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Moradi S, Firoozbakhtian A, Hosseini M, Karaman O, Kalikeri S, Raja GG, Karimi-Maleh H. Advancements in wearable technology for monitoring lactate levels using lactate oxidase enzyme and free enzyme as analytical approaches: A review. Int J Biol Macromol 2024; 254:127577. [PMID: 37866568 DOI: 10.1016/j.ijbiomac.2023.127577] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 10/06/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
Lactate is a metabolite that holds significant importance in human healthcare, biotechnology, and the food industry. The need for lactate monitoring has led to the development of various devices for measuring lactate concentration. Traditional laboratory methods, which involve extracting blood samples through invasive techniques such as needles, are costly, time-consuming, and require in-person sampling. To overcome these limitations, new technologies for lactate monitoring have emerged. Wearable biosensors are a promising approach that offers non-invasiveness, low cost, and short response times. They can be easily attached to the skin and provide continuous monitoring. In this review, we evaluate different types of wearable biosensors for lactate monitoring using lactate oxidase enzyme as biological recognition element and free enzyme systems.
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Affiliation(s)
- Sara Moradi
- Nanobiosensors Lab, Department of Life Science Engineering, Faculty of New Sciences & Technologies, University of Tehran, Tehran 1439817435, Iran
| | - Ali Firoozbakhtian
- Nanobiosensors Lab, Department of Life Science Engineering, Faculty of New Sciences & Technologies, University of Tehran, Tehran 1439817435, Iran
| | - Morteza Hosseini
- Nanobiosensors Lab, Department of Life Science Engineering, Faculty of New Sciences & Technologies, University of Tehran, Tehran 1439817435, Iran; Medical Biomaterials Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Onur Karaman
- Akdeniz University, Department of Medical Imaging Techniques, Antalya, Turkey.
| | - Shankramma Kalikeri
- Division of Nanoscience and Technology, School of Lifesciences, Mysuru, JSS Academy of Higher Education and Research, Mysuru-570015, Karnataka, India
| | - G Ganesh Raja
- Instituto de Alta Investigación, Universidad de Tarapacá, Arica-1000000, Chile
| | - Hassan Karimi-Maleh
- The Quzhou Affiliated Hospital of Wenzhu Medical University, Quzhou Peoplés Hospital, PR China; School of Resources and Environment, University of Electronic Science and Technology of China, PR China; School of Engineering, Lebanese American University, Byblos, Lebanon.
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Sendekie AK, Netere AK, Kasahun AE, Belachew EA. Medication adherence and its impact on glycemic control in type 2 diabetes mellitus patients with comorbidity: A multicenter cross-sectional study in Northwest Ethiopia. PLoS One 2022; 17:e0274971. [PMID: 36130160 PMCID: PMC9491880 DOI: 10.1371/journal.pone.0274971] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Medication nonadherence in patients with chronic diseases, particularly in type 2 diabetes mellitus (T2DM) with comorbidity, has continued to be the cause of treatment failure. The current study assessed medication adherence and its impact on glycemic control in T2DM patients with comorbidity. METHODS An institutional-based multicenter cross-sectional study was conducted among T2DM patients with comorbidity at the selected hospitals in Northwest Ethiopia. Medication adherence was measured using a structured questionnaire of the General Medication Adherence Scale (GMAS). A logistic regression model was used to identify predictors of the level of medication adherence and glycemic control. P < 0.05 at 95% confidence interval (CI) was statistically significant. RESULTS A total of 403 samples were included in the final study. This study showed that more than three-fourths (76.9%) of the participants were under a low level of medication adherence. Source of medication cost coverage [AOR = 10.593, 95% CI (2.628-41.835; P = 0.003], monthly income (P < 0.00), self-monitoring of blood glucose (SMBG) practice [AOR = 0.266, 95% CI (0.117-0.604); P = 0.002], number of medications [AOR = 0.068, 95% CI (0.004-0.813); P = 0.014] and medical conditions [AOR = 0.307, 95% CI (0.026-0.437); P = 0.018] were found to be significant predictors of medication adherence. Significantly, majority (74.7%) of participants had poor levels of glycemic control. Patients who had a high level of medication adherence [AOR = 0.003, 95% CI (0.000-0.113); P = 0.002] were found less likely to have poor glycemic control compared with patients who were low adherent to their medications. CONCLUSION The current study concluded that medication adherence was low and significantly associated with poor glycemic control. Number of medical conditions and medications were found to be associated with medication adherence. Management interventions of T2DM patients with comorbidity should focus on the improvement of medication adherence.
