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Gu S, Gu J, Wang X, Wang X, Li L, Gu H, Xu B. The long-term cost-effectiveness of once-weekly semaglutide versus sitagliptin for the treatment of type 2 diabetes in China. HEALTH ECONOMICS REVIEW 2024; 14:26. [PMID: 38564113 PMCID: PMC10988849 DOI: 10.1186/s13561-024-00499-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND To estimate the long-term cost-effectiveness of once-weekly semaglutide versus sitagliptin as an add-on therapy for type 2 diabetes patients inadequately controlled on metformin in China, to better inform healthcare decision making. METHODS The Cardiff diabetes model which is a Monte Carlo micro-simulation model was used to project short-term effects of once-weekly semaglutide versus sitagliptin into long-term outcomes. Short-term data of patient profiles and treatment effects were derived from the 30-week SUSTAIN China trial, in which 868 type 2 diabetes patients with a mean age of 53.1 years inadequately controlled on metformin were randomized to receive once-weekly semaglutide 0.5 mg, once-weekly semaglutide 1 mg, or sitagliptin 100 mg. Costs and quality-adjusted life years (QALYs) were estimated from a healthcare system perspective at a discount rate of 5%. Univariate sensitivity analysis, scenario analysis, and probabilistic sensitivity analysis were conducted to test the uncertainty. RESULTS Over patients' lifetime projections, patients in both once-weekly semaglutide 0.5 mg and 1 mg arms predicted less incidences of most vascular complications, mortality, and hypoglycemia, and lower total costs compared with those in sitagliptin arm. For an individual patient, compared with sitagliptin, once-weekly semaglutide 0.5 mg conferred a small QALY improvement of 0.08 and a lower cost of $5173, while once-weekly semaglutide 1 mg generated an incremental QALY benefit of 0.12 and a lower cost of $7142, as an add-on to metformin. Therefore, both doses of once-weekly semaglutide were considered dominant versus sitagliptin with more QALY benefits at lower costs. CONCLUSION Once-weekly semaglutide may represent a cost-effective add-on therapy alternative to sitagliptin for type 2 diabetes patients inadequately controlled on metformin in China.
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Affiliation(s)
- Shuyan Gu
- Center for Health Policy and Management Studies, School of Government, Nanjing University, 163 Xianlin Road, Nanjing, 210023, Jiangsu, China
| | - Jinghong Gu
- Department of Economics, University of Washington, Seattle, WA, USA
| | - Xiaoyong Wang
- Health Insurance Office, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaoling Wang
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Li
- Department of Pharmacy, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hai Gu
- Center for Health Policy and Management Studies, School of Government, Nanjing University, 163 Xianlin Road, Nanjing, 210023, Jiangsu, China.
| | - Biao Xu
- Center for Health Policy and Management Studies, School of Government, Nanjing University, 163 Xianlin Road, Nanjing, 210023, Jiangsu, China.
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Liang D, Zhu W, Huang J, Dong Y. A health economic analysis of an integrated diabetes care program in China: based on real-world evidence. Front Public Health 2023; 11:1211671. [PMID: 38169641 PMCID: PMC10758444 DOI: 10.3389/fpubh.2023.1211671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction An integrated care program was set up in China to improve the collaboration between primary healthcare centers and hospitals on diabetes management. This study aims to evaluate the economic value of this program with real-world data and to examine whether it can be promoted in primary healthcare settings in China. Methods This integrated diabetes care program was implemented in Yuhuan City, China, to coordinate primary care and specialty care, treatment and prevention services, as well as the responsibilities of doctors and nurses. Cost-effectiveness analysis was used to compare the short-term economic value of this program (intervention group) versus usual diabetes management (control group). The cost data were collected from a societal perspective, while the effectiveness indicators pointed to the improvement of control rates of fasting blood glucose (FBG), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels after the 1 year intervention. In addition, cost-utility analysis was applied to evaluate the long-term value of the two groups. Patients' long-term diabetes management costs and quality-adjusted life years (QALYs) were simulated by the United Kingdom Prospective Diabetes Study Outcomes Model 2. Results The results showed that for 1% FBG, SPB, and DBP control rate improvement, the costs for the intervention group were 290.53, 124.39, and 249.15 Chinese Yuan (CNY), respectively, while the corresponding costs for the control group were 655.19, 610.43, and 1460.25 CNY. Thus, the intervention group's cost-effectiveness ratios were lower than those of the control group. In addition, compared to the control group, the intervention group's incremental costs per QALY improvement were 102.67 thousand CNY, which means that the intervention was cost-effective according to the World Health Organization's standards. Discussion In conclusion, this study suggested that this integrated diabetes care program created short-term and long-term economic values through patient self-management support, primary care strengthening, and care coordination. As this program followed the principles of integrated care reform, it can be promoted in China. Also, its elements can provide valuable experience for other researchers to build customized integrated care models.
