 30 °C SAI/IAI/MI could be stored for up to 25 days or 12 days, respectively. Thereafter, patient in-use was possible for up to 28 days. Novo Nordisk provided extensive data: compared to baseline, after three and six months at 25 °C, loss of SAI activity was 1.8% and 3.2% to 3.5%, respectively. Loss of IAI activity was 1.2% to 1.9% after three months and 2.0% to 2.3% after six months. Compared to baseline, after one, two and three months at 37 °C, loss of SAI activity was 2.2% to 2.8%, 5.7% and 8.3% to 8.6%, respectively. Loss IAI activity was 1.4% to 1.8%, 3.0% to 3.8% and 4.7% to 5.3%, respectively. There was no relevant increase in insulin degradation products observed. Up to six months at 25 °C and up to two months at 37 °C high molecular weight proteins were within specifications. Appearance, visible particles or macroscopy, particulate matter, zinc, pH, metacresol and phenol complied with specifications. There were no data for cold environmental conditions and insulin pumps. AUTHORS' CONCLUSIONS Under difficult living conditions, pharmaceutical companies' data indicate that it is possible to store unopened SAI and IAI vials and cartridges at up to 25 °C for a maximum of six months and at up to 37 °C for a maximum of two months without a clinically relevant loss of insulin potency. Also, oscillating temperatures between 25 °C and 37 °C for up to three months result in no loss of insulin activity for SAI, IAI and MI. In addition, ambient temperature can be lowered by use of simple cooling devices such as clay pots for insulin storage. Clinical studies on opened and unopened insulin containers should be performed to measure insulin potency and stability after varying storage conditions. Furthermore, more data are needed on MI, insulin pumps, sterility and cold climate conditions.
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Affiliation(s)
- Bernd Richter
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Brenda Bongaerts
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
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Agarwal S, Wade AN, Mbanya JC, Yajnik C, Thomas N, Egede LE, Campbell JA, Walker RJ, Maple-Brown L, Graham S. The role of structural racism and geographical inequity in diabetes outcomes. Lancet 2023; 402:235-249. [PMID: 37356447 PMCID: PMC11329296 DOI: 10.1016/s0140-6736(23)00909-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/27/2023]
Abstract
Diabetes is pervasive, exponentially growing in prevalence, and outpacing most diseases globally. In this Series paper, we use new theoretical frameworks and a narrative review of existing literature to show how structural inequity (structural racism and geographical inequity) has accelerated rates of diabetes disease, morbidity, and mortality globally. We discuss how structural inequity leads to large, fixed differences in key, upstream social determinants of health, which influence downstream social determinants of health and resultant diabetes outcomes in a cascade of widening inequity. We review categories of social determinants of health with known effects on diabetes outcomes, including public awareness and policy, economic development, access to high-quality care, innovations in diabetes management, and sociocultural norms. We also provide regional perspectives, grounded in our theoretical framework, to highlight prominent, real-world challenges.
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Affiliation(s)
- Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Department of Endocrinology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jean Claude Mbanya
- Division of Endocrinology, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Leonard E Egede
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Endocrinology, Royal Darwin and Palmerston Hospitals, Darwin, NT, Australia
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Danne T, Heinemann L, Pieber TR. New Insulins, Biosimilars, and Insulin Therapy. Diabetes Technol Ther 2023; 25:S44-S69. [PMID: 36802184 DOI: 10.1089/dia.2023.2504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Thomas Danne
- Diabetes-Zentrum für Kinder and Jugendliche, Kinder- und Jugendkrankenhaus "AUF DER BULT", Hannover, Germany
| | | | - Thomas R Pieber
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Katte JC, McDonald TJ, Sobngwi E, Jones AG. The phenotype of type 1 diabetes in sub-Saharan Africa. Front Public Health 2023; 11:1014626. [PMID: 36778553 PMCID: PMC9912986 DOI: 10.3389/fpubh.2023.1014626] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023] Open
Abstract
The phenotype of type 1 diabetes in Africa, especially sub-Saharan Africa, is poorly understood. Most previously conducted studies have suggested that type 1 diabetes may have a different phenotype from the classical form of the disease described in western literature. Making an accurate diagnosis of type 1 diabetes in Africa is challenging, given the predominance of atypical diabetes forms and limited resources. The peak age of onset of type 1 diabetes in sub-Saharan Africa seems to occur after 18-20 years. Multiple studies have reported lower rates of islet autoantibodies ranging from 20 to 60% amongst people with type 1 diabetes in African populations, lower than that reported in other populations. Some studies have reported much higher levels of retained endogenous insulin secretion than in type 1 diabetes elsewhere, with lower rates of type 1 diabetes genetic susceptibility and HLA haplotypes. The HLA DR3 appears to be the most predominant HLA haplotype amongst people with type 1 diabetes in sub-Saharan Africa than the HLA DR4 haplotype. Some type 1 diabetes studies in sub-Saharan Africa have been limited by small sample sizes and diverse methods employed. Robust studies close to diabetes onset are sparse. Large prospective studies with well-standardized methodologies in people at or close to diabetes diagnosis in different population groups will be paramount to provide further insight into the phenotype of type 1 diabetes in sub-Saharan Africa.
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Affiliation(s)
- Jean Claude Katte
- Institute of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, United Kingdom,National Obesity Centre and Endocrinology and Metabolic Diseases Unit, Yaounde Central Hospital, Yaoundé, Cameroon,*Correspondence: Jean Claude Katte ✉
| | - Timothy J. McDonald
- Institute of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, United Kingdom,Academic Department of Clinical Biochemistry, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Eugene Sobngwi
- National Obesity Centre and Endocrinology and Metabolic Diseases Unit, Yaounde Central Hospital, Yaoundé, Cameroon,Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Angus G. Jones
- Institute of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, United Kingdom,Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
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Tagoe ET, Nonvignon J, van Der Meer R, Megiddo I, Godman B. Challenges to the delivery of clinical diabetes services in Ghana created by the COVID-19 pandemic. J Health Serv Res Policy 2023; 28:58-65. [PMID: 35786026 PMCID: PMC9253720 DOI: 10.1177/13558196221111708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The barriers to delivering clinical non-communicable disease services in low- and middle-income countries have risen with the onset of COVID-19. Using Ghana as a case study, this article examines the changes COVID-19 has brought to diabetes service delivery and considers policy responses to deal with future such outbreaks. METHODS We conducted 18 interviews between November 2020 and February 2021 with health professionals and administrators from primary, secondary and tertiary facilities within the Ghana Health Service. The analysis was performed using deductive and inductive methods. RESULTS There were six general themes in interviewees' responses: (1) COVID-19 had exacerbated the problems of high medicine and service costs and medicine shortages, (2) the pandemic had exacerbated problems of poor patient record keeping, (3) COVID-19 had reduced the availability of suitably trained health providers, (4) staff had become demoralized by management's unwillingness to make innovative changes to cope with the pandemic, (5) COVID-19 led to a reorganization of diabetes services, and (6) the country's national health insurance scheme lacked flexibility in dealing with the pandemic. CONCLUSIONS Access to resources is limited in LMICs. However, our study highlights practical policy responses that can improve health providers' response to COVID-19 and future pandemics.
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Affiliation(s)
- Eunice Twumwaa Tagoe
- Eunice Twumwaa Tagoe, Management Science,
University of Strathclyde, 16 Richmond Street, Glasgow, SL G1 1XQ, UK.
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Harrington A, Vo V, Papp K, Tillett RL, Chang CL, Baker H, Shen S, Amei A, Lockett C, Gerrity D, Oh EC. Urban monitoring of antimicrobial resistance during a COVID-19 surge through wastewater surveillance. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 853:158577. [PMID: 36087661 PMCID: PMC9450474 DOI: 10.1016/j.scitotenv.2022.158577] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/25/2022] [Accepted: 09/03/2022] [Indexed: 05/31/2023]
Abstract
During the early phase of the COVID-19 pandemic, infected patients presented with symptoms similar to bacterial pneumonias and were treated with antibiotics before confirmation of a bacterial or fungal co-infection. We reasoned that wastewater surveillance could reveal potential relationships between reduced antimicrobial stewardship, specifically misprescribing antibiotics to treat viral infections, and the occurrence of antimicrobial resistance (AMR) in an urban community. Here, we analyzed microbial communities and AMR profiles in sewage samples from a wastewater treatment plant (WWTP) and a community shelter in Las Vegas, Nevada during a COVID-19 surge in December 2020. Using a respiratory pathogen and AMR enrichment next-generation sequencing panel, we identified four major phyla in the wastewater, including Actinobacteria, Firmicutes, Bacteroidetes and Proteobacteria. Consistent with antibiotics that were reportedly used to treat COVID-19 infections (e.g., fluoroquinolones and beta-lactams), we also measured a significant spike in corresponding AMR genes in the wastewater samples. AMR genes associated with colistin resistance (mcr genes) were also identified exclusively at the WWTP, suggesting that multidrug resistant bacterial infections were being treated during this time. We next compared the Las Vegas sewage data to local 2018-2019 antibiograms, which are antimicrobial susceptibility profile reports about common clinical pathogens. Similar to the discovery of higher levels of beta-lactamase resistance genes in sewage during 2020, beta-lactam antibiotics accounted for 51 ± 3 % of reported antibiotics used in antimicrobial susceptibility tests of 2018-2019 clinical isolates. Our data highlight how wastewater-based epidemiology (WBE) can be leveraged to complement more traditional surveillance efforts by providing community-level data to help identify current and emerging AMR threats.
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Affiliation(s)
- Anthony Harrington
- Laboratory of Neurogenetics and Precision Medicine, UNLV School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
| | - Van Vo
- Laboratory of Neurogenetics and Precision Medicine, UNLV School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA; Nevada Institute of Personalized Medicine, UNLV School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
| | - Katerina Papp
- Southern Nevada Water Authority, P.O. Box 99954, Las Vegas, NV 89193, USA
| | - Richard L Tillett
- Nevada Institute of Personalized Medicine, UNLV School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
| | - Ching-Lan Chang
- Laboratory of Neurogenetics and Precision Medicine, UNLV School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
| | - Hayley Baker
- Laboratory of Neurogenetics and Precision Medicine, UNLV School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
| | - Shirley Shen
- Nevada Institute of Personalized Medicine, UNLV School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
| | - Amei Amei
- Department of Mathematical Sciences, UNLV School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
| | | | - Daniel Gerrity
- Southern Nevada Water Authority, P.O. Box 99954, Las Vegas, NV 89193, USA
| | - Edwin C Oh
- Laboratory of Neurogenetics and Precision Medicine, UNLV School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA; Nevada Institute of Personalized Medicine, UNLV School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA; Department of Internal Medicine, UNLV School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA.
