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Heshmat R, Darvishi A, Abdi Dezfouli R, Nikkhah A, Radmanesh R, Moslemi E. A short-term economic evaluation of early insulin therapy compared to oral anti-diabetic drugs in order to reduce the major adverse events in type 2 diabetes patients in Iran. Curr Med Res Opin 2024; 40:765-772. [PMID: 38533582 DOI: 10.1080/03007995.2024.2333425] [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: 11/02/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE While there are some recommendations about early insulin therapy in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients, there is not sufficient evidence on this strategy's cost-effectiveness. This study compared early insulin therapy versus oral anti-diabetic drugs (OADs) for managing T2DMusing a cost-effectiveness analysis approach in Iran. METHODS In this economic evaluation, a decision analytic model was designed. The target population was newly diagnosed type 2 diabetic patients, and the study was carried out from the perspective of Iran's healthcare system with a one-year time horizon. Basal insulin, Dipeptidyl peptidase-4 (DPP-4) inhibitors, and Thiazolidinediones (TZDs) were compared in this evaluation. The main outcome for assessing the effectiveness of each intervention was the reduction in the occurrence of diabetes complications. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and deterministic and probabilistic sensitivity analyses were carried out. RESULTS The DPP-4 inhibitors strategy was the dominant strategy with the highest effectiveness and the lowest cost. Early insulin therapy was dominated (ICER: $-53,703.18), meaning that it was not cost-effective. The sensitivity analyses consistently affirmed the robustness of the base case findings. The probabilistic sensitivity analysis indicated probabilities of 77%, 22%, and 1% for DPP-4 inhibitors, TZDs strategies, and early insulin therapy, respectively, in terms of being cost-effective. CONCLUSION In terms of cost-effectiveness, early insulin therapy was not cost-effective compared to OADs for managing newly diagnosed T2DM patients. Future studies in this regard, utilizing more comprehensive evidence, can yield more accurate results.
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Affiliation(s)
- Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Darvishi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Abdi Dezfouli
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Adeleh Nikkhah
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Radmanesh
- Department of Pharmacoeconomics and Pharmaceutical Management, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Elham Moslemi
- Department of Pharmacoeconomics and Pharmaceutical Management, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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Lechleitner M, Roden M, Weitgasser R, Ludvik B, Fasching P, Hoppichler F, Kautzky-Willer A, Schernthaner G, Prager R, Kaser S, Wascher TC. [Injection therapy of diabetes]. Wien Klin Wochenschr 2023; 135:45-52. [PMID: 37101024 PMCID: PMC10133050 DOI: 10.1007/s00508-023-02171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
The present article is a recommendation of the Austrian Diabetes Association for the practical use of injection therapy (GLP1-receptor agonists and insulin) in type 2 diabetes.
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Affiliation(s)
- Monika Lechleitner
- Avomed-Arbeitskreis für Vorsorgemedizin und Gesundheitsförderung in Tirol, Innsbruck, Österreich
| | - Michael Roden
- Klinik für Endokrinologie und Diabetologie, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetesforschung, Düsseldorf, Deutschland
- Deutsches Zentrum für Diabetesforschung (DZD e. V.), München-Neuherberg, Deutschland
| | - Raimund Weitgasser
- Abteilung für Innere Medizin, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich
- Universitätsklinik für Innere Medizin I, LKH Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Bernhard Ludvik
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
| | - Peter Fasching
- Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
| | - Friedrich Hoppichler
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Österreich
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Spitalgasse 23, 1090, Wien, Österreich.
| | - Guntram Schernthaner
- Department of Internal Medicine II, Medizinische Universität Wien, Wien, Österreich
| | - Rudolf Prager
- Stoffwechselzentrum im Rudolfinerhaus, Rudolfinerhaus Privatklinik, Wien, Österreich
| | - Susanne Kaser
- Department für Innere Medizin 1, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - T C Wascher
- Medizinische Abteilung, Hanusch-Krankenhaus, Wien, Österreich
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Jeon H, Kim W, Kim B, Shin J. Relationship between the early initiation of insulin treatment and diabetic complications in patients newly diagnosed with type 2 diabetes mellitus in Korea: A nationwide cohort study. J Diabetes Investig 2022; 13:830-838. [PMID: 34825507 PMCID: PMC9077737 DOI: 10.1111/jdi.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/24/2021] [Revised: 11/10/2021] [Accepted: 11/24/2021] [Indexed: 12/03/2022] Open
Abstract
AIMS/INTRODUCTION To evaluate the relationship between early insulin initiation within a year after type 2 diabetes mellitus diagnosis and the risk of diabetic complications. MATERIALS AND METHODS We carried out a cohort study using the Korean National Health Insurance Service database. The study participants were newly diagnosed with type 2 diabetes mellitus between 2009 and 2013. After applying propensity score matching (1:1) to the cohort of patients who received two or more oral antidiabetic drugs (OADs) or insulin as the first prescription within 1 year after type 2 diabetes mellitus diagnosis, we computed hazard ratios (HRs) and 95% confidence intervals (CIs) using a Cox proportional hazards regression to compare the risk of diabetes-related microvascular and macrovascular complications and all-cause mortality in insulin versus OAD initiators. RESULTS Within the cohort, 52,188 and 1,804 patients received OAD and insulin, respectively. After matching, each group contained 534 patients. Compared with the OAD group, the risk of overall microvascular complications was significantly higher for insulin (HR 1.48, 95% CI 1.28-1.71). No increased risks of overall macrovascular complications (HR 0.90, 95% CI 0.62-1.30) and all-cause mortality were observed (HR 1.06, 95% CI 0.67-1.68). CONCLUSIONS In the present study, early insulin treatment was not associated with the risk of macrovascular complications and all-cause mortality compared with OAD treatment; however, the risk of microvascular complications was higher in the insulin group.