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Affiliation(s)
- Di Liang
- School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment, National Health Commission, Shanghai, China
| | - Wenjun Zhu
- School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment, National Health Commission, Shanghai, China
| | - Jiayan Huang
- School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment, National Health Commission, Shanghai, China
| | - Yin Dong
- The People’s Hospital of Yuhuan, Taizhou, China
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Zhang L, Liu H, Zou Z, Su S, Ong JJ, Ji F, Cui F, Chan PL, Ning Q, Li R, Shen M, Fairley CK, Liu L, Seto WK, Wong WC. Shared-care models are highly effective and cost-effective for managing chronic hepatitis B in China: reinterpreting the primary care and specialty divide. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 35:100737. [PMID: 37424676 PMCID: PMC10326699 DOI: 10.1016/j.lanwpc.2023.100737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/22/2023]
Abstract
Background We evaluate the impact and cost-effectiveness of shared primary-specialty chronic hepatitis B (CHB) care models in China. Methods We constructed a decision-tree Markov model to simulate hepatitis B virus (HBV) disease progression in a cohort of 100,000 CHB individuals aged ≥18 years over their lifetime (aged 80). We evaluated the population impacts and cost-effectiveness in three scenarios: (1) status quo; (2) shared-care model with HBV testing and routine CHB follow-ups in primary care and antiviral treatment initiation in specialty care; and (3) shared-care model with HBV testing, treatment initiation and routine CHB follow-up in primary care and treatment for predetermined conditions in specialty care. We evaluated from a healthcare provider's perspective with 3% discounting rate and a willingness-to-pay (WTP) threshold of 1-time China's GDP. Findings Compared with status quo, scenario 2 would result in an incremental cost of US$5.79-132.43m but a net gain of 328-16,993 quality-adjusted life years (QALYs) and prevention of 39-1935 HBV-related deaths over cohort's lifetime. Scenario 2 was not cost-effective with a WTP of 1-time GDP per capita, but became cost-effective when treatment initiation rate increased to 70%. In contrast, compared with status quo, secnario 3 would save US$144.59-192.93m in investment and achieve a net gain of 23,814-30,476 QALYs and prevention of 3074-3802 HBV-related deaths. Improving HBV antiviral treatment initiation among eligible CHB individuals substantially improved the cost-effectiveness of the shared-care models. Interpretation Shared-care models with HBV testing, follow up and referring of predetermined conditions to specialty care at an appropriate time, especially antiviral treatment initiation in primary care, are highly effective and cost-effective in China. Funding National Natural Science Foundation of China.
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Affiliation(s)
- Lei Zhang
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Hanting Liu
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Zhuoru Zou
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Shu Su
- Clinical Research Management Office, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jason J. Ong
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
| | - Fanpu Ji
- Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fuqiang Cui
- School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Po-lin Chan
- Division of Communicable Disease, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Qin Ning
- Department and Institute of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Mingwang Shen
- China–Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Lan Liu
- Chinese Medical Association Publishing House, 69 Dongheyanjie Street, XiCheng District, Beijing, China
| | - Wai-Kay Seto
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Medicine, School of Clinical Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China
| | - William C.W. Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Liu X, Zhang L, Chen W. Trends in economic burden of type 2 diabetes in China: Based on longitudinal claim data. Front Public Health 2023; 11:1062903. [PMID: 37143967 PMCID: PMC10151735 DOI: 10.3389/fpubh.2023.1062903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/29/2023] [Indexed: 05/06/2023] Open
Abstract
Objective Diabetes is a major health issue in China that has a significant economic burden on society. Understanding the economic impact of diabetes can help policymakers make informed decisions about healthcare spending and priorities. This study aims to estimate the economic burden of patients with diabetes in an urban setting in China and to identify the impact of hospitalization and complications on health care costs for people with diabetes. Methods The study was conducted in a sample city located in eastern China. All patients diagnosed with diabetes before January 2015 were identified from the official health management information system, and their social demographics and records of their health care uses and costs were extracted from the claim database from 2014 to 2019. Six groups of complications were identified according to ICD-10 codes. The diabetes-related direct medical cost (DM cost) was described for patients in stratified groups. A multiple linear regression model was applied to identify the effect of hospitalization and complications on the DM cost of diabetic patients. Results Our research included 44,994 patients with diabetes, the average annual DM costs for diabetic patients increased from 1,292.72 USD in 2014 to 2,092.87 USD in 2019. The costs of diabetes are closely related to hospitalizations and the type and number of complications. The average annual DM cost of patients who were hospitalized was 2.23 times that of those without hospitalization, and it rose as the number of complications increased. Cardiovascular complications and nephropathic complications were the complications that had the greatest impact on patients' DM costs, increasing by an average of 65 and 54%, respectively. Conclusion The economic burden of diabetes in urban China has increased significantly. Hospitalization and the type and number of complications have significant impacts on the economic burden of patients with diabetes. Efforts should be made to prevent the development of long-term complications in the population with diabetes.
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Xu C, Shen P, Lu F, Chen X, Zhang J, Zhong J. The Impact of a Family Doctor Contract Service on Outcomes for Type 2 Diabetes Patients in Zhejiang Province. Asia Pac J Public Health 2022; 34:643-648. [PMID: 35950322 DOI: 10.1177/10105395221113778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study evaluated the effect of family doctor contract service on the health management in Chinese type 2 diabetes mellitus (T2DM) patients over a 24-month period. According to whether patients signing contracts with family doctors or not, the contracting status was divided into contracted and noncontracted. The analysis of covariance was used to examine changes in weight, body mass index, waist circumference, systolic blood pressure, fasting plasma glucose, and lipid parameters between the two groups. The hazard ratios for incident diabetes-related complications were calculated using a Cox proportional hazard model. Of the 2310 patients, 1155 were contracted. The contracted patients displayed the improved fasting blood glucose control and lower low-density lipoprotein cholesterol level than the noncontracted group. Patients signed up with family doctors had a lower risk of diabetes-related complications than those who did not. The data suggested that family doctor contract service might help to achieve better T2DM control.