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Xie J, Wang M, Long Z, Ning H, Li J, Cao Y, Liao Y, Liu G, Wang F, Pan A. Global burden of type 2 diabetes in adolescents and young adults, 1990-2019: systematic analysis of the Global Burden of Disease Study 2019. BMJ 2022; 379:e072385. [PMID: 36740855 PMCID: PMC9727920 DOI: 10.1136/bmj-2022-072385] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To estimate the global burden of type 2 diabetes in adolescents and young adults (aged 15-39 years) from 1990 to 2019. DESIGN Systematic analysis. DATA SOURCE Global Burden of Disease Study 2019. Participants aged 15-39 years from 204 countries and territories, 1990-2019. MAIN OUTCOMES MEASURES Age standardised incidence rate, age standardised disability adjusted life years (DALY) rate, and age standardised mortality rate for type 2 diabetes in people aged 15-39 years from 1990 to 2019, and proportional DALY attributable to different risk factors. RESULTS From 1990 to 2019, significant increases in age standardised incidence rate and age standardised DALY rate were found for type 2 diabetes in adolescents and young adults globally (P<0.001). Age standardised incidence rate (per 100 000 population) increased from 117.22 (95% confidence interval 117.07 to 117.36) in 1990 to 183.36 (183.21 to 183.51) in 2019, and age standardised DALY rate (per 100 000 population) increased from 106.34 (106.20 to 106.48) in 1990 to 149.61 (149.47 to 149.75) in 2019. The age standardised mortality rate (per 100 000 population) was modestly increased from 0.74 (0.72 to 0.75) in 1990 to 0.77 (0.76 to 0.78) in 2019. When grouped by countries with different sociodemographic indexes, countries with a low-middle and middle sociodemographic index had the highest age standardised incidence rate and age standardised DALY rate in 2019, whereas countries with a low sociodemographic index had the lowest age standardised incidence rate but the highest age standardised mortality rate. Women generally had higher mortality and DALY rates than men at ages <30 years, but differences between the sexes were reversed in those aged >30 years except in countries with a low sociodemographic index. The main attributable risk factor for DALY for early onset type 2 diabetes was high body mass index in all regions by sociodemographic index. The proportional contribution of other risk factors varied across regions, however, with higher proportions of ambient particulate air pollution and smoking in countries with a high sociodemographic index and higher proportions of household air pollution from solid fuels and diet low in fruit in countries with a low sociodemographic index. CONCLUSIONS Early onset type 2 diabetes is a growing global health problem in adolescents and young adults, especially in countries with a low-middle and middle sociodemographic index. A greater disease burden in women aged <30 years was found. Specific measures are needed in countries with different levels of socioeconomic development because of the variable attributable risk factors for type 2 diabetes in adolescents and young adults.
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Affiliation(s)
- Jinchi Xie
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Maoqing Wang
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Zhiping Long
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Hua Ning
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jingkuo Li
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yukun Cao
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yunfei Liao
- Department of Endocrinology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Fan Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Beran D, Giachino M, Perrin C, Macé C. Prequalification of insulin: what is missing? Lancet Diabetes Endocrinol 2022; 10:842-843. [PMID: 36343659 DOI: 10.1016/s2213-8587(22)00316-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva 1211, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Marina Giachino
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva 1211, Switzerland
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Perehudoff K, Wirtz VJ, Wong A, Rusu V, Kohler J. A global social contract to ensure access to essential medicines and health technologies. BMJ Glob Health 2022; 7:bmjgh-2022-010057. [DOI: 10.1136/bmjgh-2022-010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/07/2022] [Indexed: 11/13/2022] Open
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Gregory GA, Robinson TIG, Linklater SE, Wang F, Colagiuri S, de Beaufort C, Donaghue KC, Magliano DJ, Maniam J, Orchard TJ, Rai P, Ogle GD. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study. Lancet Diabetes Endocrinol 2022; 10:741-760. [PMID: 36113507 DOI: 10.1016/s2213-8587(22)00218-2] [Citation(s) in RCA: 292] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Accurate data on type 1 diabetes prevalence, incidence, associated mortality and life expectancy are crucial to inform public health policy, but these data are scarce. We therefore developed a model based on available data to estimate these values for 201 countries for the year 2021 and estimate the projected prevalent cases in 2040. METHODS We fitted a discrete-time illness-death model (Markov model) to data on type 1 diabetes incidence and type 1 diabetes-associated mortality to produce type 1 diabetes prevalence, incidence, associated mortality and life expectancy in all countries. Type 1 diabetes incidence and mortality data were available from 97 and 37 countries respectively. Diagnosis rates were estimated using data from an expert survey. Mortality was modelled using random-forest regression of published type 1 diabetes mortality data, and life expectancy was calculated accordingly using life tables. Estimates were validated against observed prevalence data for 15 countries. We also estimated missing prevalence (the number of additional people who would be alive with type 1 diabetes if their mortality matched general population rates). FINDINGS In 2021, there were about 8·4 (95% uncertainty interval 8·1-8·8) million individuals worldwide with type 1 diabetes: of these 1·5 million (18%) were younger than 20 years, 5·4 million (64%) were aged 20-59 years, and 1·6 million (19%) were aged 60 years or older. In that year there were 0·5 million new cases diagnosed (median age of onset 39 years), about 35 000 non-diagnosed individuals died within 12 months of symptomatic onset. One fifth (1·8 million) of individuals with type 1 diabetes were in low-income and lower-middle-income countries. Remaining life expectancy of a 10-year-old diagnosed with type 1 diabetes in 2021 ranged from a mean of 13 years in low-income countries to 65 years in high-income countries. Missing prevalent cases in 2021 were estimated at 3·7 million. In 2040, we predict an increase in prevalent cases to 13·5-17·4 million (60-107% higher than in 2021) with the largest relative increase versus 2021 in low-income and lower-middle-income countries. INTERPRETATION The burden of type 1 diabetes in 2021 is vast and is expected to increase rapidly, especially in resource-limited countries. Most incident and prevalent cases are adults. The substantial missing prevalence highlights the premature mortality of type 1 diabetes and an opportunity to save and extend lives of people with type 1 diabetes. Our new model, which will be made publicly available as the Type 1 Diabetes Index model, will be an important tool to support health delivery, advocacy, and funding decisions for type 1 diabetes. FUNDING JDRF International.
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Affiliation(s)
- Gabriel A Gregory
- Life for a Child Program, Diabetes NSW, Glebe, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia; Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | | | - Fei Wang
- JDRF Australia, St Leonards, NSW, Australia
| | - Stephen Colagiuri
- Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Carine de Beaufort
- DECCP, Pediatric Clinic, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg; Department of Science, Technology and Medicine, University of Luxembourg, Luxembourg
| | - Kim C Donaghue
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia; Children's Hospital at Westmead, Westmead, NSW, Australia
| | | | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Monash University, School of Public Health and Preventive Medicine, Melbourne, VIC, Australia
| | - Jayanthi Maniam
- Life for a Child Program, Diabetes NSW, Glebe, NSW, Australia
| | - Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Graham D Ogle
- Life for a Child Program, Diabetes NSW, Glebe, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.
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Vencio S, Caiado-Vencio R, Caixeta LF, Masierek M, Mlynarski W, Drzewoski J, Gregory JM. A randomized pharmacokinetic and pharmacodynamic trial of two regular human insulins demonstrates bioequivalence in type 1 diabetes and availability of biosimilar insulin may improve access to this medication. Diabetes Obes Metab 2022; 24:1544-1552. [PMID: 35441466 PMCID: PMC10146588 DOI: 10.1111/dom.14724] [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: 12/13/2021] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
AIMS To compare the pharmacokinetic (PK) and pharmacodynamic (PD) effects and safety of therapeutic dosages of a regular insulin (experimental drug) produced by Bioton S.A. (Warsaw, Poland) versus Humulin® R, a regular insulin (reference drug) produced by Eli Lilly (Indianapolis, Indiana). MATERIALS AND METHODS In a single-centre, randomized, double-blinded phase 1 crossover study, we used the manual euglycaemic clamp technique to compare PK and PD profiles between single subcutaneous doses (0.3 units/kg) of the two regular insulins in participants with type 1 diabetes (T1DM) with a washout period of 14 (± 7) days between tests. RESULTS We evaluated 56 participants. The mean participant age and body mass index were 32.9 years and 22.9 kg/m2 , respectively. The ratios (experimental/reference) of the geometric means of maximum plasma insulin concentration and for plasma insulin area under the curve (AUC) were 0.909 (90% confidence interval [CI] 0.822-1.01) and 0.993 (90% CI 0.944-1.04), respectively. The ratios of the geometric means of maximum glucose infusion rate (GIR) and for GIR AUC were 0.999 (95% CI 0.912-1.09) and 1.04 (95% CI 0.962-1.12), respectively. CONCLUSIONS The experimental product regular human insulin and comparator Humulin® R are bioequivalent in patients with T1DM. Wider entry to the pharmaceutical market of affordable, biosimilar regular insulins may substantially improve access to insulin for many socioeconomically disadvantaged patients with diabetes.
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Affiliation(s)
- Sérgio Vencio
- UFG - Federal University of Goiás, Aparecida de Goiania, Brazil
- ICF - Institute of Pharmaceutical Sciences, Aparecida de Goiania, Brazil
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Zargar AH, Kalra S, K M PK, Murthy S, Negalur V, Rajput R, Rastogi A, Saboo B, Sharma SK, Sahay R, Aravind SR, Shaikh S, Tiwaskar M, Ingole S, Kamble S. Rising cost of insulin: A deterrent to compliance in patients with diabetes mellitus. Diabetes Metab Syndr 2022; 16:102528. [PMID: 35863268 DOI: 10.1016/j.dsx.2022.102528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS The rapid increase in burden of type 2 diabetes mellitus (T2DM), poses a huge medico-economic challenge, especially when the cost of care is funded by out-of-pocket expenses. The aim of this review is to highlight various issues associated with rising cost of insulin, prevalence of cost-related insulin underuse, insulin related cost-saving behaviors, and viable solutions for the benefit of patients with T2DM receiving insulin. METHODS Electronic databases (PubMed and Google Scholar) from 2000 to 2020 were searched using the key terms uncontrolled diabetes mellitus, insulin therapy, glycemic control, direct cost, indirect cost, out-of-pocket expenses, cost-related insulin underuse, cost-saving behaviors, and biosimilar insulin in developed countries and India. RESULTS In majority of the patients with T2DM on monotherapy, addition of another oral antidiabetic agent is required. Despite these measures, the target glycemic goals are not achieved in majority of the patients resulting in various complications. These complications can be prevented and target glycemic goals can be achieved with early initiation of insulin therapy. However, rising cost is a major deterrent to the lifelong use of insulin. This results in non-compliance and further deterioration of glycemic control. Recently, biosimilar insulins have revolutionized the management of T2DM and look promising from the economic point of view. CONCLUSIONS Biosimilar insulins are likely to further enhance the compliance of patients and should be used whenever feasible in patients with DM. However, the patient, along with prescriber should be allowed to make shared, informed decisions regarding the insulin they wish to use.
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Affiliation(s)
- Abdul Hamid Zargar
- Centre for Diabetes and Endocrine Care, Gulshan Nagar, Chanpora, Srinagar, 190015, Jammu and Kashmir, India.
| | - Sanjay Kalra
- Bharati Hospital, Karnal, 132001, Haryana, India.
| | - Prasanna Kumar K M
- Centre for Diabetes & Endocrine Care & Diabetacare, Kalyan Nagar Post, Bangalore, 560043, Karnataka, India.
| | - Sreenivasa Murthy
- Lifecare Hospital and Research Centre, Sahakaranagara, Bangalore, 560092, Karnataka, India.
| | - Vijay Negalur
- Dr Negalur's Diabetes & Thyroid Specialty Centre, Gloria Chambers, Thane, 400603, Maharashtra, India.
| | - Rajesh Rajput
- Department of Endocrinology, PGIMS Rohtak, Rohtak, 124001, Haryana, India.
| | - Ashu Rastogi
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Banshi Saboo
- Dia Care (Diabetes Care & Hormone Clinic), Department of Diabetology, Near Nehru Nagar Circle, Ahmedabad, Gujrat, India.
| | | | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, 500095, Telangana, India.
| | - S R Aravind
- Diacon Hospital, Rajajinagar, Bangalore, 560019, Karnataka, India.
| | - Shehla Shaikh
- K.G.N. Clinic, Patel Arcade, Nagpada Junction, Mumbai, 400008, Maharashtra, India.
| | - Mangesh Tiwaskar
- Department of Medicine, Shilpa Medical Research Centre, Dahisar East, Mumbai, 400068, Maharashtra, India.
| | - Shahu Ingole
- Department of Medical Affairs, Wockhardt Towers Bandra Kurla Complex, Bandra (East), Mumbai, 400051, Maharashtra, India.
| | - Sanjay Kamble
- Department of Medical Affairs, Wockhardt Towers Bandra Kurla Complex, Bandra (East), Mumbai, 400051, Maharashtra, India.