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Affiliation(s)
- Ha‐Lim Jeon
- School of PharmacySungkyunkwan UniversitySuwonKorea
- Department of Biohealth Regulatory ScienceSungkyunkwan UniversitySuwonKorea
| | - Won Kim
- School of PharmacySungkyunkwan UniversitySuwonKorea
| | - Bongseong Kim
- Department of Statistics and Actuarial ScienceSoongsil UniversitySeoulKorea
| | - Ju‐Young Shin
- School of PharmacySungkyunkwan UniversitySuwonKorea
- Department of Biohealth Regulatory ScienceSungkyunkwan UniversitySuwonKorea
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST)Sungkyunkwan UniversitySeoulKorea
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Jude EB, Malecki MT, Gomez Huelgas R, Prazny M, Snoek F, Tankova T, Giugliano D, Khunti K. Expert Panel Guidance and Narrative Review of Treatment Simplification of Complex Insulin Regimens to Improve Outcomes in Type 2 Diabetes. Diabetes Ther 2022; 13:619-634. [PMID: 35274219 PMCID: PMC8913205 DOI: 10.1007/s13300-022-01222-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/02/2022] [Indexed: 11/03/2022] Open
Abstract
Given the progressive nature of type 2 diabetes (T2D), most individuals with the disease will ultimately undergo treatment intensification. This usually involves the stepwise addition of a new glucose-lowering agent or switching to a more complex insulin regimen. However, complex treatment regimens can result in an increased risk of hypoglycaemia and high treatment burden, which may impact negatively on both therapeutic adherence and overall quality of life. Individuals with good glycaemic control may also be overtreated with unnecessarily complex regimens. Treatment simplification aims to reduce individual treatment burden, without compromising therapeutic effectiveness or safety. Despite data showing that simplifying therapy can achieve good glycaemic control without negatively impacting on treatment efficacy or safety, it is not always implemented in clinical practice. Current clinical guidelines focus on treatment intensification, rather than simplification. Where simplification is recommended, clear guidance is lacking and mostly focused on treatment of the elderly. An expert, multidisciplinary panel evaluated the current treatment landscape with respect to guidance, published evidence, recommendations and approaches regarding simplification of complex insulin regimens. This article outlines the benefits of treatment simplification and provides practical recommendations on simplifying complex insulin treatment strategies in people with T2D using illustrative cases.
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Affiliation(s)
- Edward B Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
- University of Manchester, Manchester, UK
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Ricardo Gomez Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Martin Prazny
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Frank Snoek
- Department of Medical Psychology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Dario Giugliano
- Division of Endocrinology and Metabolic Diseases, University Hospital, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK.
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Kim HU, Park SP, Kim YK. Long-term HbA1c variability and the development and progression of diabetic retinopathy in subjects with type 2 diabetes. Sci Rep 2021; 11:4731. [PMID: 33637847 PMCID: PMC7910456 DOI: 10.1038/s41598-021-84150-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/12/2021] [Indexed: 01/02/2023] Open
Abstract
This study aimed to investigate whether long-term HbA1c variability is associated with the development and progression of diabetic retinopathy (DR) in subjects with type 2 diabetes. We retrospectively reviewed 434 type 2 diabetes subjects without DR who underwent regular DR screening. We reviewed fundus findings, collected HbA1c levels, and calculated the coefficient of variation (CV) and average real variability (ARV) of each subject’s HbA1c level. DR was developed in 55 subjects and progressed to moderate nonproliferative DR or worse DR in 23 subjects. On Cox proportional hazards regression analysis, HbA1c ARV, but not HbA1c CV, was significantly associated with DR development. However, the association between HbA1c variability and the DR progression rate to moderate nonproliferative DR or worse DR was not significant. The inter-visit HbA1c difference value on consecutive examination predicted DR development well and more careful screening for DR is needed for those with an absolute value change of 2.05%, an absolute increase of 1.75%, and an absolute decrease of 1.45% in HbA1c levels on consecutive examination. These results indicate that long-term glucose variability measured by HbA1c ARV might be an independent risk factor for DR development in addition to the mean HbA1c level in early diabetic subjects.
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Affiliation(s)
- Han Ul Kim
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Yong-Kyu Kim
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea.
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