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Affiliation(s)
- Chunxiao Xu
- Department of Chronic Non-Communicable Diseases Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, P.R. China
| | - Peng Shen
- Department of Chronic Diseases and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, P.R. China
| | - Feng Lu
- Department of Chronic Non-Communicable Diseases Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, P.R. China
| | - Xiangyu Chen
- Department of Chronic Non-Communicable Diseases Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, P.R. China
| | - Jie Zhang
- Department of Chronic Non-Communicable Diseases Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, P.R. China
| | - Jieming Zhong
- Department of Chronic Non-Communicable Diseases Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, P.R. China
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Wang J, Wu W, Dong G, Huang K, Fu J. Pediatric diabetes in China: Challenges and actions. Pediatr Diabetes 2022; 23:545-550. [PMID: 35419896 DOI: 10.1111/pedi.13344] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/05/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022] Open
Abstract
Pediatric diabetes is growing in China. The annual incidence of childhood type 1 diabetes is about 2.02-5.3 per 100,000 person-years. Type 2 diabetes in children and adolescents is increasing dramatically with the high-speed urbanization of China. The prevalence of type 2 diabetes varies from 1.64/100, 000 to 15.16/100,000 based on the geography and economy. Monogenic diabetes used to be underestimated in China and now more cases are emerging. In this review, we give an overview of pediatric diabetes in China, present the progresses and challenges in management of pediatric diabetes, and discuss the government policy and potential actions in China, for better life quality of diabetic families.
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Affiliation(s)
- Jinling Wang
- Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Wei Wu
- Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guanping Dong
- Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ke Huang
- Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Junfen Fu
- Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Hu S, Wang S, Qi C, Gu S, Shi C, Mao L, Fan G. Cost-Utility Analysis of Once-Weekly Semaglutide, Dulaglutide, and Exenatide for Type 2 Diabetes Patients Receiving Metformin-Based Background Therapy in China. Front Pharmacol 2022; 13:831364. [PMID: 35250578 PMCID: PMC8894868 DOI: 10.3389/fphar.2022.831364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/31/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: The substantial financial burden associated with type 2 diabetes (T2D) over a lifetime cannot be neglected. Therefore, the objective of this study was to evaluate the pharmacoeconomic value of three once-weekly GLP-1 RAs, namely subcutaneous semaglutide (sc. SEMA), dulaglutide (DULA), and extended-release exenatide (e-r EXEN), in treating patients with T2D that cannot be controlled with metformin-based background therapy, and to find a suitable price reduction for non-cost-effective medications, to provide reasonable recommendations to the administration for adjusting drug prices. Methods: The baseline characteristics of the simulation patient cohort were sourced from a comprehensive meta-analysis synthesizing 453 trials evaluating 21 hypoglycemic agents from nine categories of drugs. The UKPDS OM2 was applied to project the long-term effectiveness and costs from a Chinese health care provider’s perspective. After cost-utility analysis, the reasonable price adjustment of non-cost-effective options was explored via binary search. Uncertainty was measured by means of sensitivity analysis. Results: After a 40-year simulation, the sc. SEMA, DULA, and e-r EXEN groups yielded 9.6315, 9.5968, and 9.5895 quality-adjusted life years (QALYs), respectively. In terms of expenditure, the total costs for the sc. SEMA, DULA, and e-r EXEN groups were $42012.47, $24931.27, and $40264.80, respectively. DULA was dominant over e-r EXEN due to the higher QALYs and lower total costs. The ICURs of sc. SEMA vs. DULA and sc. SEMA vs. e-r EXEN were $492994.72/QALY and $41622.69/QALY (ICUR > λ), respectively, indicating that sc. SEMA was not more cost-effective than DULA or e-r EXEN. The INMB and absolute NMB yielded the same conclusions which were robust to one-way, scenario, and probabilistic sensitivity analyses. After several assumptions in the binary search, sc. SEMA and e-r EXEN appear to become cost-effective when their annual costs are decreased by 57.67% and 70.34%, respectively, with DULA as a counterpart. Conclusion: From the cost-utility analysis, DULA appears to be the most cost-effective option among sc. SEMA, DULA, and e-r EXEN for the treatment of patients with T2D receiving metformin-based background therapy. With a 57.67% or 70.34% reduction in cost, sc. SEMA or e-r EXEN, respectively, would become as cost-effective as DULA in China.