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Ngassa Piotie P, Filmalter C, Mohlala MG, Zulu N, Segale A, Koenaite C, Muchiri JW, Webb EM, Rheeder P. Factors affecting the implementation of a complex health intervention to improve insulin management in primary care: A SWOT analysis. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 35924623 PMCID: PMC9350473 DOI: 10.4102/phcfm.v14i1.3467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/13/2022] [Accepted: 04/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address these challenges, a multidisciplinary team from the University of Pretoria (South Africa) developed the Tshwane Insulin project (TIP) intervention. Aim To determine internal and external factors, either facilitators or barriers, that could influence the implementation of the TIP intervention and propose strategies to ensure sustainability. Setting Tshwane District, Gauteng province, South Africa. Methods We used the SWOT framework to qualitatively analyse the strengths, weaknesses, opportunities, and threats influencing the implementation of the TIP intervention. Four field researchers and three managers from the TIP team participated in an online group discussion. We also conducted semi-structured interviews with healthcare providers (HCPs) (seven nurses, five doctors) and patients with type 2 diabetes (n = 13). Results Regardless of the identified weaknesses, the TIP intervention was accepted by PLWD and HCPs. Participants identified strengths including app-enabled insulin initiation and titration, pro-active patient follow-up, patient empowerment and provision of glucose monitoring devices. Participants viewed insulin resistance and the attitudes of HCPs as potential threats. Participants suggested that weaknesses and threats could be mitigated by translating education material into local languages and using the lived experiences of insulin-treated patients to address insulin resistance. The procurement of glucose monitoring devices by national authorities would promote the sustainability of the intervention. Conclusion Our findings may help decision-makers and health researchers to improve insulin management for PLWD in resource-constrained settings by using telehealth interventions.
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Affiliation(s)
- Patrick Ngassa Piotie
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, University of Pretoria Diabetes Research Centre Faculty of Health Sciences, University of Pretoria, Pretoria.
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22
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Laugesen SH, Chou DHC, Safavi-Hemami H. Unconventional insulins from predators and pathogens. Nat Chem Biol 2022; 18:688-697. [PMID: 35761080 DOI: 10.1038/s41589-022-01068-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/18/2022] [Indexed: 11/09/2022]
Abstract
Insulin and its related peptides are found throughout the animal kingdom, in which they serve diverse functions. This includes regulation of glucose homeostasis, neuronal development and cognition. The surprising recent discovery that venomous snails evolved specialized insulins to capture fish demonstrated the nefarious use of this hormone in nature. Because of their streamlined role in predation, these repurposed insulins exhibit unique characteristics that have unraveled new aspects of the chemical ecology and structural biology of this important hormone. Recently, insulins were also reported in other venomous predators and pathogenic viruses, demonstrating the broader use of insulin by one organism to manipulate the physiology of another. In this Review, we provide an overview of the discovery and biomedical application of repurposed insulins and other hormones found in nature and highlight several unique insights gained from these unusual compounds.
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Affiliation(s)
| | - Danny Hung-Chieh Chou
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA, USA
| | - Helena Safavi-Hemami
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark. .,Department of Biochemistry, University of Utah, Salt Lake City, UT, USA. .,School of Biological Sciences, University of Utah, Salt Lake City, UT, USA.
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23
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Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland.
| | | | - John S Yudkin
- Division of Medicine, University College London, London, UK
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Saeed A, Lambojon K, Saeed H, Saleem Z, Anwer N, Aziz MM, Ji W, Liu W, Chen C, Yang C, Fang Y, Babar ZUD. Access to Insulin Products in Pakistan: A National Scale Cross-Sectional Survey on Prices, Availability, and Affordability. Front Pharmacol 2022; 13:820621. [PMID: 35431962 PMCID: PMC9010947 DOI: 10.3389/fphar.2022.820621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/03/2022] [Indexed: 12/16/2022] Open
Abstract
Background: Diabetes is among the top ten most prevalent diseases in Pakistan, and the availability of medicines to treat the disease is vital for a great percentage of the country’s population. Insulin was discovered a century ago; however, its access in several parts of the globe remains an issue. This study aims to evaluate prices, availability, and affordability (access components) of insulin and five comparator medicine access in Pakistan. Methods: A nationwide cross-sectional survey was conducted to evaluate the access to insulin and some comparator medicines in eight cities of Pakistan, using a modified WHO/HAI methodology. The survey included 80 medicine outlets, i.e., 40 private pharmacies and 40 public hospitals. Data for every unique insulin product available in the Pakistani market were obtained, including five comparator medicines. Percentage availability, median unit prices (MUPs), and affordability (the number of days’ wages (NDWs) required for a month’s course by the lowest-paid unskilled government worker) of all products were calculated, including originator brands (OBs) and biosimilar (BS) products. Results: Of all insulin products surveyed (n = 320), 87.5% were manufactured by foreign multinational companies (MNCs). None of the insulin products had an ideal availability of 80% in any of the surveyed health facilities. In the public sector, none of the insulin products had an availability of more than 50%. In the public sector, the overall availability of human insulin was 70% (including OB and BS). While in the private sector, the overall availability of human insulin was 90% and that of analog insulin was 62.5%. The analog insulin products were 72.8% costlier than the human insulin products. The median prices of BS insulin were 25.4% lower than the OB products, indicating that almost one-fourth of the cost could be saved by switching to BS human insulin from OB human insulin. All oral anti-diabetic medicines were found to be affordable, whereas none of the insulin was affordable. The NDWs for human and analog insulin were 1.38 and 5.06. Conclusion: In Pakistan, the insulin availability falls short of the WHO’s benchmark of 80%. Insulin continues to be unaffordable in both private and government sectors. To increase insulin access, the government should optimize insulin procurement at all levels, promote local production, enforce biosimilar prescribing, and provide financial subsidies for these products.
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Affiliation(s)
- Amna Saeed
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
| | - Krizzia Lambojon
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
| | - Hamid Saeed
- Department of Pharmaceutics, University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Zikria Saleem
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Naveed Anwer
- Saulat Institute of Pharmaceutical Sciences, Quaid e Azam University Islamabad, Lahore, Pakistan
| | - Muhammad Majid Aziz
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
| | - Wenchen Liu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
| | - Chen Chen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- *Correspondence: Yu Fang,
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
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Noor F, Rehman A, Ashfaq UA, Saleem MH, Okla MK, Al-Hashimi A, AbdElgawad H, Aslam S. Integrating Network Pharmacology and Molecular Docking Approaches to Decipher the Multi-Target Pharmacological Mechanism of Abrus precatorius L. Acting on Diabetes. Pharmaceuticals (Basel) 2022; 15:414. [PMID: 35455411 PMCID: PMC9029140 DOI: 10.3390/ph15040414] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 12/26/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a notable health care load that imposes a serious impact on the quality of life of patients. The small amount of reported data and multiple spectra of pathophysiological mechanisms of T2DM make it a challenging task and serious economic burden in health care management. Abrus precatorius L. is a slender, perennial, deciduous, and woody twining plant used in various regions of Asia to treat a variety of ailments, including diabetes mellitus. Various in vitro studies revealed the therapeutic significance of A. precatorius against diabetes. However, the exact molecular mechanism remains unclarified. In the present study, a network pharmacology technique was employed to uncover the active ingredients, their potential targets, and signaling pathways in A. precatorius for the treatment of T2DM. In the framework of this study, we explored the active ingredient-target-pathway network and figured out that abrectorin, abrusin, abrisapogenol J, sophoradiol, cholanoic acid, precatorine, and cycloartenol decisively contributed to the development of T2DM by affecting AKT1, MAPK3, TNFalpha, and MAPK1 genes. Later, molecular docking was employed to validate the successful activity of the active compounds against potential targets. Lastly, we conclude that four highly active constituents, namely, abrusin, abrisapogenol J, precatorine, and cycloartenol, help in improving the body's sensitivity to insulin and regulate the expression of AKT1, MAPK3, TNFalpha, and MAPK1, which may act as potential therapeutic targets of T2DM. Integrated network pharmacology and docking analysis revealed that A. precatorius exerted a promising preventive effect on T2DM by acting on diabetes-associated signaling pathways. This provides a basis to understand the mechanism of the anti-diabetes activity of A. precatorius.
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Affiliation(s)
- Fatima Noor
- Department of Bioinformatics and Biotechnology, Government College University Faisalabad, Faisalabad 38000, Pakistan; (F.N.); (A.R.); (U.A.A.)
| | - Abdur Rehman
- Department of Bioinformatics and Biotechnology, Government College University Faisalabad, Faisalabad 38000, Pakistan; (F.N.); (A.R.); (U.A.A.)
| | - Usman Ali Ashfaq
- Department of Bioinformatics and Biotechnology, Government College University Faisalabad, Faisalabad 38000, Pakistan; (F.N.); (A.R.); (U.A.A.)
| | - Muhammad Hamzah Saleem
- College of Plant Science and Technology, Huazhong Agricultural University, Wuhan 430070, China;
| | - Mohammad K. Okla
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (M.K.O.); (A.A.-H.)
| | - Abdulrahman Al-Hashimi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (M.K.O.); (A.A.-H.)
| | - Hamada AbdElgawad
- Integrated Molecular Plant Physiology Research, Department of Biology, University of Antwerp, 2000 Antwerpen, Belgium;
| | - Sidra Aslam
- Department of Bioinformatics and Biotechnology, Government College University Faisalabad, Faisalabad 38000, Pakistan; (F.N.); (A.R.); (U.A.A.)