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Affiliation(s)
- Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Adeladlew Kassie Netere
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Emagn Kasahun
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Eyayaw Ashete Belachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Self-Monitoring of Blood Glucose and Hypoglycemia-Related Hospitalization in a Population-Based Cohort of Canadian Patients With Type 1 or Type 2 Diabetes. Can J Diabetes 2020; 44:335-341.e3. [DOI: 10.1016/j.jcjd.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/14/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022]
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Yi WM, Van Wieren Jones EM, Hansen BK, Vora J. The Impact of Self-Monitoring Blood Glucose Adherence On Glycemic Goal Attainment in an Indigent Population, With Pharmacy Assistance. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2019; 44:554-559. [PMID: 31485151 PMCID: PMC6705474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Self-monitoring of bood glucose alone is not a good predictor of HbA1c goal attainment. Health plans might benefit from formulary restrictions to provide more cost-effective care, without negatively impacting glycemic control. And by using targeted inteventions, healthcare providers could help maximize SMBG's clinical benefit for patients who receive test strips. Self-monitoring of blood glucose (SMBG) can be an important tool in diabetes treatment, both for patient self-management and for guiding clinicians regarding medication adjustments. Evidence supports the association of SMBG with clinical outcomes in patients with type-1 diabetes mellitus (T1DM) although it is mixed for patients with type-2 diabetes mellitus (T2DM). The cost of SMBG comprises a substantial portion of the total cost for patients with diabetes, and test strips are one of the main expenditures of the University of North Carolina Medical Center Pharmacy Assistance Program (PAP), which provides medication coverage, including test strips, to indigent patients who have no pharmacy insurance. The objective of this study is to evaluate the utility of SMBG based on the impact of test-strip adherence on glycemic goal attainment in an indigent population that is provided with low-copay test strips. This retrospective cohort study included patients with T1DM or T2DM who were enrolled in PAP in 2016 and who received a prescription for test strips during the 90 days prior to hemoglobin A1c (HbA1c) measurement. Adherence was defined as the proportion of days covered (PDC) > 0.8. Of the 498 patients encountered, 20% of the adherent group (n = 245) and 25% of the nonadherent group (n = 253) had a goal of HbA1c < 7% (P = 0.24). There were no differences in mean HbA1c between the groups, except in the multiple daily injections (MDI) of the insulin subgroup (8.9% vs. 9.6%, P = 0.009). The adherent group was 80% less likely to have a diabetes-related hospitalization (odds ratio [OR], 0.2; 95% CI, 0.04-0.92). The total test-strip cost to PAP was more than $200,000. In conclusion, in an indigent population, adherence to SMBG does not correlate with glycemic goal attainment and imposes a substantial cost burden on the healthcare system.
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Pollock RF, Norrbacka K, Cameron C, Mancillas-Adame L, Jeddi M. A cost-utility analysis of dulaglutide versus insulin glargine as third-line therapy for Type 2 diabetes in Canada. J Comp Eff Res 2019; 8:229-240. [PMID: 30644328 DOI: 10.2217/cer-2018-0073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM The prevalence of Type 2 diabetes in Canada is estimated to be 7.6% and rising. Given the substantial economic burden associated with Type 2 diabetes treatment, optimizing healthcare expenditure is extremely important. In the present analysis, we evaluated the cost-effectiveness of dulaglutide 1.5 mg, a once-weekly glucagon-like peptide 1 agonist as third-line therapy relative to insulin glargine from the perspective of a Canadian healthcare payer. METHODS A patient-level cost-utility model of Type 2 diabetes was developed to capture seven microvascular and macrovascular complications and severe and nonsevere hypoglycemia. Cohort characteristics and the relative efficacy of dulaglutide 1.5 mg and insulin glargine were derived from the AWARD-2 head-to-head trial, which was identified by systematic literature review. Cost data were derived from Canadian sources and expressed in 2016 Canadian dollars (CAD), and future cost and quality-adjusted life expectancy (QALE) estimates were discounted at 1.5% per annum. One-way and probabilistic sensitivity analyses were conducted. RESULTS Based on the AWARD-2 trial, relative to insulin glargine, dulaglutide 1.5 mg was projected to increase QALE by 0.38 quality-adjusted life years and increase costs by CAD 19,773, resulting in an incremental cost-effectiveness ratio of CAD 52,580 per quality-adjusted life year gained. CONCLUSION A computer simulation analysis showed that dulaglutide 1.5 mg would likely be cost-effective relative to insulin glargine in patients with Type 2 diabetes inadequately controlled on metformin and sulfonylurea in Canada.
