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Heshmat R, Darvishi A, Abdi Dezfouli R, Nikkhah A, Radmanesh R, Moslemi E. A short-term economic evaluation of early insulin therapy compared to oral anti-diabetic drugs in order to reduce the major adverse events in type 2 diabetes patients in Iran. Curr Med Res Opin 2024; 40:765-772. [PMID: 38533582 DOI: 10.1080/03007995.2024.2333425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE While there are some recommendations about early insulin therapy in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients, there is not sufficient evidence on this strategy's cost-effectiveness. This study compared early insulin therapy versus oral anti-diabetic drugs (OADs) for managing T2DMusing a cost-effectiveness analysis approach in Iran. METHODS In this economic evaluation, a decision analytic model was designed. The target population was newly diagnosed type 2 diabetic patients, and the study was carried out from the perspective of Iran's healthcare system with a one-year time horizon. Basal insulin, Dipeptidyl peptidase-4 (DPP-4) inhibitors, and Thiazolidinediones (TZDs) were compared in this evaluation. The main outcome for assessing the effectiveness of each intervention was the reduction in the occurrence of diabetes complications. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and deterministic and probabilistic sensitivity analyses were carried out. RESULTS The DPP-4 inhibitors strategy was the dominant strategy with the highest effectiveness and the lowest cost. Early insulin therapy was dominated (ICER: $-53,703.18), meaning that it was not cost-effective. The sensitivity analyses consistently affirmed the robustness of the base case findings. The probabilistic sensitivity analysis indicated probabilities of 77%, 22%, and 1% for DPP-4 inhibitors, TZDs strategies, and early insulin therapy, respectively, in terms of being cost-effective. CONCLUSION In terms of cost-effectiveness, early insulin therapy was not cost-effective compared to OADs for managing newly diagnosed T2DM patients. Future studies in this regard, utilizing more comprehensive evidence, can yield more accurate results.
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Affiliation(s)
- Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Darvishi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Abdi Dezfouli
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Adeleh Nikkhah
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Radmanesh
- Department of Pharmacoeconomics and Pharmaceutical Management, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Elham Moslemi
- Department of Pharmacoeconomics and Pharmaceutical Management, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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Bhat S, Chowta M, Chowta N, Shastry R, Kamath P. The Proportion of Type 2 Diabetic Patients Achieving Treatment Goals and the Survey of Patients' Attitude Towards Insulin In tiation ini Patient s with Inadequate Glycaemic Control with Oral Anti-diabetic Drugs. Curr Diabetes Rev 2021; 17:e110620182719. [PMID: 32525779 DOI: 10.2174/1573399816666200611134121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/14/2020] [Accepted: 05/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Type 2 diabetic patients often require insulin therapy for better glycaemic control. However, many of these patients do not receive insulin or do not receive it in a timely manner. OBJECTIVE The study was planned to assess the proportion of type 2 diabetic patients attaining treatment goals as per the ADA 2018 guidelines. In addition, patient's perception of insulin therapy was assessed and compared between insulin naïve and insulin-initiated type 2 diabetic patients. METHODS The study was conducted in type 2 diabetic patients. Data on their demographics, medical history, duration of diabetes, history of diabetes related complications, the current anti-diabetic medication received, and the most recent glycaemic parameters were all noted. Patient's perception of insulin initiation was recorded through a structured interview. RESULTS A total of 129 patients were included in the study. Around 76.7% patients achieved HbA1c target (<7%). The duration of the disease is much higher in patients who did not meet the HBA1c target. A good number of patients felt that insulin injection would be physically painful (56.5%). The majority of the patients also felt that insulin would make their life less flexible (64.8%). Many patients have the opinion that insulin is required for life long (73.2%). More number of patients on insulin agreed with the statement 'Leads to good short-term outcomes as well as long-term benefits' compared to insulin naïve patients. CONCLUSION The results highlight that the proportion of patients achieving the recommended glycaemic target is not satisfactory. Many patients who are inadequately controlled with oral anti-diabetic drugs were reluctant to initiate insulin.
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Affiliation(s)
- Shivashankara Bhat
- Department of Pharmacology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Manipal, Karnataka, 576104, India
| | - Mukta Chowta
- Department of Pharmacology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Manipal, Karnataka, 576104, India
| | - Nithyananda Chowta
- Department of Pharmacology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Manipal, Karnataka, 576104, India
| | - Rajeshwari Shastry
- Department of Pharmacology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Manipal, Karnataka, 576104, India
| | - Priyanka Kamath
- Department of Pharmacology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Manipal, Karnataka, 576104, India
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Das S, Rastogi A, Harikumar KVS, Dutta D, Sahay R, Kalra S, Ghosh S, Gupta SK, Pandit K, Jabbar PK, Damodaran S, Nagesh VS, Sheikh S, Madhu SV, Bantwal G. Diagnosis and Management Considerations in Steroid-Related Hyperglycemia in COVID-19: A Position Statement from the Endocrine Society of India. Indian J Endocrinol Metab 2021; 25:4-11. [PMID: 34386386 PMCID: PMC8323636 DOI: 10.4103/ijem.ijem_227_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
The current coronavirus disease (COVID-19) pandemic is showing no signs of abatement and result in significant morbidity and mortality in the infected patients. Many therapeutic agents ranging widely between antivirals and anti-inflammatory drugs have been used to mitigate the disease burden. In the deluge of the drugs being used for COVID-19 infection, glucocorticoids (GCs) stand out by reducing mortality amongst in-hospital severe-to-critically ill patients. Health-care practitioners have seen this as a glimmer of hope and started using these drugs more frequently than ever in clinical practice. The fear of mortality in the short term has overridden the concern of adverse long-term consequences with steroid use. The ease of availability, low cost, and apparent clinical improvement in the short term have led to the unscrupulous use of the steroids even in mild COVID-19 patients including self-medication with steroids. The use of GCs has led to the increasing incidence of hyperglycemia and consequent acute complications of diabetic ketoacidosis and mucormycosis in COVID-19 patients. There is an urgent need to dissipate information about optimum management of hyperglycemia during steroid use. In view of this, the Endocrine Society of India has formulated this position statement about the diagnosis and management of hyperglycemia due to the use of GCs in patients with COVID-19 infection.