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Liu S, Liu J, Yu Y, Si L, Tang C, Liu Z, Chen Y. What Is Valued Most by Patients With Type 2 Diabetes Mellitus When Selecting Second-Line Antihyperglycemic Medications in China. Front Pharmacol 2022; 12:802897. [PMID: 35002736 PMCID: PMC8733399 DOI: 10.3389/fphar.2021.802897] [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] [Received: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 11/14/2022] Open
Abstract
Objective: To estimate patient preferences for second-line antihyperglycemic medications in China. Methods: A face to face survey with the best-worst scaling (BWS) choices was administered in patients with diagnosed type 2 diabetes mellitus (T2DM). Study participants were asked to indicate which attribute they valued most and which attribute they valued least in 11 choice sets, each of which consisted of five alternatives out of 11 antihyperglycemic medication-specific attributes (treatment efficacy, weight change, hypoglycemic events, gastrointestinal side effects, cardiovascular health, urinary tract infection and genital infection side effects, edema, mode of administration, bone fracture, dosing frequency and out-of-pocket cost). A counting approach, a conditional logit model, and K-means clustering were used to estimate the relative importance of items and preference heterogeneity. Results: A total of 362 participants were included with a mean age of 63.6 (standard deviation: 11.8) years. There were 56.4% of participants were women, and 56.3% being diagnosed with diabetes for at least 5 years. Efficacy, cardiovascular health and hypoglycemic events were valued most, while dosing frequency, mode of administration and bone fracture were valued least. The K-means clustering further showed preference heterogeneity in out-of-pocket cost across the participants. Conclusion: Our study suggests that treatment efficacy, cardiovascular health and hypoglycemic events are valued most by Chinese patients with T2DM when selecting second-line antihyperglycemic medications. The study improves the understanding of patients’ preferences for second-line antihyperglycemic medications in China.
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Affiliation(s)
- Shimeng Liu
- School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Jing Liu
- School of Management, Hainan Medical University, Haikou, China
| | - Yijiang Yu
- Huai'an Hospital of Traditional Chinese Medicine, Huai'an, China
| | - Lei Si
- The George Institute for Global Health, UNSW Sydney, Kensington, NSW, Australia
| | - Chengxiang Tang
- School of Public Administration, Guangzhou University, Guangzhou, China
| | - Zhigang Liu
- School of Management, Hainan Medical University, Haikou, China
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
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Yu Y, Xie K, Lou Q, Xia H, Wu D, Dai L, Hu C, Shan S, Wang K, Tang W. The clinical characteristics of Chinese elderly patients with different durations of type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2022; 13:904347. [PMID: 35966087 PMCID: PMC9372462 DOI: 10.3389/fendo.2022.904347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS To explore the clinical characteristics among elderly (aged ≥60 years) patients with type 2 diabetes (T2DM) of different durations. METHODS Clinical characteristics were investigated in 3840 elderly T2DM patients according to their different durations of diabetes (< 1 year, 1~5 years, 5~10 years, and ≥ 10 years). Kruskal-Wallis and Dunn tests were used to assess the differences among groups for continuous variables. The chi-square and post hoc tests were carried out for dichotomous variables. The logistic regression was adopted to investigate the relationships between various durations of diabetes and the control rates of achieving the control targets for T2DM as well as diabetic vascular complications. RESULTS There were 972, 896, 875 and 1097 patients with a duration of diabetes of <1, 1~5, 5~10 and ≥10 years, respectively. In logistic regression models adjusted for age, sex, education, BMI, smoking and family history of diabetes, elderly T2DM patients with a duration of diabetes of ≥10 years were more likely to reach the comprehensive control targets for TC (ORTC = 1.36, 95% CI =1.14-1.63), LDL-C (ORLDL-C = 1.39, 95% CI =1.17-1.66), TG (ORTG = 1.76, 95% CI =1.46-2.12) and BMI (ORBMI = 1.82, 95% CI =1.52-2.18). Elderly T2DM patients with a duration of diabetes of 1~5 years were more likely to achieve the HbA1c control target (ORHbA1c = 1.92, 95% CI = 1.59-2.31) than elderly T2DM patients with a duration of diabetes of <1 year. Furthermore, in elderly T2DM patients with a duration of diabetes of 5~10 years or ≥ 10 years, the duration of diabetes was positively associated with diabetic macrovascular complications (coronary heart disease and peripheral artery disease). In elderly T2DM patients with a duration of diabetes of over 10 years, the duration of diabetes was associated with diabetes kidney disease (all P < 0.05). CONCLUSIONS It is worth noting that the clinical characteristics of elderly patients with type 2 diabetes in different durations of diabetes are different.
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Affiliation(s)
- Yun Yu
- Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Kaipeng Xie
- Department of Public Health, Nanjing Maternity and Child Health Care Hospital, Women’s Hospital of Nanjing Medical University, Nanjing, China
| | - Qinglin Lou
- Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Xia
- Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Dan Wu
- Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Lingli Dai
- Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Cuining Hu
- Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Shan Shan
- Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Kunlin Wang
- Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Tang
- Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Wei Tang,
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Ding C, Bao Y, Bai B, Liu X, Shi B, Tian L. An update on the economic burden of type 2 diabetes mellitus in China. Expert Rev Pharmacoecon Outcomes Res 2021; 22:617-625. [PMID: 34937503 DOI: 10.1080/14737167.2022.2020106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study aims to update the statistics on the economic burden of T2DM and to identify the factors affecting the economic costs of T2DM in China. METHODS This study conducts a systematic review of the existing literature that has reported on the direct economic costs (mainly the direct medical resource consumption) and indirect economic costs (mainly non-medical costs and intangible costs) of T2DM as of 31 May 2019. RESULTS The total expenditure on diabetes in China's western region is still relatively low. Additionally, the mean direct costs of T2DM are high in China's northern urban areas. However, compared to urban areas, in rural areas, the largest proportion of the total economic costs of T2DM is the mean indirect costs. Furthermore, age, sex, type and number of complications, type of medical insurance, diabetes duration, level of education, and income are the primary factors that influence the economic burden of T2DM. CONCLUSION There is a considerable economic burden associated with T2DM in China. Therefore, to address the economic burden of T2DM, it is vital to take measures to reduce the prevalence rate of diabetes.