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Affiliation(s)
| | | | - Chris Cameron
- Cornerstone Research Group, Inc., Burlington Ontario, Canada
| | - Leonardo Mancillas-Adame
- Eli Lilly Canada, Inc., Toronto, Canada.,Endocrinology Division, Internal Medicine Department, Medical School & University Hospital 'Dr. Jose E. Gonzalez', Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
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Kermani SK, Khatony A, Jalali R, Rezaei M, Abdi A. Accuracy and Precision of Measured Blood Sugar Values by Three Glucometers Compared to the Standard Technique. J Clin Diagn Res 2017. [PMID: 28571181 DOI: 10.7860/jcdr/2017/23926.9613 pmc5449827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The prevalence of diabetes mellitus has magnified, globally. Being cost effective and user friendly, using the glucometer systems has become more widespread. However, despite their advantages, there are controversies regarding their accuracy and precision. AIM To determine the accuracy and precision of the common glucometers of Bionime, Accu-check, and Beurer compared with the laboratory technique. MATERIALS AND METHODS In a cross-sectional study, 257 patients of a general internal unit of Imam Reza hospital of Kermanshah were recruited. The blood sample of the subjects was transferred to the laboratory, then, two samples of capillary blood were tested by the three glucometers. The data was entered into a checklist, then entered to SPSS-16.0 software, and analyzed by descriptive and inferential statistics. RESULTS In this study, there was a positive correlation between the three blood glucose measurement methods with the standard approach, significantly, which indicates acceptable accuracy. However, this correlation was higher in the Beurer Glucometer (r=0.976, p<0.001). There were no significant differences in repeated measurements of blood glucose in the glucometers of Beurer (t=0.96, p=0.92), and Bionime (t=0.50, p=0.61) by paired t-test, but this test was significant for Accu-chek system (t=2.7, p=0.006). CONCLUSION With respect to the acceptable accuracy and precision of Beurer and Bionime glucometers, it is suggested to use these methods for diabetic patients at homes as well as in the hospital units.
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Affiliation(s)
- Shadi Khakpour Kermani
- Faculty of Nursing, Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Associate Professor, Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Assistance Professor, Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mansur Rezaei
- Associate Professor, Department of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Assistance Professor, Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Falk J, Friesen KJ, Okunnu A, Bugden S. Patterns, Policy and Appropriateness: A 12-Year Utilization Review of Blood Glucose Test Strip Use in Insulin Users. Can J Diabetes 2017; 41:385-391. [PMID: 28410881 DOI: 10.1016/j.jcjd.2016.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Considerable attention has been paid to the rising costs of the use of blood glucose test strips (BGTS). Insulin users have generally been treated as a single homogeneous group, resulting in policies that cap usage (8.2 strips/day) in provincial drug insurance programs. The objective of this study was to conduct a utilization review of BGTS by insulin users and to evaluate use patterns against current insulin use patterns and BGTS policy. METHODS BGTS usage was examined in a cohort of insulin users with type 1 and type 2 diabetes over a 12-year period (2001 to 2013) using the population-based administrative data in Manitoba, Canada. RESULTS Total BGTS strip use increased by 121%, from $4.3 to $9.5 million. However, the number of insulin users also increased by 115%. Use has been stable at 1.5 strips per day per person since 2004 by insulin users with type 2 diabetes but has risen from 1.9 to 3.0 strips per day per person in those with type 1 diabetes. Mean daily test strip use was below the number of daily tests recommended for patients using insulin as per the current Canadian guidelines, with 11% and 15% of insulin users with type 1 and type 2 diabetes not claiming any BGTS use and a further 15% (type 1) and 28% (type 2) using fewer than 1 strip per day. CONCLUSIONS BGTS use per insulin user has been stable for most of the past decade, and the vast majority of use falls well below provincial insurance caps. The amount of low-level testing (0 to <1 strip/day) suggests that greater attention should be directed to ensuring a safe level of testing by all insulin users.