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Ansbro É, Issa R, Willis R, Blanchet K, Perel P, Roberts B. Chronic NCD care in crises: A qualitative study of global experts' perspectives on models of care for hypertension and diabetes in humanitarian settings. J Migr Health 2022; 5:100094. [PMID: 35434681 PMCID: PMC9010603 DOI: 10.1016/j.jmh.2022.100094] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 10/29/2022] Open
Abstract
Background The high and rising global burden of non-communicable diseases (NCDs) is reflected among crisis-affected populations. People living with NCDs are especially vulnerable in humanitarian crises. Limited guidance exists to support humanitarian actors in designing effective models of NCD care for crisis-affected populations in low- and middle-income countries (LMICs). We aimed to synthesise expert opinion on current care models for hypertension and diabetes (HTN/DM) in humanitarian settings in LMICs, to examine the gaps in delivering good quality HTN/DM care and to propose solutions to address these gaps. Methods We interviewed twenty global experts, purposively selected based on their expertise in provision of NCD care in humanitarian settings. Data were analysed using a combination of inductive and deductive methods. We used a conceptual framework for primary care models for HTN/DM in humanitarian settings, guided by the WHO health systems model, patient-centred care models and literature on NCD care in LMICs. Results HTN/DM care model design was highly dependent on the type of humanitarian crisis, the implementing organisation, the target population, the underlying health system readiness to deal with NCDs and its resilience in the face of crisis. Current models were mainly based at primary-care level, in prolonged crisis settings. Participants focussed on the basic building blocks of care, including training the workforce, and strengthening supply chains and information systems. Intermediate health system goals (responsiveness, quality and safety) and final goals received less attention. There were notable gaps in standardisation and continuity of care, integration with host systems, and coordination with other actors. Participants recommended a health system strengthening approach and aspired to providing patient-centred care. However, more evidence on effective integration and on patients' priorities and experience is needed. More funding is needed for NCD care and related research. Conclusions Comprehensive guidance would foster standardization, continuity, integration and, thus, better quality care. Future models should take a health system strengthening approach, use patient-centred design, and should be co-created with patients and providers. Those designing new models may draw on lessons learned from existing chronic care models in high- and low-income settings.
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Key Words
- BP, Blood Pressure
- COPD, Chronic Obstructive Pulmonary Disease
- Conflict
- DM I/II, Diabetes Mellitus Type I or II
- Diabetes
- FBS, Fasting Blood Sugar
- HCW, Health Care Workers
- HTN, Hypertension
- HbA1c, Glycosylated Haemoglobin
- Humanitarian
- Hypertension
- LMIC, Low- and Middle-Income Countries
- MENA, Middle East and North Africa
- MHPSS, Mental Health and Psychosocial Support
- MOH, Ministry of Health
- MSF, Médecins sans Frontières
- NCDs, Non-communicable Diseases
- NGOs, Non-governmental Organisations
- Noncommunicable disease
- Refugee
- UNHCR, United Nations High Commissioner for Refugees
- WHO, World Health Organization
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Affiliation(s)
- Éimhín Ansbro
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine,15-17 Tavistock Place, London WC1H 9SH, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
| | - Rita Issa
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine,15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Ruth Willis
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine,15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Karl Blanchet
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
| | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
| | - Bayard Roberts
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine,15-17 Tavistock Place, London WC1H 9SH, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
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Jarosinski MA, Chen YS, Varas N, Dhayalan B, Chatterjee D, Weiss MA. New Horizons: Next-Generation Insulin Analogues: Structural Principles and Clinical Goals. J Clin Endocrinol Metab 2022; 107:909-928. [PMID: 34850005 PMCID: PMC8947325 DOI: 10.1210/clinem/dgab849] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 11/19/2022]
Abstract
Design of "first-generation" insulin analogues over the past 3 decades has provided pharmaceutical formulations with tailored pharmacokinetic (PK) and pharmacodynamic (PD) properties. Application of a molecular tool kit-integrating protein sequence, chemical modification, and formulation-has thus led to improved prandial and basal formulations for the treatment of diabetes mellitus. Although PK/PD changes were modest in relation to prior formulations of human and animal insulins, significant clinical advantages in efficacy (mean glycemia) and safety (rates of hypoglycemia) were obtained. Continuing innovation is providing further improvements to achieve ultrarapid and ultrabasal analogue formulations in an effort to reduce glycemic variability and optimize time in range. Beyond such PK/PD metrics, next-generation insulin analogues seek to exploit therapeutic mechanisms: glucose-responsive ("smart") analogues, pathway-specific ("biased") analogues, and organ-targeted analogues. Smart insulin analogues and delivery systems promise to mitigate hypoglycemic risk, a critical barrier to glycemic control, whereas biased and organ-targeted insulin analogues may better recapitulate physiologic hormonal regulation. In each therapeutic class considerations of cost and stability will affect use and global distribution. This review highlights structural principles underlying next-generation design efforts, their respective biological rationale, and potential clinical applications.
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Affiliation(s)
- Mark A Jarosinski
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yen-Shan Chen
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nicolás Varas
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Balamurugan Dhayalan
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Deepak Chatterjee
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael A Weiss
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Chemistry, Indiana University, Bloomington, Indiana, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
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Cousin E, Duncan BB, Stein C, Ong KL, Vos T, Abbafati C, Abbasi-Kangevari M, Abdelmasseh M, Abdoli A, Abd-Rabu R, Abolhassani H, Abu-Gharbieh E, Accrombessi MMK, Adnani QES, Afzal MS, Agarwal G, Agrawaal KK, Agudelo-Botero M, Ahinkorah BO, Ahmad S, Ahmad T, Ahmadi K, Ahmadi S, Ahmadi A, Ahmed A, Ahmed Salih Y, Akande-Sholabi W, Akram T, Al Hamad H, Al-Aly Z, Alcalde-Rabanal JE, Alipour V, Aljunid SM, Al-Raddadi RM, Alvis-Guzman N, Amini S, Ancuceanu R, Andrei T, Andrei CL, Anjana RM, Ansar A, Antonazzo IC, Antony B, Anyasodor AE, Arabloo J, Arizmendi D, Armocida B, Artamonov AA, Arulappan J, Aryan Z, Asgari S, Ashraf T, Astell-Burt T, Atorkey P, Atout MMW, Ayanore MA, Badiye AD, Baig AA, Bairwa M, Baker JL, Baltatu OC, Banik PC, Barnett A, Barone MTU, Barone-Adesi F, Barrow A, Bedi N, Belete R, Belgaumi UI, Bell AW, Bennett DA, Bensenor IM, Beran D, Bhagavathula AS, Bhaskar S, Bhattacharyya K, Bhojaraja VS, Bijani A, Bikbov B, Birara S, Bodolica V, Bonny A, Brenner H, Briko NI, Butt ZA, Caetano dos Santos FL, Cámera LA, Campos-Nonato IR, Cao Y, Cao C, Cerin E, Chakraborty PA, Chandan JS, Chattu VK, Chen S, Choi JYJ, Choudhari SG, Chowdhury EK, Chu DT, Corso B, Dadras O, Dai X, Damasceno AAM, Dandona L, Dandona R, Dávila-Cervantes CA, De Neve JW, Denova-Gutiérrez E, Dhamnetiya D, Diaz D, Ebtehaj S, Edinur HA, Eftekharzadeh S, El Sayed I, Elgendy IY, Elhadi M, Elmonem MA, Faisaluddin M, Farooque U, Feng X, Fernandes E, Fischer F, Flood D, Freitas M, Gaal PA, Gad MM, Gaewkhiew P, Getacher L, Ghafourifard M, Ghanei Gheshlagh R, Ghashghaee A, Ghith N, Ghozali G, Gill PS, Ginawi IA, Glushkova EV, Golechha M, Gopalani SV, Guimarães RA, Gupta RD, Gupta R, Gupta VK, Gupta VB, Gupta S, Habtewold TD, Hafezi-Nejad N, Halwani R, Hanif A, Hankey GJ, Haque S, Hasaballah AI, Hasan SS, Hashi A, Hassanipour S, Hay SI, Hayat K, Heidari M, Hossain MBH, Hossain S, Hosseini M, Hoveidamanesh S, Huang J, Humayun A, Hussain R, Hwang BF, Ibitoye SE, Ikuta KS, Inbaraj LR, Iqbal U, Islam MS, Islam SMS, Islam RM, Ismail NE, Isola G, Itumalla R, Iwagami M, Iyamu IO, Jahani MA, Jakovljevic M, Jayawardena R, Jha RP, John O, Jonas JB, Joo T, Kabir A, Kalhor R, Kamath A, Kanchan T, Kandel H, Kapoor N, Kayode GA, Kebede SA, Keshavarz P, Keykhaei M, Khader YS, Khajuria H, Khan MAB, Khan MN, Khan M, Khater AM, Khoja TAM, Khubchandani J, Kim MS, Kim YJ, Kimokoti RW, Kisa S, Kisa A, Kivimäki M, Korshunov VA, Korzh O, Koyanagi A, Krishan K, Kuate Defo B, Kumar GA, Kumar N, Kusuma D, La Vecchia C, Lacey B, Larsson AO, Lasrado S, Lee WC, Lee CB, Lee PH, Lee SWH, Li MC, Lim SS, Lim LL, Lucchetti G, Majeed A, Malik AA, Mansouri B, Mantovani LG, Martini S, Mathur P, McAlinden C, Mehedi N, Mekonnen T, Menezes RG, Mersha AG, Miao Jonasson J, Miazgowski T, Michalek IM, Mirica A, Mirrakhimov EM, Mirza AZ, Mithra P, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohammed A, Mokdad AH, Molokhia M, Monasta L, Moni MA, Moradpour F, Moradzadeh R, Mostafavi E, Mueller UO, Murray CJL, Mustafa A, Nagel G, Nangia V, Naqvi AA, Nayak BP, Nazari J, Ndejjo R, Negoi RI, Neupane Kandel S, Nguyen CT, Nguyen HLT, Noubiap JJ, Nowak C, Oancea B, Odukoya OO, Oguntade AS, Ojo TT, Olagunju AT, Onwujekwe OE, Ortiz A, Owolabi MO, Palladino R, Panda-Jonas S, Pandi-Perumal SR, Pardhan S, Parekh T, Parvizi M, Pepito VCF, Perianayagam A, Petcu IR, Pilania M, Podder V, Polibin RV, Postma MJ, Prashant A, Rabiee N, Rabiee M, Rahimi-Movaghar V, Rahman MA, Rahman MM, Rahman M, Rahmawaty S, Rajai N, Ram P, Rana J, Ranabhat K, Ranasinghe P, Rao CR, Rao S, Rawaf S, Rawaf DL, Rawal L, Renzaho AMN, Rezaei N, Rezapour A, Riahi SM, Ribeiro D, Rodriguez JAB, Roever L, Rohloff P, Rwegerera GM, Ryan PM, Saber-Ayad MM, Sabour S, Saddik B, Saeedi Moghaddam S, Sahebkar A, Sahoo H, Saif-Ur-Rahman KM, Salimzadeh H, Samaei M, Sanabria J, Santric-Milicevic MM, Sathian B, Sathish T, Schlaich MP, Seidu AA, Šekerija M, Senthil Kumar N, Seylani A, Shaikh MA, Shamshad H, Shawon MSR, Sheikhbahaei S, Shetty JK, Shiri R, Shivakumar KM, Shuval K, Singh JA, Singh A, Skryabin VY, Skryabina AA, Sofi-Mahmudi A, Soheili A, Sun J, Szerencsés V, Szócska M, Tabarés-Seisdedos R, Tadbiri H, Tadesse EG, Tariqujjaman M, Thankappan KR, Thapar R, Thomas N, Timalsina B, Tobe-Gai R, Tonelli M, Tovani-Palone MR, Tran BX, Tripathy JP, Tudor Car L, Tusa BS, Uddin R, Upadhyay E, Valadan Tahbaz S, Valdez PR, Vasankari TJ, Verma M, Villalobos-Daniel VE, Vladimirov SK, Vo B, Vu GT, Vukovic R, Waheed Y, Wamai RG, Werdecker A, Wickramasinghe ND, Winkler AS, Wubishet BL, Xu X, Xu S, Yahyazadeh Jabbari SH, Yatsuya H, Yaya S, Yazie TSY, Yi S, Yonemoto N, Yunusa I, Zadey S, Zaman SB, Zamanian M, Zamora N, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Zhong C, Zmaili M, Zumla A, Naghavi M, Schmidt MI. Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019. Lancet Diabetes Endocrinol 2022; 10:177-192. [PMID: 35143780 PMCID: PMC8860753 DOI: 10.1016/s2213-8587(21)00349-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/27/2021] [Accepted: 12/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990-2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. FINDINGS In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (-28·4 to -2·9) for all diabetes, and by 21·0% (-33·0 to -5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (-13·6% [-28·4 to 3·4]) and for type 1 diabetes (-13·6% [-29·3 to 8·9]). INTERPRETATION Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. FUNDING Bill & Melinda Gates Foundation.
