Irbesartan and amlodipine in the treatment of patients with microalbuminuria,hypertension and type 2 diabetes in Taiwan: a modelling projection over 25 years

Summary

This modelling study aimed to evaluate the long-term cost effectiveness of four treatment strategies: early irbesartan; late irbesartan; amlodipine; and standard hypertensive treatment in patients with diabetes, hypertension and microalbuminuria in Taiwan. A Markov model was used to project costs and clinical outcomes over lifetimes.

Early irbesartan (initiated in microalbuminuric patients) yielded the largest improvements in life expectancy (0.78 years) compared with standard treatment. Late irbesartan and amlodipine (started in patients with overt nephropathy) also resulted in slight improvements in life expectancy (0.109 and 0.001 years, respectively). Both early and late irbesartan reduced lifetime costs compared with control (US$7,603 and US$3,233, respectively), whereas amlodipine increased lifetime costs by US$300. Improvements were attributed to reductions in the cumulative incidence of end-stage renal disease with early use of irbesartan.

Treating hypertensive diabetic patients with early irbesartan was projected to be life extending and cost saving, and to reduce the incidence of ESRD in Taiwan.     

Economic outcomes of exenatide vs liraglutide in type 2 diabetes patients in the United States: results from a retrospective claims database analysis

Abstract

Objective:

The safety and efficacy of the GLP-1 receptor agonists exenatide BID (exenatide) and liraglutide for treating type 2 diabetes mellitus (T2DM) have been established in clinical trials. Effective treatments may lower overall treatment costs. This study examined cost offsets and medication adherence for exenatide vs liraglutide in a large, managed care population in the US.

Methods:

This was a retrospective cohort analysis comprising adult patients with T2DM who initiated exenatide or liraglutide between 1/1/2010 and 6/30/2010 and had 6 months pre-index and post-index continuous eligibility. Patients were propensity score-matched to controls for baseline differences. Medication adherence was measured by proportion of days covered (PDC). Paired t-test and McNemar’s test were used to compare outcomes.

Results:

Matched exenatide and liraglutide cohorts (n?=?1347 pairs) had similar average total 6-month follow-up costs ($6688 vs $7346). However, exenatide patients had significantly lower mean pharmacy costs ($2925 vs $3272, p?<?0.001). Among liraglutide patients, patients receiving the 1.8?mg dose had significantly higher average total costs compared to those receiving the 1.2?mg dose ($8031 vs $6536, p?=?0.026), with higher mean pharmacy costs in the 1.8?mg cohort ($3935 vs $3146, p?<?0.001). There were no significant differences in inpatient or outpatient costs or medication adherence between groups (mean PDC: exenatide 56% vs liraglutide 57%, p?=?0.088).

Limitations:

The study assumed that all information needed for case classification and matching of cohorts was present and not differential across cohorts. The study did not control for covariates that were unavailable, such as HbA1c and duration of diabetes.

Conclusions:

Patients initiating exenatide vs liraglutide for T2DM had similar medication adherence and total healthcare costs; however, exenatide patients had significantly lower total pharmacy costs. Patients prescribed 1.8?mg liraglutide had significantly higher costs compared to those on 1.2?mg.     

Real-world rates,predictors, and associated costs of hypoglycemia among patients with type 2 diabetes mellitus treated with insulin glargine: results of a pooled analysis of six retrospective observational studies

Abstract

Objective:

To evaluate the real-world rates of hypoglycemia and related costs among patients with type 2 diabetes mellitus (T2DM) who initiated insulin glargine with either a disposable pen or vial-and-syringe.

Methods:

Pooled data were evaluated from six previously published, retrospective, observational studies using US health plan insurance claims databases to investigate adults with T2DM who initiated insulin glargine. The current study evaluated baseline characteristics, hypoglycemic events, and costs during the 6 months prior to and 12 months following insulin glargine initiation. Comparisons were made between patients initiating treatment with a disposable pen (GLA-P) and vial-and-syringe (GLA-V). Multivariate analyses using baseline characteristics as covariates determined predictors of hypoglycemia after initiating insulin glargine.

Results:

This study included 23,098 patients (GLA-P: 14,911; GLA-V: 8187). Overall annual prevalence of hypoglycemia was low (6.3% overall, 2.2% related to hospital admission or emergency department visit). Prevalence was significantly lower with GLA-P (5.5% vs 7.7%; p?<?0.0001). Furthermore, average glycated hemoglobin HbA1c reduction was higher with GLA-P (?1.22% vs ?0.86%; p?=?0.0012). The average annual hypoglycemia-related cost associated with initiating insulin glargine was $293, with GLA-P being 46% lower than GLA-V ($225 vs $417; p?=?0.001). Patients who had already developed microvascular complications at the time of initiating insulin therapy were at higher risk for developing hypoglycemia.

Limitations:

This study is limited by the use of retrospective data and ICD-9-CM codes, which are subject to coding error. In addition, this pooled analysis used unmatched cohorts, with multivariate regression analyses employed to adjust for between-group differences. Finally, results describe a managed care sample and cannot be generalized to all patients with T2DM.

Conclusions:

Patients with T2DM initiating insulin glargine treatment showed low rates of hypoglycemia, especially when using a disposable pen device. Hypoglycemia-related costs were low, contributing a very small proportion to overall diabetes-related healthcare costs.     

Exenatide BID and liraglutide QD treatment patterns among type 2 diabetes patients in Germany

Abstract

Objectives:

This study evaluated patient and prescriber characteristics, treatment patterns, average daily dose (ADD), and glycemic control of patients initiating glucagon-like peptide 1 (GLP-1) receptor agonists in Germany.