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Affiliation(s)
- Jamie Falk
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kevin J Friesen
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anuoluwapo Okunnu
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shawn Bugden
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Kermani SK, Khatony A, Jalali R, Rezaei M, Abdi A. Accuracy and Precision of Measured Blood Sugar Values by Three Glucometers Compared to the Standard Technique. J Clin Diagn Res 2017; 11:OC05-OC08. [PMID: 28571181 DOI: 10.7860/jcdr/2017/23926.9613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/23/2016] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The prevalence of diabetes mellitus has magnified, globally. Being cost effective and user friendly, using the glucometer systems has become more widespread. However, despite their advantages, there are controversies regarding their accuracy and precision. AIM To determine the accuracy and precision of the common glucometers of Bionime, Accu-check, and Beurer compared with the laboratory technique. MATERIALS AND METHODS In a cross-sectional study, 257 patients of a general internal unit of Imam Reza hospital of Kermanshah were recruited. The blood sample of the subjects was transferred to the laboratory, then, two samples of capillary blood were tested by the three glucometers. The data was entered into a checklist, then entered to SPSS-16.0 software, and analyzed by descriptive and inferential statistics. RESULTS In this study, there was a positive correlation between the three blood glucose measurement methods with the standard approach, significantly, which indicates acceptable accuracy. However, this correlation was higher in the Beurer Glucometer (r=0.976, p<0.001). There were no significant differences in repeated measurements of blood glucose in the glucometers of Beurer (t=0.96, p=0.92), and Bionime (t=0.50, p=0.61) by paired t-test, but this test was significant for Accu-chek system (t=2.7, p=0.006). CONCLUSION With respect to the acceptable accuracy and precision of Beurer and Bionime glucometers, it is suggested to use these methods for diabetic patients at homes as well as in the hospital units.
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Affiliation(s)
- Shadi Khakpour Kermani
- Faculty of Nursing, Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Associate Professor, Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Assistance Professor, Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mansur Rezaei
- Associate Professor, Department of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Assistance Professor, Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Gomes T, Martins D, Tadrous M, Paterson JM, Shah BR, Juurlink DN, Singh S, Mamdani MM. Self-Monitoring of Blood Glucose Levels: Evaluating the Impact of a Policy of Quantity Limits on Test-Strip Use and Costs. Can J Diabetes 2016; 40:431-435. [DOI: 10.1016/j.jcjd.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/23/2016] [Accepted: 03/04/2016] [Indexed: 11/26/2022]
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Boulin M, Diaby V, Tannenbaum C. Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada. PLoS One 2016; 11:e0162951. [PMID: 27648831 PMCID: PMC5029920 DOI: 10.1371/journal.pone.0162951] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 08/31/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes. METHODS An economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services) and Canadian public health payer perspectives were adopted. FINDINGS Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada. CONCLUSIONS Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.
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Affiliation(s)
- Mathieu Boulin
- Institut Universitaire de Gériatrie de Montréal, Quebec, Canada
| | - Vakaramoko Diaby
- College of Pharmacy and Pharmaceutical Sciences, Florida A&M University (FAMU), Tallahassee, Florida, United States of America
| | - Cara Tannenbaum
- Institut Universitaire de Gériatrie de Montréal, Quebec, Canada
- Université de Montréal, Faculties of Medicine and Pharmacy, Quebec, Canada
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Tavares R, Duclos M, Brabant MJ, Checchin D, Bosnic N, Turvey K, Terres JAR. Differences in self-monitored, blood glucose test strip utilization by therapy for type 2 diabetes mellitus. Acta Diabetol 2016; 53:483-92. [PMID: 26972690 PMCID: PMC4877426 DOI: 10.1007/s00592-015-0823-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/02/2015] [Indexed: 11/03/2022]
Abstract
AIMS To determine whether blood glucose test strip (BGTS) utilization in patients with type 2 diabetes (T2D) is associated with the type of diabetes therapy, classified according to hypoglycemic risk. METHODS A retrospective, longitudinal (2006-2012) study of Canadian private drug plans (PDP) and Ontario Public Drug Programs (OPDP) prescription claims was conducted. Analyses were restricted to patients with T2D with or without a claim for BGTS. Daily BGTS utilization (TS/patient/day) was evaluated by diabetes therapy classified by hypoglycemic risk. Multivariate analyses were conducted to identify determinants of BGTS utilization. RESULTS The T2D cohort comprised 5,759,591 observations from 1,949,129 claimants. Mean BGTS utilization was 0.84 TS/patient/day and differed between PDP and OPDP (0.66 vs. 1.00). Daily utilization was greatest in patients receiving therapy associated with a pre-defined high risk of hypoglycemia [insulin: basal + bolus (2.16), premixed (1.65), basal (1.16), other insulin regimens (2.13), and sulfonylureas (0.74)] versus non-sulfonylurea non-insulin-based regimens (0.52). For non-insulin therapy, BGTS utilization was greater for patients on multiple non-insulin therapies versus monotherapy (0.74 vs. 0.53 TS/patient/day). In multivariate analyses, drivers for BGTS utilization included insulin use, previous BGTS use, and female gender. Previous diabetes therapy and duration of therapy were negatively correlated with BGTS utilization. CONCLUSIONS BGTS utilization varies depending on the type of therapy used to treat T2D according to hypoglycemic risk. Decision making regarding BGTS needs to account for robust analyses of current utilization and its value in those settings, including in patients not receiving diabetes therapy and the prevalence of circumstances conducive to more intensive monitoring.