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Affiliation(s)
- Chunchun Ding
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, Gansu Province, China
| | - Yun Bao
- Institute of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, Gansu Province, China
| | - Bona Bai
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China.,The First School of Clinical Medicine, Lanzou University, Lanzhou 730000, Gansu Province, China
| | - Xuerun Liu
- The First School of Clinical Medicine, Lanzou University, Lanzhou 730000, Gansu Province, China
| | - Bingyin Shi
- Department of Endocrinology and Metabolism, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shanxi Province, China
| | - Limin Tian
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China.,Clinical Research Center for Metabolic Diseases, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
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11
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Gao D, Yu P, Jing S, Yan C, Ding D, Qiao Y, Wu G. miR-193a as a potential mediator of WT-1/synaptopodin in the renoprotective effect of losartan on diabetic kidney. Can J Physiol Pharmacol 2021; 100:26-34. [PMID: 34411489 DOI: 10.1139/cjpp-2021-0150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Diabetic nephropathy (DN) is the most common complication of diabetic patients, and has become a global healthcare problem. In this study, we used diabetic mice to evaluate the effect of Losartan on diabetic nephropathy, in which the experimental animals were divided into three groups: non-diabetic mice (db/m group), untreated-diabetic mice (db/db group), and Losartan-treated diabetic mice (db/db-losartan). Next, immunohistochemistry and immunofluorescence were used to detect WT-1 and synaptopodin expression, respectively. Protein levels of WT-1, synaptopodin, claudin1, and Pax-2 were assessed by Western blotting and real-time PCR. The miR-193a mRNA levels were quantitated by real-time PCR. The results showed that albuminuria was increased in diabetic mice compared with control animals and was significantly ameliorated by treatment with Losartan. In addition, Losartan significantly upregulated the immunopositive cell numbers of WT-1, the expression of WT-1 and synaptopodin in renal tissue. By contrast, expression of claudin1 and Pax-2 in renal tissue were decreased in db/db-losartan group. Besides, expression of miR-193a was decreased significantly in db/db-losartan group compared to the untreated diabetic group. Thus, Losartan has renoprotective effects on the control of tissue damage possibly by inhibiting the expression of miR-193a, thereby promoting the repair of podocyte injury in mice with diabetic nephropathy.
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Affiliation(s)
- Dan Gao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;
| | - Pei Yu
- The First Affiliated Hospital of Zhengzhou University, Department of Nephrology, Zhengzhou, China;
| | - Sanhui Jing
- The First Affiliated Hospital of Zhengzhou University, Department of Nephrology, Zhengzhou, China.,Heze Hospital of Traditional Chinese Medicine, Department of Nephrology, Heze, China;
| | - Chengcheng Yan
- The First Affiliated Hospital of Zhengzhou University, Department of Nephrology, Zhengzhou, China;
| | - Dandan Ding
- The First Affiliated Hospital of Zhengzhou University, Department of Nephrology, Zhengzhou, China;
| | - Yingjin Qiao
- The First Affiliated Hospital of Zhengzhou University, Blood Purification Center, Zhengzhou, China;
| | - Ge Wu
- The First Affiliated Hospital of Zhengzhou University, Department of Nephrology, Zhengzhou, China;
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12
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Artificial Intelligence-Based Diagnosis of Diabetes Mellitus: Combining Fundus Photography with Traditional Chinese Medicine Diagnostic Methodology. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5556057. [PMID: 33969117 PMCID: PMC8081616 DOI: 10.1155/2021/5556057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/02/2021] [Accepted: 04/05/2021] [Indexed: 12/12/2022]
Abstract
In this study, we propose a technique for diagnosing both type 1 and type 2 diabetes in a quick, noninvasive way by using equipment that is easy to transport. Diabetes mellitus is a chronic disease that affects public health globally. Although diabetes mellitus can be accurately diagnosed using conventional methods, these methods require the collection of data in a clinical setting and are unlikely to be feasible in areas with few medical resources. This technique combines an analysis of fundus photography of the physical and physiological features of the patient, namely, the tongue and the pulse, which are used in Traditional Chinese Medicine. A random forest algorithm was used to analyze the data, and the accuracy, precision, recall, and F1 scores for the correct classification of diabetes were 0.85, 0.89, 0.67, and 0.76, respectively. The proposed technique for diabetes diagnosis offers a new approach to the diagnosis of diabetes, in that it may be convenient in regions that lack medical resources, where the early detection of diabetes is difficult to achieve.