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Palmer T, Jennings HM, Shannon G, Salustri F, Grewal G, Chelagat W, Sarker M, Pelletier N, Haghparast-Bidgoli H, Skordis J. Improving access to diabetes care for children: An evaluation of the changing diabetes in children project in Kenya and Bangladesh. Pediatr Diabetes 2022; 23:19-32. [PMID: 34713540 DOI: 10.1111/pedi.13277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The changing diabetes in children (CDiC) project is a public-private partnership implemented by Novo Nordisk, to improve access to diabetes care for children with type 1 diabetes. This paper outlines the findings from an evaluation of CDiC in Bangladesh and Kenya, assessing whether CDiC has achieved its objectives in each of six core program components. RESEARCH DESIGN AND METHODS The Rapid Assessment Protocol for Insulin Access (RAPIA) framework was used to analyze the path of insulin provision and the healthcare infrastructure in place for diagnosis and treatment of diabetes. The RAPIA facilitates a mixed-methods approach to multiple levels of data collection and systems analysis. Information is collected through questionnaires, in-depth interviews and focus group discussions, site visits, and document reviews, engaging a wide range of stakeholders (N = 127). All transcripts were analyzed thematically. RESULTS The CDiC scheme provides a stable supply of free insulin to children in implementing facilities in Kenya and Bangladesh, and offers a comprehensive package of pediatric diabetes care. However, some elements of the CDiC program were not functioning as originally intended. Transitions away from donor funding and toward government ownership are a particular concern, as patients may incur additional treatment costs, while services offered may be reduced. Additionally, despite subsidized treatment costs, indirect costs remain a substantial barrier to care. CONCLUSION Public-private partnerships such as the CDiC program can improve access to life-saving medicines. However, our analysis found several limitations, including concerns over the sustainability of the project in both countries. Any program reliant on external funding and delivered in a high-turnover staffing environment will be vulnerable to sustainability concerns.
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Affiliation(s)
- Tom Palmer
- Institute for Global Health, University College London, London, UK
| | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
| | | | | | | | - Mithun Sarker
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Nicole Pelletier
- Institute for Global Health, University College London, London, UK
| | | | - Jolene Skordis
- Institute for Global Health, University College London, London, UK
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Abstract
This is a protocol for a Cochrane Review (prototype). The objectives are as follows: To analyse the effects of storing human insulin above or below the manufacturers' recommended insulin temperature storage range or advised usage time, or both, after dispensing human insulin to people with diabetes.
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31
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Beran D, Besançon S, Ewen M, Gale EAM, Lazo-Porras M, Lepeska M, Lipska K, Zafra-Tanaka J, Zhaparova A, Yudkin JS. Diabetes and the WHO Model List of Essential Medicines. Lancet Diabetes Endocrinol 2022; 10:17-18. [PMID: 34919864 DOI: 10.1016/s2213-8587(21)00323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva and Geneva University Hospitals, Geneva 1208, Switzerland.
| | | | | | | | - Maria Lazo-Porras
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Kasia Lipska
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Jessica Zafra-Tanaka
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - John S Yudkin
- Division of Medicine, University College London, London, UK
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Chan JCN, Lim LL, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, Lau ESH, Eliasson B, Kong APS, Ezzati M, Aguilar-Salinas CA, McGill M, Levitt NS, Ning G, So WY, Adams J, Bracco P, Forouhi NG, Gregory GA, Guo J, Hua X, Klatman EL, Magliano DJ, Ng BP, Ogilvie D, Panter J, Pavkov M, Shao H, Unwin N, White M, Wou C, Ma RCW, Schmidt MI, Ramachandran A, Seino Y, Bennett PH, Oldenburg B, Gagliardino JJ, Luk AOY, Clarke PM, Ogle GD, Davies MJ, Holman RR, Gregg EW. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet 2021; 396:2019-2082. [PMID: 33189186 DOI: 10.1016/s0140-6736(20)32374-6] [Citation(s) in RCA: 303] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/06/2020] [Accepted: 11/05/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China.
| | - Lee-Ling Lim
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, La Trobe University, Melbourne, VIC, Australia
| | - Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Ping Zhang
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric S H Lau
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Björn Eliasson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Endocrinology and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alice P S Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Medical Research Council Centre for Environment and Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
| | - Carlos A Aguilar-Salinas
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Margaret McGill
- Diabetes Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Medicine and Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Guang Ning
- Shanghai Clinical Center for Endocrine and Metabolic Disease, Department of Endocrinology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China; Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jean Adams
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Paula Bracco
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Gabriel A Gregory
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jingchuan Guo
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Xinyang Hua
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Emma L Klatman
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Boon-Peng Ng
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - David Ogilvie
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jenna Panter
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Meda Pavkov
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hui Shao
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nigel Unwin
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Martin White
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Constance Wou
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Maria I Schmidt
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India
| | - Yutaka Seino
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, Japan; Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe, Japan
| | - Peter H Bennett
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Brian Oldenburg
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; WHO Collaborating Centre on Implementation Research for Prevention and Control of NCDs, University of Melbourne, Melbourne, VIC, Australia
| | - Juan José Gagliardino
- Centro de Endocrinología Experimental y Aplicada, UNLP-CONICET-CICPBA, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Graham D Ogle
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Edward W Gregg
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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Green A, Hede SM, Patterson CC, Wild SH, Imperatore G, Roglic G, Beran D. Type 1 diabetes in 2017: global estimates of incident and prevalent cases in children and adults. Diabetologia 2021; 64:2741-2750. [PMID: 34599655 PMCID: PMC8563635 DOI: 10.1007/s00125-021-05571-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS Data on type 1 diabetes incidence and prevalence are limited, particularly for adults. This study aims to estimate global numbers of incident and prevalent cases of type 1 diabetes in 2017 for all age groups, by country and areas defined by income and region. METHODS Incidence rates of type 1 diabetes in children (available from 94 countries) from the IDF Atlas were used and extrapolated to countries without data. Age-specific incidence rates in adults (only known across full age range for fewer than ten countries) were obtained by applying scaling ratios for each adult age group relative to the incidence rate in children. Age-specific incidence rates were applied to population estimates to obtain incident case numbers. Duration of diabetes was estimated from available data and adjusted using differences in childhood mortality rate between countries from United Nations demographic data. Prevalent case numbers were derived by modelling the relationship between prevalence, incidence and disease duration. Sensitivity analyses were performed to quantify the impact of alternative assumptions and model inputs. RESULTS Global numbers of incident and prevalent cases of type 1 diabetes were estimated to be 234,710 and 9,004,610, respectively, in 2017. High-income countries, with 17% of the global population, accounted for 49% of global incident cases and 52% of prevalent cases. Asia, which has the largest proportion of the world's population (60%), had the largest number of incident (32%) and prevalent (31%) cases of type 1 diabetes. Globally, 6%, 35%, 43% and 16% of prevalent cases were in the age groups 0-14, 15-39, 40-64 and 65+ years, respectively. Based on sensitivity analyses, the estimates could deviate by ±15%. CONCLUSIONS/INTERPRETATION Globally, type 1 diabetes represents about 2% of the estimated total cases of diabetes, ranging from less than 1% in certain Pacific countries to more than 15% in Northern European populations in 2017. This study provides information for the development of healthcare and policy approaches to manage type 1 diabetes. The estimates need further validation due to limitations and assumptions related to data availability and estimation methods.
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Affiliation(s)
- Anders Green
- Institute of Applied Economics and Health Research, Copenhagen, Denmark.
- Steno Diabetes Center Odense, Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense, Denmark.
| | - Simone M Hede
- Institute of Applied Economics and Health Research, Copenhagen, Denmark
| | | | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Gojka Roglic
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland.
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Dixit K, Fardindoost S, Ravishankara A, Tasnim N, Hoorfar M. Exhaled Breath Analysis for Diabetes Diagnosis and Monitoring: Relevance, Challenges and Possibilities. BIOSENSORS 2021; 11:476. [PMID: 34940233 PMCID: PMC8699302 DOI: 10.3390/bios11120476] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 05/15/2023]
Abstract
With the global population prevalence of diabetes surpassing 463 million cases in 2019 and diabetes leading to millions of deaths each year, there is a critical need for feasible, rapid, and non-invasive methodologies for continuous blood glucose monitoring in contrast to the current procedures that are either invasive, complicated, or expensive. Breath analysis is a viable methodology for non-invasive diabetes management owing to its potential for multiple disease diagnoses, the nominal requirement of sample processing, and immense sample accessibility; however, the development of functional commercial sensors is challenging due to the low concentration of volatile organic compounds (VOCs) present in exhaled breath and the confounding factors influencing the exhaled breath profile. Given the complexity of the topic and the skyrocketing spread of diabetes, a multifarious review of exhaled breath analysis for diabetes monitoring is essential to track the technological progress in the field and comprehend the obstacles in developing a breath analysis-based diabetes management system. In this review, we consolidate the relevance of exhaled breath analysis through a critical assessment of current technologies and recent advancements in sensing methods to address the shortcomings associated with blood glucose monitoring. We provide a detailed assessment of the intricacies involved in the development of non-invasive diabetes monitoring devices. In addition, we spotlight the need to consider breath biomarker clusters as opposed to standalone biomarkers for the clinical applicability of exhaled breath monitoring. We present potential VOC clusters suitable for diabetes management and highlight the recent buildout of breath sensing methodologies, focusing on novel sensing materials and transduction mechanisms. Finally, we portray a multifaceted comparison of exhaled breath analysis for diabetes monitoring and highlight remaining challenges on the path to realizing breath analysis as a non-invasive healthcare approach.
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Affiliation(s)
- Kaushiki Dixit
- Department of Electronics and Electrical Communication Engineering, Indian Institute of Technology Kharagpur, Kharagpur 721302, India;
- School of Engineering, University of British Columbia, Kelowna, BC V1V 1V7, Canada; (S.F.); (A.R.); (N.T.)
| | - Somayeh Fardindoost
- School of Engineering, University of British Columbia, Kelowna, BC V1V 1V7, Canada; (S.F.); (A.R.); (N.T.)
| | - Adithya Ravishankara
- School of Engineering, University of British Columbia, Kelowna, BC V1V 1V7, Canada; (S.F.); (A.R.); (N.T.)
| | - Nishat Tasnim
- School of Engineering, University of British Columbia, Kelowna, BC V1V 1V7, Canada; (S.F.); (A.R.); (N.T.)
- Faculty of Engineering and Computer Science, University of Victoria, Victoria, BC V8W 2Y2, Canada
| | - Mina Hoorfar
- School of Engineering, University of British Columbia, Kelowna, BC V1V 1V7, Canada; (S.F.); (A.R.); (N.T.)