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Affiliation(s)
- Ruben Tavares
- GlaxoSmithKline, 7333 Mississauga Road North, Mississauga, ON, L5N 6L4, Canada.
| | - Marc Duclos
- IMS Brogan, a unit of IMS Health, Kirkland, QC, Canada
| | | | - Daniella Checchin
- GlaxoSmithKline, 7333 Mississauga Road North, Mississauga, ON, L5N 6L4, Canada
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Serwylo O, Friesen K, Falk J, Bugden S. Opportunity Cost and Policy: A Utilization Review of Self-monitoring of Blood Glucose in Manitoba, Canada. Clin Ther 2016; 38:929-35. [DOI: 10.1016/j.clinthera.2016.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/01/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
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Gomes T, Martins D, Cheng L, Kratzer J, Juurlink DN, Shah BR, Mamdani MM, Paterson JM, Law MR. The impact of policies to reduce blood glucose test strip utilization and costs in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2015; 106:e210-6. [PMID: 26285192 PMCID: PMC6972310 DOI: 10.17269/cjph.106.4788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 05/06/2015] [Accepted: 02/20/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Several strategies have been proposed to manage the utilization of blood glucose test strips (BGTS) in Canada; however their potential impacts on utilization and costs of publically funded test strips are unknown. METHODS We investigated the impact of three potential policies that would restrict the number of test strips reimbursed by the public drug plans in Ontario and British Columbia (BC), and incorporated negotiated price reductions. These policies were based on recommendations from the Canadian Agency for Drugs and Technologies in Health, a briefing document by the Canadian Diabetes Association, and a new policy introduced by the Ontario Ministry of Health and Long-Term Care. BGTS utilization rates were assessed in two cross-sectional analyses among adults aged 18 years or older in BC and 65 or older in Ontario who received publicly-funded BGTS between January 2004 and December 2012. We modeled the 5-year utilization and cost implications of the three policies using time-series analysis. RESULTS In 2012, there were 317,130 test strip recipients in Ontario and 136,659 recipients in BC, at a cost of $104.4 million and $22.6 million respectively. Under the scenarios of reduced BGTS quantities, 5-year cost savings ranged between $98.8 million (18.2% reduction) and $224.1 million (41.4% reduction) in Ontario and between $23.1 million (19.2% reduction) and $51.1 million (42.4% reduction) in BC. Price reductions of 15% resulted in annual savings of $14.4 million (13.7% reduction) in Ontario and $3.4 million (14.1% reduction) in BC. CONCLUSIONS Policies that align with evidence and expert guidance could impart substantial cost savings in multiple jurisdictions despite different public drug plans.
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Affiliation(s)
- Tara Gomes
- Institute for Clinical Evaluative Sciences.