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13
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Guo J, Wu Y, Deng X, Liu Z, Chen L, Huang Y. Association between social determinants of health and direct economic burden on middle-aged and elderly individuals living with diabetes in China. PLoS One 2021; 16:e0250200. [PMID: 33857252 PMCID: PMC8049277 DOI: 10.1371/journal.pone.0250200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/02/2021] [Indexed: 12/14/2022] Open
Abstract
Aims The aim of this study was to determine the association between social determinants of health and direct economic burden on Chinese middle-aged and elderly individuals living with diabetes in China. Methods This study used data from the baseline wave of The China Health and Retirement Longitudinal Study (CHARLS) database, covering 17,708 middle-aged and elderly residents in China. The population with diabetes was grouped into those diagnosed with diabetes mellitus (DDM) and those undiagnosed with diabetes mellitus (UDM). Direct economic cost data, including total direct medical costs (TC) and out-of-pocket (OOP) payments, were extracted as outcome variables. A two-part model was applied to analyze the association between social determinants of health and direct economic burden. Results In our analysis, we included 958 patients with DDM and 1,285 patients with UDM. The mean TC and OOP payments were 11,193 CNY (US $1,733; 6.46 CNY = 1 USD) and 7,266 CNY (US $1,125) in DDM patients, and 3,700 CNY (US $573) and 3,060 CNY (US $474) in UDM patients. Rural-urban status (p<0.05), regional status (p<0.05), household personal consumption expenditures (p<0.05), and comorbidities(p<0.05) were crucial factors associated with medical costs in people with diabetes. Conclusion Although progress has been made in the development of current health policies intended to contain the direct economic burden of diabetes, the gaps in that burden in populations with different social characteristics remains a burning issue. More policy breakthroughs are needed to achieve health equity.
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Affiliation(s)
- Jianwei Guo
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yun Wu
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xinlei Deng
- Department of Environmental Health Sciences, University at Albany, the State University of New York, Rensselaer, New York, United States of America
| | - Zifeng Liu
- Department of Clinical Data Center, the 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lijin Chen
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yixiang Huang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- * E-mail:
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14
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Hong Y, Wang J, Zhang L, Sun W, Xu X, Zhang K. Plasma miR-193a-3p can be a potential biomarker for the diagnosis of diabetic nephropathy. Ann Clin Biochem 2021; 58:141-148. [PMID: 33302703 DOI: 10.1177/0004563220983851] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Diabetic nephropathy is one of the most common microvascular complications in patients with diabetes. MicroRNA (miRNA, miR) is closely related to the formation, development and pathophysiology of diabetic nephropathy. We aimed to investigate whether miR-193a-3p could be used as a potential biomarker for the diagnosis of diabetic nephropathy. METHODS Plasma samples were collected from all the participants. TaqMan Low Density Array analysis was employed to obtain the miRNA profiles of plasma samples, and qRT-PCR was used to confirm the result. Receiver operating characteristic curves were employed to evaluate the specificity and sensitivity of miR-193a-3p for predicting diabetic nephropathy. RESULTS The expression of miR-193a-3p and miR-320c was elevated and miR-27a-3p was decreased in diabetic nephropathy patients compared to patients with type 2 diabetes and healthy controls. We found that, in diabetic nephropathy patients, the elevated miR-193a-3p expression had a negative correlation with the level of evaluate glomerular filtration rate, while a positive correlation with the level of proteinuria. We further demonstrated that miR-193a-3p could be employed to distinguish patients with diabetic nephropathy. The Kaplan-Meier analysis showed that the high expression of miR-193a-3p significantly shortened the dialysis-free survival of diabetic nephropathy patients. CONCLUSION In conclusion, miR-193a-3p is involved in diabetic nephropathy pathogenesis and may serve as a potentially novel diagnostic biomarker for diabetic nephropathy.
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Affiliation(s)
- Yan Hong
- Department of Nephrology, the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China.,Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
| | - Jidong Wang
- Department of Nephrology, the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China.,Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
| | - Lai Zhang
- Department of Nephrology, the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China.,Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
| | - Wenjuan Sun
- Department of Nephrology, the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China.,Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
| | - Xuefang Xu
- Department of Nephrology, the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China.,Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
| | - Kaiyue Zhang
- Department of Nephrology, the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China.,Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
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15
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Shao X, Wang Y, Huang S, Liu H, Zhou S, Zhang R, Yu P. Development and validation of a prediction model estimating the 10-year risk for type 2 diabetes in China. PLoS One 2020; 15:e0237936. [PMID: 32881911 PMCID: PMC7470416 DOI: 10.1371/journal.pone.0237936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/05/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To derive and validate a concise prediction model estimating the 10-year risk for type 2 diabetes (T2DM) in China. METHODS A total of 11494 subjects from the China Health and Nutrition Survey recorded from 2004 to 2015 were analyzed and only 6023 participants were enrolled in this study. Four logistic models were analyzed using the derivation cohort. Methods of calibration and discrimination were used for the validation cohort. RESULTS In the derivation cohort, 257 patients were identified from a total of 4498 cases. In the validation cohort, 92 patients were identified from a total of 1525 cases. Four models performed nicely for both calibration and discrimination. The AUC in the derivation cohort for models A, B, C and D were 0.788 (0.761-0.816), 0.807 (0.780-0.834), 0.905 (0.879-0.932) and 0.882 (0.853-0.912), respectively. The Youden index for models A, B, C and D were 1.46, 1.48, 1.67 and 1.65, respectively. Model C showed the highest sensitivity and model D showed the highest specificity. CONCLUSION Models A and B were non-invasive and can be used to identify high-risk patients for broad screening. Models C and D may be used to provide more accurate assessments of diabetes risk. Furthermore, model C showed the best performance for predicting T2DM risk and identifying individuals who are in need of interventions, current approach improvement and additional follow-up.