- Faculty of Engineering and Computer Science, University of Victoria, Victoria, BC V8W 2Y2, Canada
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Godman B, Wladysiuk M, McTaggart S, Kurdi A, Allocati E, Jakovljevic M, Kalemeera F, Hoxha I, Nachtnebel A, Sauermann R, Hinteregger M, Marković-Peković V, Tubic B, Petrova G, Tachkov K, Slabý J, Nejezchlebova R, Krulichová IS, Laius O, Selke G, Langner I, Harsanyi A, Inotai A, Jakupi A, Henkuzens S, Garuolienė K, Gulbinovič J, Bonanno PV, Rutkowski J, Ingeberg S, Melien Ø, Mardare I, Fürst J, MacBride-Stewart S, Holmes C, Pontes C, Zara C, Pedrola MT, Hoffmann M, Kourafalos V, Pisana A, Banzi R, Campbell S, Wettermark B. Utilisation Trend of Long-Acting Insulin Analogues including Biosimilars across Europe: Findings and Implications. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9996193. [PMID: 34676266 PMCID: PMC8526244 DOI: 10.1155/2021/9996193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetes mellitus rates and associated costs continue to rise across Europe enhancing health authority focus on its management. The risk of complications is enhanced by poor glycaemic control, with long-acting insulin analogues developed to reduce hypoglycaemia and improve patient convenience. There are concerns though with their considerably higher costs, but moderated by reductions in complications and associated costs. Biosimilars can help further reduce costs. However, to date, price reductions for biosimilar insulin glargine appear limited. In addition, the originator company has switched promotional efforts to more concentrated patented formulations to reduce the impact of biosimilars. There are also concerns with different devices between the manufacturers. As a result, there is a need to assess current utilisation rates for insulins, especially long-acting insulin analogues and biosimilars, and the rationale for patterns seen, among multiple European countries to provide future direction. Methodology. Health authority databases are examined to assess utilisation and expenditure patterns for insulins, including biosimilar insulin glargine. Explanations for patterns seen were provided by senior-level personnel. RESULTS Typically increasing use of long-acting insulin analogues across Europe including both Western and Central and Eastern European countries reflects perceived patient benefits despite higher prices. However, activities by the originator company to switch patients to more concentrated insulin glargine coupled with lowering prices towards biosimilars have limited biosimilar uptake, with biosimilars not currently launched in a minority of European countries. A number of activities were identified to address this. Enhancing the attractiveness of the biosimilar insulin market is essential to encourage other biosimilar manufacturers to enter the market as more long-acting insulin analogues lose their patents to benefit all key stakeholder groups. CONCLUSIONS There are concerns with the availability and use of insulin glargine biosimilars among European countries despite lower costs. This can be addressed.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Magdalene Wladysiuk
- Chair of Epidemiology and Preventive Medicine, Medical College, Jagiellonian University, Krakow, Poland
- HTA Consulting, Starowiślna Str. 17/3, 31-038 Krakow, Poland
| | - Stuart McTaggart
- Public Health Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche ‘Mario Negri' IRCCS, Milan, Italy
| | - Mihajlo Jakovljevic
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
- Institute of Comparative Economic Studies, Faculty of Economics, Hosei University Tokyo, Tokyo, Japan
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Anna Nachtnebel
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Robert Sauermann
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Manfred Hinteregger
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Vanda Marković-Peković
- Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Biljana Tubic
- Faculty of Medicine, Department of Medicinal Chemistry, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- Agency for Medicinal Product and Medical Devices of Bosnia and Herzegovina, 78000 Banja Luka, Bosnia and Herzegovina
| | - Guenka Petrova
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Tachkov
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Juraj Slabý
- State Institute for Drug Control, Prague, Czech Republic
| | | | - Iva Selke Krulichová
- Department of Medical Biophysics, Faculty of Medicine in Hradec Králové, Charles University, Simkova 870, 500 03 Hradec Králové, Czech Republic
| | - Ott Laius
- State Agency of Medicines, Nooruse 1, 50411 Tartu, Estonia
| | - Gisbert Selke
- Wissenschaftliches Institut der AOK (WIdO), Rosenthaler Straße 31, 10178 Berlin, Germany
| | - Irene Langner
- Wissenschaftliches Institut der AOK (WIdO), Rosenthaler Straße 31, 10178 Berlin, Germany
| | - András Harsanyi
- Department of Health Policy and Health Economics, Eotvos Lorand University, Budapest, Hungary
| | - András Inotai
- Syreon Research Institute and Semmelweis University, Center of Health Technology Assessment, Budapest, Hungary
| | - Arianit Jakupi
- Faculty of Pharmacy, UBT Higher Education Institute, Pristina, Kosovo
| | | | - Kristina Garuolienė
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Patricia Vella Bonanno
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Department of Health Services Management, University of Malta, Valletta, Malta
| | - Jakub Rutkowski
- HTA Consulting, Starowiślna Str. 17/3, 31-038 Krakow, Poland
| | - Skule Ingeberg
- Medicines Committee, Oslo University Hospitals, Oslo, Norway
| | - Øyvind Melien
- Medicines Committee, Oslo University Hospitals, Oslo, Norway
| | - Ileana Mardare
- Faculty of Medicine, Public Health and Management Department, “Carol Davila” University of Medicine and Pharmacy Bucharest, 050463 Bucharest, Romania
| | - Jurij Fürst
- Health Insurance Institute, Miklosiceva 24, SI-1507 Ljubljana, Slovenia
| | | | | | - Caridad Pontes
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Corinne Zara
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
| | - Marta Turu Pedrola
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
| | | | - Vasileios Kourafalos
- National Organization for the Provision of Healthcare Services (EOPYY), Athens, Greece
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rita Banzi
- Istituto di Ricerche Farmacologiche ‘Mario Negri' IRCCS, Milan, Italy
| | - Stephen Campbell
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Bjorn Wettermark
- Department of Pharmacy, Disciplinary Domain of Medicine and Pharmacy, Uppsala University, Uppsala, Sweden
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Sarkar S, Heyward J, Alexander GC, Kalyani RR. Trends in Insulin Types and Devices Used by Adults With Type 2 Diabetes in the United States, 2016 to 2020. JAMA Netw Open 2021; 4:e2128782. [PMID: 34636912 PMCID: PMC8511976 DOI: 10.1001/jamanetworkopen.2021.28782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Despite rising costs and public scrutiny devoted to insulin, less is known regarding recent trends in its ambulatory use in the United States. OBJECTIVE To characterize trends in ambulatory insulin use, overall and based on insulin characteristics, among adults with type 2 diabetes in the United States from January 1, 2016, through December 31, 2020. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study included patients whose data were collected in IQVIA's National Disease and Therapeutic Index (NDTI), a 2-stage, all-payer, nationally representative audit of outpatient care. Approximately 4800 physicians each calendar quarter completed a form for 2 consecutive days regarding visits for each of their patients, including diagnoses, treatments, and demographic information. Data were collected from January 2016 through December 2020. EXPOSURES Ambulatory use of insulin. MAIN OUTCOMES AND MEASURES Nationally representative projections for ambulatory use of insulin (ie, treatment visits), overall and aggregated by insulin molecule (insulins regular, neutral protamine Hagedorn [NPH], lispro, glulisine, glargine, detemir, degludec, and aspart), delivery devices (vials/syringes or pens), therapeutic class (short-acting, rapid-acting, long-acting, intermediate-acting, and premixed insulin), insulin type (human, analog, and biosimilar), and date of approval (newer: before 2010; and older: after 2010). RESULTS There were 27 860 691 insulin treatment visits between 2016 and 2020. Among all patient encounters that indicated use of insulin in 2020, 1 989 154 (43.9%) were among those aged 60 to 74 years; 2 372 629 (52.4%) among men; 2 646 247 (58.4%) among White patients; 811 639 (17.9%) among Black patients; and 701 912 (15.5%) among Hispanic patients. Insulin glargine was the most frequently used insulin from 2016 to 2020, accounting for approximately half of treatment visits (eg, 2020: 2.6 of 4.9 million visits; 95% CI, 2.1-3.1 million). Among insulin classes, long-acting insulin accounted for approximately two-thirds of treatment visits during this period (eg, 2020: 3.7 million visits; 95% CI, 3.0-4.4 million). Treatment visits for insulin pens increased from 36.1% in 2016 (2.2 of 6.0 million visits; 95% CI, 1.7-2.7 million) to 58.7% in 2020 (2.9 million visits; 95% CI, 2.3-3.5 million), while use of insulin vials/syringes declined in parallel. Analog insulin use predominated and accounted for more than 80% of total treatment visits across all years (eg, 2020: 4.3 million visits; 95% CI, 3.4-5.1 million). Newer insulins were increasingly used, from 18.1% of total treatment visits in 2016 (1.1 million visits; 95% CI, 0.8-1.4 million) to 40.9% in 2020 (2.0 million visits; 95% CI, 1.5-2.5 million). The use of biosimilar insulin, which was first approved in 2015, increased from 2.6% in 2017 (0.1 of 5.3 million visits; 95% CI, 0.04-0.2 million) to 8.2% in 2020 (0.4 million visits; 95% CI, 0.2-0.6 million) of total insulin treatment visits. The total number of insulin treatment visits declined from a peak of 6.0 million visits in 2016 to a nadir of 4.9 million visits in 2020 (approximately 18% decline). CONCLUSIONS AND RELEVANCE In this study, ambulatory insulin use in the United States during the past 5 years remained dominated by the use of insulin analogs and insulin pen delivery devices, with increasing uptake of newer products as they have been brought to market.
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Affiliation(s)
- Sudipa Sarkar
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James Heyward
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Insulin Access and Cost at 100 Years: What Would Dr. Banting Think? MED 2021; 2:1002-1004. [DOI: 10.1016/j.medj.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Herman WH, Kuo S. 100 years of Insulin: Why is Insulin So Expensive and What Can be Done to Control Its Cost? Endocrinol Metab Clin North Am 2021; 50:e21-e34. [PMID: 34763823 PMCID: PMC8597930 DOI: 10.1016/j.ecl.2021.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The discovery of insulin 100 years ago and subsequent improvements in insulin formulations and delivery devices have changed the lives of people with diabetes. Unfortunately, the average price of insulin in the United States has nearly tripled over the past decade, and the high cost of insulin has become a barrier to diabetes treatment. On the 100th anniversary of insulin's discovery, this life-saving treatment is financially out of reach for as many as one-third of people with diabetes. The challenge now is to ensure that insulin is available for all people with diabetes who need it. We explore reasons for the high cost of insulin and recommend some clinical and policy interventions to improve insulin access and affordability.