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14
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Khan S, Moore JE, Gomes T, Camacho X, Tran J, McAuley G, Juurlink DN, Paterson M, Laupacis A, Mamdani MM. The Ontario Drug Policy Research Network: Bridging the gap between Research and Drug Policy. Health Policy 2014; 117:392-8. [DOI: 10.1016/j.healthpol.2014.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 06/19/2014] [Accepted: 06/30/2014] [Indexed: 11/25/2022]
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Abstract
Many studies have tested clinical and behavioral approaches for improving glycemic control in people with diabetes. We reviewed studies to identify how blood glucose (BG) values have been used in patient-focused clinical research and interventions. We sought to describe the frequency that BG values have been the focus of patient education research and to characterize the different methods to integrate BG into an intervention, the approaches implemented to support patient education, and behavior change, and the nature of communication about BG values. Thirty-four eligible studies were identified that included patient education using BG values. Information regarding the study and intervention characteristics include: (1) characteristics of the study sample, (2) how BG values were obtained, (3) use of a graphical interface for BG values, (4) use of a BG log, (5) BG interpretation and regimen adjustments, (6) recommended actions to patient, (7) modality of intervention, and (8) intervention communication schedule. The review demonstrated that new BG technologies provide outstanding opportunities for greater access to BG data, and for patient support and intervention. However, it also indicated a need to improve and expand support for people with diabetes in their daily use of BG values to maintain and improve glycemic control. In order to make the most sustainable impact on behavior, generalizable skills such as problem solving need to be integrated into BG education.
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Affiliation(s)
- Yaa Kumah-Crystal
- Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way DOT Room 11142-C, Nashville, TN, 37232-9170, USA,
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Gucciardi E, Fortugno M, Senchuk A, Beanlands H, McCay E, Peel EE. Self-monitoring of blood glucose in Black Caribbean and South Asian Canadians with non-insulin treated Type 2 diabetes mellitus: a qualitative study of patients' perspectives. BMC Endocr Disord 2013; 13:46. [PMID: 24119213 PMCID: PMC3853160 DOI: 10.1186/1472-6823-13-46] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/18/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To examine the views and current practice of SMBG among Black Caribbean and South Asian individuals with non-insulin treated Type 2 diabetes mellitus. METHODS Twelve participants completed semi-structured interviews that were guided by the Health Belief Model and analyzed using thematic network analysis. RESULTS The frequency of monitoring among participants varied from several times a day to once per week. Most participants expressed similar experiences regarding their views and practices of SMBG. Minor differences across gender and culture were observed. All participants understood the benefits, but not all viewed SMBG as beneficial to their personal diabetes management. SMBG can facilitate a better understanding and maintenance of self-care behaviours. However, it can trigger both positive and negative emotional responses, such as a sense of disappointment when high readings are not anticipated, resulting in emotional distress. Health care professionals play a key role in the way SMBG is perceived and used by patients. CONCLUSION While the majority of participants value SMBG as a self-management tool, barriers exist that impede its practice, particularly its cost. How individuals cope with these barriers is integral to understanding why some patients adopt SMBG more than others.
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Affiliation(s)
- Enza Gucciardi
- School of Nutrition, Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada
| | - Mariella Fortugno
- School of Nutrition, Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada
| | - Andrea Senchuk
- School of Nutrition, Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada
| | - Heather Beanlands
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Elizabeth McCay
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Elizabeth E Peel
- School of Life & Health Sciences, Aston University, Birmingham, UK
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Carter AA, Gomes T, Camacho X, Juurlink DN, Shah BR, Mamdani MM. Risk of incident diabetes among patients treated with statins: population based study. BMJ 2013; 346:f2610. [PMID: 23704171 PMCID: PMC3662830 DOI: 10.1136/bmj.f2610] [Citation(s) in RCA: 273] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the risk of new onset diabetes among patients treated with different HMG-CoA reductase inhibitors (statins). DESIGN Population based cohort study with time to event analyses to estimate the relation between use of particular statins and incident diabetes. Hazard ratios were calculated to determine the effect of dose and type of statin on the risk of incident diabetes. SETTING Ontario, Canada. PARTICIPANTS All patients aged 66 or older without diabetes who started treatment with statins from 1 August 1997 to 31 March 2010. The analysis was restricted to new users who had not been prescribed a statin in at least the preceding year. Patients with established diabetes before the start of treatment were excluded. INTERVENTIONS Treatment with statins. MAIN OUTCOME MEASURE Incident diabetes. RESULTS Compared with pravastatin (the reference drug in all analyses), there was an increased risk of incident diabetes with atorvastatin (adjusted hazard ratio 1.22, 95% confidence interval 1.15 to 1.29), rosuvastatin (1.18, 1.10 to 1.26), and simvastatin (1.10, 1.04 to 1.17). There was no significantly increased risk among people who received fluvastatin (0.95, 0.81 to 1.11) or lovastatin (0.99, 0.86 to 1.14). The absolute risk for incident diabetes was about 31 and 34 events per 1000 person years for atorvastatin and rosuvastatin, respectively. There was a slightly higher [corrected] absolute risk with simvastatin (26 outcomes per 1000 person years) compared with pravastatin (23 outcomes per 1000 person years). Our findings were consistent regardless of whether statins were used for primary or secondary prevention of cardiovascular disease. Although similar results were observed when statins were grouped by potency, the risk of incident diabetes associated with use of rosuvastatin became non-significant (adjusted hazard ratio 1.01, 0.94 to 1.09) when dose was taken into account. CONCLUSIONS Compared with pravastatin, treatment with higher potency statins, especially atorvastatin and simvastatin, might be associated with an increased risk of new onset diabetes.