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Affiliation(s)
- Xian Shao
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Yao Wang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Shuai Huang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Hongyan Liu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Saijun Zhou
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Rui Zhang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Pei Yu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
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16
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Does the Encounter Type Matter When Defining Diabetes Complications in Electronic Health Records? Med Care 2020; 58 Suppl 6 Suppl 1:S53-S59. [PMID: 32011424 DOI: 10.1097/mlr.0000000000001297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Electronic health records (EHRs) and claims records are widely used in defining type 2 diabetes mellitus (T2DM) complications across different types of health care encounters. OBJECTIVE This study investigates whether using different EHR encounter types to define diabetes complications may lead to different results when examining associations between diabetes complications and their risk factors in patients with T2DM. RESEARCH DESIGN The study cohort of 64,855 adult patients with T2DM was created from EHR data from the Research Action for Health Network (REACHnet), using the Surveillance Prevention, and Management of Diabetes Mellitus (SUPREME-DM) definitions. Incidence of coronary heart disease (CHD) and stroke events were identified using International Classification of Diseases (ICD)-9/10 codes and grouped by encounter types: (1) inpatient (IP) or emergency department (ED) type, or (2) any health care encounter type. Cox proportional hazards regression was used to estimate associations between diabetes complications (ie, CHD and stroke) and risk factors (ie, low-density lipoprotein cholesterol and hemoglobin A1c). RESULTS The incidence rates of CHD and stroke in all health care settings were more than twice the incidence rates of CHD and stroke in IP/ED settings. The age-adjusted and multivariable-adjusted hazard ratios for incident CHD and stroke across different levels of low-density lipoprotein cholesterol and hemoglobin A1c were similar between IP/ED and all settings. CONCLUSION While there are large variations in incidence rates of CHD and stroke as absolute risks, the associations between both CHD and stroke and their respective risk factors measured by hazard ratios as relative risks are similar, regardless of alternative definitions.
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17
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Alzaid A, Ladrón de Guevara P, Beillat M, Lehner Martin V, Atanasov P. Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses. Expert Rev Pharmacoecon Outcomes Res 2020; 21:785-798. [PMID: 32686530 DOI: 10.1080/14737167.2020.1782748] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: To estimate the clinical and economic burden of type 2 diabetes (T2D) in established (EST) and emerging markets (EMG).Methods: Three systematic literature reviews were conducted in MEDLINE and Embase to capture all relevant publications reporting 1) the epidemiology of T2D and complications in T2D and 2) the economic burden of T2D and associated complications.Results: In total, 294 studies were included in this analysis. Evidence indicates a high and increasing overall prevalence of T2D globally, ranging up to 23% in EMG markets and 14% in EST markets. Undiagnosed cases were higher in EMG versus EST markets (up to 67% vs 38%), potentially due to a lack of education and disease awareness in certain regions, that could lead to important clinical and economic consequences. Poor glycemic control was associated with the development of several complications (e.g. retinopathy, cardiovascular diseases and nephropathy) that increase the risk of morbidity and mortality. Direct costs were up to 9-fold higher in patients with vs without T2D-related complications.Conclusions: The burden of T2D, related complications and inherent costs are higher in emerging versus established market countries. This review explores potential strategies to reduce costs and enhance outcomes of T2D treatment in developing countries.
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Affiliation(s)
- Aus Alzaid
- Consultant Diabetologist, Riyadh, Saudi Arabia
| | - Patricia Ladrón de Guevara
- Health Economics & Market Access, Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | - Maud Beillat
- Global Market Access, Health Economics & Outcomes Research, Servier Global Market Access & HEOR, France
| | | | - Petar Atanasov
- Health Economics & Market Access, Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
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18
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Gao L, Wang X. Healthcare Supply Chain Network Coordination Through Medical Insurance Strategies with Reference Price Effect. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3479. [PMID: 31540517 PMCID: PMC6766012 DOI: 10.3390/ijerph16183479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/17/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022]
Abstract
China has established the universal medical insurance system and individual out of pocket costs have decreased, however, the average healthcare expenditure of the Chinese population and the expenses of the whole society have increased substantially. One major challenge which impedes the progress of attaining sustainable development of the social healthcare system in China is that the number of hospital admissions is disproportionate. Superior hospitals are overcrowded, whereas subordinate hospitals are experiencing low admissions. In this paper, we apply the game theory model to coordinate the healthcare supply chain network, which is composed of the government, medical insurance fund, superior hospitals, subordinate hospitals and patients. Especially by taking the reference price effect into account, this paper analyzes different medical insurance reimbursement strategies and their influence on patient choice and the healthcare supply chain network. The result shows that the reference price effect increases the leverage of medical insurance, guides patients' choice, optimizes the allocation of medical resources and reduces the medical expends. In comparison to a decentralized decision- making strategy, a centralized decision- making strategy can stimulate both superior hospital and subordinate hospital's cooperative intentions which benefits the social healthcare system.
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Affiliation(s)
- Lingyu Gao
- School of Economics and Management, Tongji University, Shanghai 201804, China.
| | - Xiaoli Wang
- School of Economics and Management, Tongji University, Shanghai 201804, China.