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Affiliation(s)
- William H Herman
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, 1000 Wall Street, Brehm Tower, Room 6108, Ann Arbor, MI 48105, USA; Department of Epidemiology, University of Michigan School of Public Health, 1000 Wall Street, Brehm Tower, Room 6115, Ann Arbor, MI 48105, USA.
| | - Shihchen Kuo
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, 1000 Wall Street, Brehm Tower, Room 6108, Ann Arbor, MI 48105, USA
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Availability, affordability and price components of insulin products in different-level hospital pharmacies: Evidence from two cross-sectional surveys in Nanjing, China. PLoS One 2021; 16:e0255742. [PMID: 34383816 PMCID: PMC8360381 DOI: 10.1371/journal.pone.0255742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/20/2021] [Indexed: 11/21/2022] Open
Abstract
The essential medicine——insulin cannot be easily accessed and afforded in many countries. To help address this issue, we evaluated the availability, affordability and price of insulin products in Nanjing, eastern China. Two cross-sectional studies were conducted in 2016 and 2018. A total of 56 hospital pharmacies were sampled, using a simplified and adapted World Health Organization/Health Action International (WHO/HAI) methodology. Prices were expressed as Median Price Ratios (MPRs) to Australian Pharmaceutical Benefit Scheme (PBS) prices. In addition, we investigated the price components of seven selected insulin products as a case study before and after the Online Centralized Procurement Policy for Hospital Drugs in May, 2018. Affordability was presented as the number of daily wages of the lowest paid unskilled government worker (LPGW) required to purchase 1000IU of insulin based on the average courses of treatment, approximately 30 days’ treatment. The availability of insulin products was very high in secondary hospitals and tertiary hospitals both in 2016 and 2018, but in community hospitals was very low. In 2018, the availability of prandial insulin products showed fluctuation compared to 2016. The availability of pre-mixed human insulin products was over 95% overall, and also very high (80%) in community hospitals in 2018. The prices of insulin products were much lower than PBS prices of Australian in this study, with the MPRs less than 1 (0.32 to 0.71 in 2016 vs. 0.30 to 0.68 in 2018) for all insulin types. But insulin products in Nanjing in 2016 and 2018 were considered unaffordable, because the number of daily wages of the LPGW needed to purchase for the 30 days treatment of insulin products ranged from 2.26 to 8.49 in 2016 and 1.88 to 7.09 in 2018. The manufacturers’ selling price contributed the main part (74.15% to 77.70% before and 74.86% to 91.51% after the implementation of the bidding policy) of the price components of target insulin brands. The availability of insulin products was high in secondary hospitals and tertiary hospitals, but lower in community hospitals. However, the affordability in community hospitals was better than other hospitals, but the insulin products were still unaffordable for patients on low incomes. Further improvements of the availability accessibility and affordability of medicines in advancing health insurance policies and lowering drug prices should be put forward.
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40
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Sharma A, Kaplan WA. Insulin imports fail to meet many countries' needs. Science 2021; 373:494-497. [PMID: 34326225 DOI: 10.1126/science.abg4374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Abhishek Sharma
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA. .,PRECISIONheor, Precision Medicine Group, Boston, MA, USA.,World Heart Federation, Geneva, Switzerland
| | - Warren A Kaplan
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA. .,World Health Organization Collaborating Center for Pharmaceutical Policy, Boston, MA, USA
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Ansbro É, Garry S, Karir V, Reddy A, Jobanputra K, Fardous T, Sadique Z. Delivering a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: a descriptive costing study. Health Policy Plan 2021; 35:931-940. [PMID: 32621490 PMCID: PMC8312704 DOI: 10.1093/heapol/czaa050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Syrian conflict has caused enormous displacement of a population with a high
non-communicable disease (NCD) burden into surrounding countries, overwhelming health
systems’ NCD care capacity. Médecins sans Frontières (MSF) developed a primary-level NCD
programme, serving Syrian refugees and the host population in Irbid, Jordan, to assist the
response. Cost data, which are currently lacking, may support programme adaptation and
system scale up of such NCD services. This descriptive costing study from the provider
perspective explored financial costs of the MSF NCD programme. We estimated annual total,
per patient and per consultation costs for 2015–17 using a combined ingredients-based and
step-down allocation approach. Data were collected via programme budgets, facility
records, direct observation and informal interviews. Scenario analyses explored the impact
of varying procurement processes, consultation frequency and task sharing. Total annual
programme cost ranged from 4 to 6 million International Dollars (INT$), increasing
annually from INT$4 206 481 (2015) to INT$6 739 438 (2017), with costs driven mainly by
human resources and drugs. Per patient per year cost increased 23% from INT$1424 (2015) to
1751 (2016), and by 9% to 1904 (2017), while cost per consultation increased from INT$209
to 253 (2015–17). Annual cost increases reflected growing patient load and increasing
service complexity throughout 2015–17. A scenario importing all medications cut total
costs by 31%, while negotiating importation of high-cost items offered 13% savings.
Leveraging pooled procurement for local purchasing could save 20%. Staff costs were more
sensitive to reducing clinical review frequency than to task sharing review to nurses.
Over 1000 extra patients could be enrolled without additional staffing cost if care
delivery was restructured. Total costs significantly exceeded costs reported for NCD care
in low-income humanitarian contexts. Efficiencies gained by revising procurement and/or
restructuring consultation models could confer cost savings or facilitate cohort
expansion. Cost effectiveness studies of adapted models are recommended.
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Affiliation(s)
- Éimhín Ansbro
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Sylvia Garry
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Veena Karir
- Médecins sans Frontières, Plantage Middenlaan 14 1018 DD Amsterdam, The Netherlands
| | - Amulya Reddy
- Médecins Sans Frontières, Lower Ground Floor, Chancery Exchange, 10 Furnival Street, London EC4A 1AB, UK
| | - Kiran Jobanputra
- Médecins Sans Frontières, Lower Ground Floor, Chancery Exchange, 10 Furnival Street, London EC4A 1AB, UK
| | - Taissir Fardous
- Health Economy Directorate, Ministry of Health, Pr. Hamzah St., Amman, Jordan
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Aebischer Perone S, Jacquerioz Bausch F, Boulle P, Chappuis F, Miranda JJ, Beran D. Report of the WHO independent high-level commission on NCDs: where is the focus on addressing inequalities? BMJ Glob Health 2021; 5:bmjgh-2020-002820. [PMID: 32565429 PMCID: PMC7307526 DOI: 10.1136/bmjgh-2020-002820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/10/2020] [Accepted: 05/14/2020] [Indexed: 01/20/2023] Open
Affiliation(s)
- Sigiriya Aebischer Perone
- International Committee of the Red Cross, Geneva, Switzerland .,Division of Tropical and Humanitarian Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | | | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland.,Faculty of Medicine, UNIGE, Geneva, Switzerland
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Godman B, Haque M, Leong T, Allocati E, Kumar S, Islam S, Charan J, Akter F, Kurdi A, Vassalo C, Bakar MA, Rahim SA, Sultana N, Deeba F, Khan MAH, Alam ABMM, Jahan I, Kamal ZM, Hasin H, Munzur-E-Murshid, Nahar S, Haque M, Dutta S, Abhayanand JP, Kaur RJ, Rwegerera GM, do Nascimento RCRM, Dias Godói IP, Irfan M, Amu AA, Matowa P, Acolatse J, Incoom R, Sefah IA, Acharya J, Opanga S, Njeri LW, Kimonge D, Kwon HY, Bae S, Khuan KKP, Abubakar AR, Sani IH, Khan TA, Hussain S, Saleem Z, Malande OO, Piloya-Were T, Gambogi R, Hernandez Ortiz C, Alutuli L, Kalungia AC, Hoxha I, Marković-Peković V, Tubic B, Petrova G, Tachkov K, Laius O, Harsanyi A, Inotai A, Jakupi A, Henkuzens S, Garuoliene K, Gulbinovič J, Wladysiuk M, Rutkowski J, Mardare I, Fürst J, McTaggart S, MacBride-Stewart S, Pontes C, Zara C, Tagoe ET, Banzi R, Wale J, Jakovljevic M. The Current Situation Regarding Long-Acting Insulin Analogues Including Biosimilars Among African, Asian, European, and South American Countries; Findings and Implications for the Future. Front Public Health 2021; 9:671961. [PMID: 34249838 PMCID: PMC8264781 DOI: 10.3389/fpubh.2021.671961] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers. Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders. Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries. Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production. Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities.
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Affiliation(s)
- Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Trudy Leong
- Essential Drugs Programme, South African National Department of Health, Pretoria, South Africa
| | - Eleonora Allocati
- Center for Health Regulatory Policies, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milan, Italy
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Farhana Akter
- Department of Endocrinology, Chittagong Medical College, Chittagong, Bangladesh
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Carlos Vassalo
- Facultad de Ciencias Médicas, Universidad Nacional del Litoral, Santa Fe, Argentina
| | - Muhammed Abu Bakar
- Department of Endocrinology and Metabolism, Chattogram Maa-O-Shishu Hospital Medical College, Chattogram, Bangladesh
| | - Sagir Abdur Rahim
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital, Dhaka, Bangladesh
| | - Nusrat Sultana
- Department of Endocrinology and Metabolism, Bangabandhu Sheik Mujib Medical University Hospital, Dhaka, Bangladesh
| | - Farzana Deeba
- Department of Obstetrics and Gynaecology, Bangabandhu Sheik Mujib Medical University, Dhaka, Bangladesh
| | | | | | - Iffat Jahan
- Department of Physiology, Eastern Medical College, Cumilla, Bangladesh
| | | | - Humaira Hasin
- Clinical Fellow, Epsom and St Helier University Hospitals NHS Trust, Surrey, United Kingdom
| | - Munzur-E-Murshid
- Women's Integrated Sexual Health (WISH) 2 Access Choice Together Innovate Ownership Now (ACTION) Project, Handicap International, Kurigram, Bangladesh
| | - Shamsun Nahar
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Monami Haque
- Human Resource Department, Square Toiletries Limited, Rupayan Center, Dhaka, Bangladesh
| | - Siddhartha Dutta
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Rimple Jeet Kaur
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Godfrey Mutashambara Rwegerera
- Department of Medicine, Sir Ketumile Masire Teaching Hospital, Gaborone, Botswana
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Isabella Piassi Dias Godói
- Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Cidade Universitária, Marabá, Brazil
- Group (CNPq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO), Universidade Federal do Sul e Sudeste do Pará, Marabá, Brazil
| | - Mohammed Irfan
- Faculdade de Odontologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | - Patrick Matowa
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | | | - Robert Incoom
- Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Israel Abebrese Sefah
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana
- Pharmacy Practise Department of Pharmacy Practise, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | | | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practise, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - David Kimonge
- Department of Pharmaceutics and Pharmacy Practise, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, South Korea
| | - SeungJin Bae
- College of Pharmacy, Ewha Woman's University, Seoul, South Korea
| | | | - Abdullahi Rabiu Abubakar
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Bayero University, Kano, Nigeria
| | - Ibrahim Haruna Sani
- Unit of Pharmacology, College of Health Sciences, Yusuf Maitama Sule University (YUMSUK), Kano, Nigeria
| | | | | | - Zikria Saleem
- Department of Pharmacy Practise, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunisation (ECAVI), Kampala, Uganda
| | - Thereza Piloya-Were
- Paediatric Endocrinologist, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | - Luke Alutuli
- University Teaching Hospital Group, Department of Pharmacy, Lusaka, Zambia
| | | | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Vanda Marković-Peković
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Biljana Tubic
- Agency for Medicinal Products and Medical Devices of Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina
- Department of Medicinal Chemistry, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Guenka Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Tachkov
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Ott Laius
- State Agency of Medicines, Tartu, Estonia
| | - András Harsanyi
- Department of Health Policy and Health Economics, Eotvos Lorand University, Budapest, Hungary
| | - András Inotai
- Syreon Research Institute, Budapest, Hungary
- Center of Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Arianit Jakupi
- Faculty of Pharmacy, UBT Higher Education Institute, Pristina, Kosovo
| | | | - Kristina Garuoliene
- Department of Pharmacy, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania
| | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania
| | - Magdalene Wladysiuk
- Chair of Epidemiology and Preventive Medicine Jagiellonian University, Medical College, Kraków, Poland
- HTA Consulting, Kraków, Poland
| | | | - Ileana Mardare
- Faculty of Medicine, Public Health and Management Department, “Carol Davila” University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | | | | | - Caridad Pontes
- Drug Department, Catalan Health Service, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Corinne Zara
- Drug Department, Catalan Health Service, Barcelona, Spain
| | - Eunice Twumwaa Tagoe
- Department of Management Science, Business School, University of Strathclyde, Glasgow, United Kingdom
| | - Rita Banzi
- Center for Health Regulatory Policies, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milan, Italy
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Mihajlo Jakovljevic
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
- Faculty of Economics, Institute of Comparative Economic Studies, Hosei University Tokyo, Tokyo, Japan
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44
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Hunt D, Hemmingsen B, Matzke A, Varghese C, Hammerich A, Luciani S, Hennis A, Branca F, Bull F, Berdzuli N, Dangou JM, Pendse R, Pratt A, Mikkelsen B. The WHO Global Diabetes Compact: a new initiative to support people living with diabetes. Lancet Diabetes Endocrinol 2021; 9:325-327. [PMID: 33862005 DOI: 10.1016/s2213-8587(21)00111-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel Hunt
- Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.