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Affiliation(s)
| | | | - Fellow FACP
- Mills-Peninsula Health Services, San Mateo, California
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Klarenbach S, Cameron C, Singh S, Ur E. Cost-effectiveness of second-line antihyperglycemic therapy in patients with type 2 diabetes mellitus inadequately controlled on metformin. CMAJ 2011; 183:E1213-20. [PMID: 21969406 DOI: 10.1503/cmaj.110178] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Metformin is widely accepted as first-line pharmacotherapy for patients with type 2 diabetes mellitus when glycemic control cannot be achieved by lifestyle interventions alone. However, uncertainty exists regarding the optimal second-line therapy for patients whose diabetes is inadequately controlled by metformin monotherapy. Increased use of newer, more costly agents, along with the rising incidence of type 2 diabetes, carries significant budgetary implications for health care systems. We conducted this analysis to determine the relative costs, benefits and cost-effectiveness of options for second-line treatment of type 2 diabetes. METHODS We used the United Kingdom Prospective Diabetes Study Outcomes Model to forecast diabetes-related complications, quality-adjusted life-years and costs of alternative second-line therapies available in Canada for adults with type 2 diabetes inadequately controlled by metformin. We obtained clinical data from a systematic review and mixed treatment comparison meta-analysis, and we obtained information on costs and utilities from published sources. We performed extensive sensitivity analyses to test the robustness of results to variation in inputs and assumptions. RESULTS Sulphonylureas, when added to metformin, were associated with the most favourable cost-effectiveness estimate, with an incremental cost of $12 757 per quality-adjusted life-year gained, relative to continued metformin monotherapy. Treatment with other agents, including thiazolidinediones and dipeptidyl peptidase-4 inhibitors, had unfavourable cost-effectiveness estimates compared with sulphonylureas. These results were robust to extensive sensitivity analyses. INTERPRETATION For most patients with type 2 diabetes that is inadequately controlled with metformin monotherapy, the addition of a sulphonylurea represents the most cost-effective second-line therapy.
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Johnson JA. Reflections on Self-Monitoring of Blood Glucose: Why Do We Recommend the Things We Do? Can Pharm J (Ott) 2010. [DOI: 10.3821/1913-701x-143.5.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jeffrey A. Johnson
- From the School of Public Health, University of Alberta, Li Ka Shing Center for Health Research Innovation, Edmonton, Alberta. Contact:
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Butalia S, Rabi DM. To test or not to test? Self-monitoring of blood glucose in patients with type 2 diabetes managed without insulin. OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2010; 4:e114-6. [PMID: 21686300 PMCID: PMC3116684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 03/15/2010] [Indexed: 11/23/2022]
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Woo V, Cheng AY, Hanna A, Berard L. Self-monitoring of Blood Glucose in Individuals with Type 2 Diabetes Not Using Insulin: Commentary. Can J Diabetes 2010. [DOI: 10.1016/s1499-2671(10)41003-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Shah BR, Gomes T, Juurlink DN, Paterson JM, Mamdani MM. Cost Minimal Effectiveness of SMBG. Can J Diabetes 2010. [DOI: 10.1016/s1499-2671(10)43004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Woo V, Cheng AY, Hanna A, Berard L. The authors respond:. Can J Diabetes 2010. [DOI: 10.1016/s1499-2671(10)43014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Self-monitoring of blood glucose for individuals with type 2 diabetes not using insulin: Leaving no cornerstone unturned. Can J Diabetes 2010. [DOI: 10.1016/s1499-2671(10)41004-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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