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19
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Duan X, Li Y, Liu Q, Liu L, Li C. Epidemiological characteristics, medical costs and healthcare resource utilization of diabetes-related complications among Chinese patients with type 2 diabetes mellitus. Expert Rev Pharmacoecon Outcomes Res 2019; 20:513-521. [PMID: 31456456 DOI: 10.1080/14737167.2019.1661777] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives: To estimate the direct medical costs (DMCs) and healthcare resource utilization (HRU) of type 2 diabetes mellitus (T2DM)-related complications in China. Methods: Data from a total of 74,507 patients were extracted from the 2015 China Health Insurance Research Association Claims Database. The complications determined by primary diagnoses were categorized into three groups: 1) for mild acute and local chronic complications, both outpatients and inpatients were considered; 2) for severe acute complications, only inpatiens were considered; 3) for systemic chronic complications, a 1:1 propensity-score matching was performed to calculate the incremental DMCs and HRU of preexisting and new-onset patients. Results: Among the mild acute and local chronic complications, the DMCs and HRU per event were the highest for gangrene and laser treatment. Of the severe acute complications, the DMCs and HRU per event were highest for hyperosmotic nonketonic diabetic coma (HNDC), followed by severe hypoglycemia and ketosis. For systemic chronic complications, the DMCs and HRU associated with dialysis and myocardial infarction were the highest both in patients with new-onset complications and preexisting complications. Conclusions: The estimated economic data are required for policy decisions to optimize resource allocation and to evaluate different approaches for disease management.
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Affiliation(s)
- Xiaotuo Duan
- Health Economics and Outcome Research, Beijing Brainpower Pharma Consulting Co. Ltd , Beijing, China
| | - Yunguang Li
- Medical Department, Sanofi , Shanghai, China
| | - Qingjing Liu
- Beijing North Medical & Health Economic Research Center , Beijing, China
| | - Li Liu
- Health Economics and Outcome Research, Sanofi , Shanghai, China
| | - Chaoyun Li
- Health Economics and Outcome Research, Sanofi , Shanghai, China
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20
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Zhu HT, Yu M, Hu H, He QF, Pan J, Hu RY. Factors associated with glycemic control in community-dwelling elderly individuals with type 2 diabetes mellitus in Zhejiang, China: a cross-sectional study. BMC Endocr Disord 2019; 19:57. [PMID: 31170961 PMCID: PMC6555723 DOI: 10.1186/s12902-019-0384-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although exercise seems to be beneficial for type 2 diabetes mellitus (T2DM) patients, there is limited research elucidating the optimal accessible indices of adiposity and insulin resistance for identifying elderly T2DM patients with poor glycemic control, which could be improved by performing regular exercise. METHODS A community-based, cross-sectional study was conducted with 918 Chinese elderly individuals with T2DM in Zhejiang. Relevant risk factors for poor glycemic control, as determined using glycated haemoglobin A1c (HbA1c) > 7%, were explored using logistic regression analyses and included body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), fasting blood glucose (FBG), triglycerides (TGs), total cholesterol (TC), the product of fasting triglycerides and glucose (TyG), visceral adiposity index (VAI), lipid accumulation product (LAP), TyG-BMI, and TyG-WC. Comparisons of the risk factors' ability to discriminate poor glycemic control as well as their optimal cutoff values were determined using receiver operating characteristic (ROC) analyses, and then the extent of poor glycemic control risk reduction through regular exercise was examined using multivariate logistic regression analyses. RESULTS The overall poor glycemic control rate was 49.3%. The factors associated with poor glycemic control included FBG > 3.869, TyG > 8.73, TyG-BMI > 222.45, and TyG-WC > 713.48 in logistic regression analyses. The optimal cutoff points of FBG, TyG, TyG-WC, and TyG-BMI in discriminating poor glycemic control were 7.38, 9.22, 813.33, and 227.77, and their corresponding areas under the ROC curves were 0.864(0.840-0.886), 0.684(0.653-0.714), 0.604(0.571-0.635), and 0.574(0.541-0.606), respectively. Occasional and regular exercise reduced the odds ratios (95% confidence interval) of poor glycemic control to 0.187 (0.063-0.557) and 0.183 (0.059-0.571) for subjects with TyG-WC > 813.33 (p = 0.008), to 0.349 (0.156-0.782) and 0.284 (0.123-0.652) for subjects with TyG > 9.22 (p = 0.011), and to 0.390 (0.175-0.869) and 0.300(0.130-0.688) for subjects with TyG-BMI > 227.77 (p = 0.017), respectively, after adjusting for multiple confounding factors. CONCLUSION Among elderly individuals with T2DM, poor glycemic control risk might be identified using indices calculated from FBG, TG, BMI, and WC measurements, which are indicative of adiposity and insulin resistance. TyG-WC seems to be an accessible and useful indicator to identify which elderly T2DM patients would benefit from performing regular exercise to achieve good glycemic control.
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Affiliation(s)
- Hong-Ting Zhu
- Yongkang Municipal Center for Disease Control and Prevention, Jinghua, Zhejiang, 321300 China
| | - Min Yu
- Department of Occupational Diseases, Zhejiang Academy of Medical Sciences, Zhejiang, 310013 Hangzhou China
| | - Hao Hu
- Yongkang Municipal Center for Disease Control and Prevention, Jinghua, Zhejiang, 321300 China
| | - Qing-Fang He
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng Road, Zhejiang, 310051 Hangzhou China
| | - Jin Pan
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng Road, Zhejiang, 310051 Hangzhou China
| | - Ru-Ying Hu
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng Road, Zhejiang, 310051 Hangzhou China
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