| | - Bianca Hemmingsen
- Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Alena Matzke
- Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Cherian Varghese
- Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Asmus Hammerich
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Silvana Luciani
- World Health Organization Regional Office for the Americas, Washington, DC, USA
| | - Anselm Hennis
- World Health Organization Regional Office for the Americas, Washington, DC, USA
| | - Francesco Branca
- Department for Health Promotion, World Health Organization, Geneva, Switzerland
| | - Fiona Bull
- Department for Health Promotion, World Health Organization, Geneva, Switzerland
| | - Nino Berdzuli
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Jean-Marie Dangou
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Razia Pendse
- World Health Organization Country Office for Sri Lanka, Colombo, Sri Lanka
| | - Angela Pratt
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Bente Mikkelsen
- Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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45
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Beran D, Lazo-Porras M, Mba CM, Mbanya JC. A global perspective on the issue of access to insulin. Diabetologia 2021; 64:954-962. [PMID: 33483763 PMCID: PMC8012321 DOI: 10.1007/s00125-020-05375-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/03/2020] [Indexed: 02/08/2023]
Abstract
The discovery of insulin in 1921 changed the prognosis for people with type 1 diabetes. A century later, availability and affordability of insulin remain a challenge in many parts of the globe. Using the WHO's framework on understanding the life cycle of medicines, this review details the global and national challenges that affect patients' abilities to access and afford insulin. Current research and development in diabetes has seen some innovations, but none of these have truly been game-changing. Currently, three multinational companies control over 95% of global insulin supply. The inclusion of insulin on the WHO's Prequalification Programme is an opportunity to facilitate entry of new companies into the market. Many governments lack policies on the selection, procurement, supply, pricing and reimbursement of insulin. Moreover, mark-ups in the supply chain also affect the final price to the consumer. Whilst expenses related to diabetes are mostly covered by insurance in high-income countries, many patients from low- and middle-income countries have to pay out of their own pockets. The organisation of diabetes management within the healthcare system also affects patient access to insulin. The challenges affecting access to insulin are complex and require a wide range of solutions. Given that 2021 marks the centenary of the discovery of insulin, there is need for global advocacy to ensure that the benefits of insulin and innovations in diabetes care reach all individuals living with diabetes.
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Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Maria Lazo-Porras
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Camille M Mba
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
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46
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Boulton AJM, Hussain A. One hundred years of insulin: What we have learned and the Future? Diabetes Res Clin Pract 2021; 175:108865. [PMID: 34082052 DOI: 10.1016/j.diabres.2021.108865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Andrew J M Boulton
- International Diabetes Federation, IDF, Brussels, Belgian; University of Manchester, UK
| | - Akhtar Hussain
- International Diabetes Federation, IDF, Brussels, Belgian; Faculty of Health Sciences, Nord University, Bodø, Norway
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47
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Beran D, Colagiuri S, Ernoult N, Ewen M, Fleury C, Lepeska M, Londeix P, Pfiester E, Yudkin JS, Besançon S. Failing to address access to insulin in its centenary year would be a catastrophic moral failure. Lancet Diabetes Endocrinol 2021; 9:194-196. [PMID: 33675694 DOI: 10.1016/s2213-8587(21)00048-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/20/2022]
Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva 1211, Switzerland; Geneva University Hospitals, Geneva, Switzerland.
| | - Stephen Colagiuri
- Boden Collaboration, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, SNW, Australia
| | | | | | - Cynthia Fleury
- Conservatoire National des Arts et Métiers, Paris, France
| | | | - Pauline Londeix
- NGO Santé Diabète, Grenoble, France; Observatoire de la Transparence dans les Politiques du Médicament, Paris, France
| | | | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK
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48
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Kaufmann B, Boulle P, Berthou F, Fournier M, Beran D, Ciglenecki I, Townsend M, Schmidt G, Shah M, Cristofani S, Cavailler P, Foti M, Scapozza L. Heat-stability study of various insulin types in tropical temperature conditions: New insights towards improving diabetes care. PLoS One 2021; 16:e0245372. [PMID: 33534816 PMCID: PMC7857579 DOI: 10.1371/journal.pone.0245372] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 12/29/2020] [Indexed: 01/08/2023] Open
Abstract
Strict storage recommendations for insulin are difficult to follow in hot tropical regions and even more challenging in conflict and humanitarian emergency settings, adding an extra burden to the management of people with diabetes. According to pharmacopeia unopened insulin vials must be stored in a refrigerator (2-8°C), while storage at ambient temperature (25-30°C) is usually permitted for the 4-week usage period during treatment. In the present work we address a critical question towards improving diabetes care in resource poor settings, namely whether insulin is stable and retains biological activity in tropical temperatures during a 4-week treatment period. To answer this question, temperature fluctuations were measured in Dagahaley refugee camp (Northern Kenya) using log tag recorders. Oscillating temperatures between 25 and 37°C were observed. Insulin heat stability was assessed under these specific temperatures which were precisely reproduced in the laboratory. Different commercialized formulations of insulin were quantified weekly by high performance liquid chromatography and the results showed perfect conformity to pharmacopeia guidelines, thus confirming stability over the assessment period (four weeks). Monitoring the 3D-structure of the tested insulin by circular dichroism confirmed that insulin monomer conformation did not undergo significant modifications. The measure of insulin efficiency on insulin receptor (IR) and Akt phosphorylation in hepatic cells indicated that insulin bioactivity of the samples stored at oscillating temperature during the usage period is identical to that of the samples maintained at 2-8°C. Taken together, these results indicate that insulin can be stored at such oscillating ambient temperatures for the usual four-week period of use. This enables the barrier of cold storage during use to be removed, thereby opening up the perspective for easier management of diabetes in humanitarian contexts and resource poor settings.
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Affiliation(s)
- Beatrice Kaufmann
- Pharmaceutical Biochemistry, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | | | - Flavien Berthou
- Faculty of Medicine, Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Margot Fournier
- Faculty of Medicine, Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Iza Ciglenecki
- Médecins Sans Frontières Switzerland, Geneva, Switzerland
| | | | | | - Maya Shah
- Médecins Sans Frontières Switzerland, Geneva, Switzerland
| | | | | | - Michelangelo Foti
- Faculty of Medicine, Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Leonardo Scapozza
- Pharmaceutical Biochemistry, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
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49
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van Crevel R, Critchley JA. The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice. Trop Med Infect Dis 2021; 6:tropicalmed6010008. [PMID: 33435609 PMCID: PMC7838867 DOI: 10.3390/tropicalmed6010008] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetes Mellitus increases the risk of developing Tuberculosis (TB) disease by about three times; it also doubles the risk of death during TB treatment and other poor TB treatment outcomes. Diabetes may increase the risk of latent infection with Mycobacterium tuberculosis (LTBI), but the magnitude of this effect is less clear. Whilst this syndemic has received considerable attention, most of the published research has focussed on screening for undiagnosed diabetes in TB patients or observational follow-up of TB treatment outcomes by diabetes status. There are thus substantial research and policy gaps, particularly with regard to prevention of TB disease in people with diabetes and management of patients with TB-diabetes, both during TB treatment and after successful completion of TB treatment, when they likely remain at high risk of TB recurrence, mortality from TB and cardiovascular disease. Potential strategies to prevent development of TB disease might include targeted vaccination programmes, screening for LTBI and preventive therapy among diabetes patients or, perhaps ideally, improved diabetes management and prevention. The cost-effectiveness of each of these, and in particular how each strategy might compare with targeted TB prevention among other population groups at higher risk of developing TB disease, is also unknown. Despite research gaps, clinicians urgently need practical management advice and more research evidence on the choice and dose of different anti-diabetes medication and effective medical therapies to reduce cardiovascular risks (statins, anti-hypertensives and aspirin). Substantial health system strengthening and integration may be needed to prevent these at risk patients being lost to care at the end of TB treatment.
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Affiliation(s)
- Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Correspondence:
| | - Julia A. Critchley
- Population Health Research Institute, St George’s, University of London, London SW17 ORE, UK;
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50
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Ngassa Piotie P, Wood P, Webb EM, Hugo JF, Rheeder P. Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings. Ther Adv Endocrinol Metab 2021; 12:20420188211054688. [PMID: 34733467 PMCID: PMC8558786 DOI: 10.1177/20420188211054688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In South Africa, initiating insulin for people with type 2 diabetes and subsequent titration is a major challenge for the resource-constrained healthcare system. Inadequate support systems in primary care, including not being able to access blood glucose monitors and test strips for self-monitoring of blood glucose, results in patients with type 2 diabetes being referred to higher levels of care. In primary care, initiation of insulin may be delayed due to a shortage of healthcare workers. The delayed initiation of insulin is also exacerbated by the reported resistance of both healthcare providers and people with type 2 diabetes to start insulin. In South Africa, telehealth provides an opportunity to overcome these challenges and manage insulin therapy in primary care. METHODS We describe the development of a digital health intervention including the framework used, the theoretical approach and subsequent implementation strategies. RESULTS This intervention is an innovative, nurse-driven and app-enabled intervention called 'the Tshwane Insulin Project intervention'. The Tshwane Insulin Project intervention was designed and evaluated using the framework recommended by the Medical Research Council for complex interventions. The Tshwane Insulin Project intervention was developed in four sequential phases: planning, design, implementation and evaluation. The Tshwane Insulin Project intervention followed the Integrated Chronic Disease Management framework to facilitate implementation and acceptability. The Tshwane Insulin Project comprises a facility-level intervention, where nurses evaluate patients and initiate insulin, an individual-level intervention where community healthcare workers visit patients at their homes to follow-up and provide educational information, while using telehealth to enable physician-directed insulin titration if needed, and a community-level intervention aimed at empowering community healthcare workers to support people living with diabetes and raise awareness of diabetes. CONCLUSION The technological advancements in digital health and telemedicine present an opportunity to improve diabetes care in resource-limited countries. This work can inform those intending to develop and implement complex interventions in primary healthcare in developing countries.
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Affiliation(s)
| | - Paola Wood
- Division of Biokinetics, Department of Physiology, Faculty of Health Sciences, University of Pretoria, Hatfield, South Africa
| | - Elizabeth M. Webb
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Johannes F.M. Hugo
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa; UP COPC Research Unit, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Paul Rheeder
- Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
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