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Affiliation(s)
- Sambit Das
- Professor of Endocrinology, Hi Tech Medical College and Hospitals, Bhubaneswar, Odisha, India
| | - Ashu Rastogi
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - K. V. S. Harikumar
- Senior Consultant Endocrinologist, Magna Clinics, Hyderabad, Telangana, India
| | - Deep Dutta
- Department of Endocrinology, Cedar Superspecialty Clinics, Dwarka, New Delhi, India
| | - Rakesh Sahay
- Professor of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Sanjay Kalra
- Endocrinologist, Bharti Hospital, Karnal, Haryana, India
| | - Sujoy Ghosh
- Department of Endocrinology, IPGME and R, Kolkata, West Bengal, India
| | - Sushil K. Gupta
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Kaushik Pandit
- Consultant Endocrinologist and Diabetologist, Fortis Medical Centre, Kolkata, West Bengal, India
| | - P. K. Jabbar
- Department of Endocrinology, Medical College Trivandrum, Trivandrum, Kerala, India
| | - Suresh Damodaran
- Consultant Diabetologist and Endocrinologist, Ramakrishna Hospital and Harvey speciality clinic, Coimbatore, Tamil Nadu, India
| | - V. Sri Nagesh
- Endocrinologist, Srinagesh Diabetes, Thyroid and Endocrine Clinic, Hyderabad, Telangana, India
| | - Shehla Sheikh
- Consultant Endocrinologist, Nagpada-Mumbai Central, Mumbai, Maharashtra, India
| | - S. V. Madhu
- Department of Endocrinology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Ganapathi Bantwal
- Professor of Endocrinology, St Johns Medical College and Hospital, John Nagar, Koramangala, Bengaluru, Karnataka, India
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Stompór T, Adamczak M, Masajtis-Zagajewska A, Mazanowska O, Maziarska K, Witkowska A, Więcek A. Diagnosis and treatment of type 2 diabetes mellitus in patients with chronic kidney disease and eGFR < 60 mL/min - a position statement of the Polish Society of Nephrology Working Group on Metabolic and Endocrine Disorders in Kidney Diseases. Endokrynol Pol 2020; 70:3-14. [PMID: 32129464 DOI: 10.5603/EP.a2019.0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 11/25/2022]
Abstract
Diabetes mellitus is one the most frequent co-morbid conditions in patients with chronic kidney disease (CKD), frequently leading to chronic kidney failure. Progression of CKD accelerates several metabolic disorders, predominantly those related to abnormalities of carbohydrate metabolism. Patients with CKD are usually characterised by an insulin resistance additionally aggravated by several co-morbid conditions (for example chronic low-grade inflammation). Treatment with anti-diabetic medications in patients with CKD remains a challenge because, along with the disease progression, the dosing of several drugs needs to be adjusted to the reduced kidney function (especially those that are excreted intact with urine or as active metabolites). Progression of CKD also increases the risk of hypoglycaemia in patients treated with anti-diabetic drugs, and other adverse drug reactions may occur more frequently. Usefulness of the new generation drugs has not yet been verified in patients with advanced kidney disease (although some of them act through kidney-related mechanisms). The current position statement of the Polish Society of Nephrology Working Group provides practical recommendations for the diagnosis and treatment of type 2 diabetes mellitus in patients with CKD and reduced kidney function.
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Kosinski C, Besson C, Amati F. Exercise Testing in Individuals With Diabetes, Practical Considerations for Exercise Physiologists. Front Physiol 2019; 10:1257. [PMID: 31611821 PMCID: PMC6777138 DOI: 10.3389/fphys.2019.01257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/17/2019] [Indexed: 12/19/2022] Open
Abstract
Exercise and sports activities are crucial for individuals with diabetes. Diabetic patients are often referred to sports clinics for cardiopulmonary exercise testing to evaluate physical capacity, exercise-related symptoms, or to obtain medical clearance. While there is an abundance of literature on cardiopulmonary testing, practical recommendations for exercise physiologists and sports clinic specialists performing exercise testing for this specific population are lacking. The goal of this report is to provide a practical framework to understand, prepare, and perform exercise testing in patients with diabetes, maximizing exercise physiology outcomes, diagnostic value, and ensuring safety.
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Affiliation(s)
- Christophe Kosinski
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cyril Besson
- Sports Medicine Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Francesca Amati
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Sports Medicine Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Physiology and Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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