Methods:

The LifeLink? EMR-EU database was searched to identify patients initiating exenatide twice daily (BID) or liraglutide once daily (QD) during the index period (January 1, 2009–April 4, 2010). Eligible patients had ≥180 days pre-index history, ≥90 days post-index follow-up, and a pre-index type 2 diabetes diagnosis. Univariate tests were conducted at α?=?0.05.

Results:

Six hundred and ninety-two patients were included (exenatide BID 292, liraglutide QD 400): mean (SD) age 59 (10) years, 59% male. Diabetologists prescribed liraglutide QD to a larger share of patients (65% vs 35% exenatide BID) than non-diabetologists (51% vs 49%). GLP-1 receptor agonist choice was not associated with age (p?=?0.282), gender (p?=?0.960), number of pre-index glucose-lowering medications (2.0 [0.9], p?=?0.159), pre-index HbA1c (8.2 [1.5%], p?=?0.231) or Charlson Comorbidity Index score (0.45 [0.78], p?=?0.547). Mean (SD) ADD was 16.7?mcg (9.2, label range 10–20?mcg) for exenatide BID and 1.4?mg (0.7, label range 0.6–1.8?mg) for liraglutide QD. Among patients with post-index HbA1c tests, mean unadjusted values did not differ between cohorts. Exenatide BID patients were more likely than liraglutide QD patients to continue pre-index glucose-lowering medications (67.1% vs 60.3%, p?=?0.027) or to start concomitant glucose-lowering medications at index (32.2% vs 25.0%, p?=?0.013); exenatide BID patients were less likely to augment treatment with another drug post-index (15.8% vs 22.5%, p?=?0.027).

Limitations:

Results may not be generalizable. Lab measures for clinical outcomes were available only for a sub-set of patients.

Conclusions:

Results suggested that some differences exist between patients initiating exenatide BID or liraglutide QD, with respect to prescribing physician specialty and pre- and post-index treatment patterns. Both GLP-1 receptor agonists showed comparable post-index HbA1c values in a sub-set of patients.     

生活方式、天然产物和药物在预防和治疗Ⅱ型糖尿病中的作用

Ⅱ型糖尿病通常会引起眼、肾及神经系统的并发症，并会增加患有心脑血管疾病和肿瘤的风险。过量的脂肪组织会分泌一些炎症因子来加重Ⅱ型糖尿病的病情。从治疗的观点来看，合理的饮食和运动能增强葡萄糖的自身稳定，如果再控制好体重完全可以战胜Ⅱ型糖尿病。此外，一些天然产物也能起到辅助治疗的作用。当然，药物在治疗糖尿病中起到至关重要的作用。现将讨论一些与生活方式密切结合的药物疗法在预防和治疗Ⅱ型糖尿病中的作用。     

姜黄素防治2型糖尿病的研究进展

姜黄素是从姜黄中提取的一种多酚类物质,具有抗癌,抗炎,抗氧化等多种生物学作用,最近研究发现姜黄素具有明显降低糖尿病大鼠血糖、血脂,明显改善2型糖尿病大鼠糖代谢,脂代谢紊乱的症状。     

维生素B12与叶酸联合二甲双胍治疗2型糖尿病的疗效及其对同型半胱氨酸的影响

目的探究维生素B12与叶酸联合二甲双胍治疗2型糖尿病的疗效及其对同型半胱氨酸的影响。方法我院2010年07月至2010年12月临床诊断为2型糖尿病患者90例。随机分为三组:对照组:每日给予二甲双胍0.75mg;治疗一组:每日给予二甲双胍0.75mg及叶酸片;治疗二组:每日给予二甲双胍0.75mg及叶酸15mg、维生素B12片1500g,连服14d。分别于治疗前、治疗后定期抽血测定同型半胱氨酸、叶酸、VitB12水平,比较治疗前后各项指标变化,并长期观察患者糖尿病相关并发症发生情况。结果二甲双胍治疗后糖尿病患者叶酸、维生素B12水平较治疗前有明显下降(P<0.05),而同型半胱氨酸水平较治疗前有明显升高(P<0.05);治疗一组叶酸水平较治疗前无明显变化,维生素B12水平较治疗前有下降(P<0.05),治疗二组各指标均较前治疗前无明显下降。治疗一组和治疗二组中同型半胱氨酸水平较治疗前无明显变化;对照组治疗2型糖尿病发生并发症多于治疗一组和治疗二组,具有统计学差异(P<0.05),而治疗组两组之间无统计学差异(P>0.05)。结论维生素B12与叶酸联合二甲双胍治疗2型糖尿病可以维持体内同型半胱氨酸水平,并可以防治2型糖尿病各项相关并发症的发生。     

The relationship between employment and mental and physical health in South Africa

This paper estimated the relationship between employment and depression, hypertension, diabetes and tuberculosis in South Africa between 2008 and 2014. South Africa has high levels of economic inactivity and unemployment as well as a high disease burden occasioned by depression, other non-communicable diseases and tuberculosis. Data came from the National Income Dynamics Study panel dataset. Using fixed effects, random effects and pooled ordinary least squares regressions, depression and diabetes were associated with a 4–6 percentage point decline in employment probability, while tuberculosis was associated with a 12–13 percentage point employment decline. The results suggested that the employment-health relationship possibly operated through illness being associated with increased economic inactivity, rather than through making the search efforts of the unemployed unsuccessful. Moreover, the employment-health relationship not only existed contemporaneously, but extended into the future (especially for the physical health indicators).     

Long-term health economic benefits of sensor-augmented pump therapy vs continuous subcutaneous insulin infusion alone in type 1 diabetes: a UK perspective

Aims/hypothesis:

Continuous subcutaneous insulin infusion (CSII) is an important treatment option for type 1 diabetes patients unable to achieve adequate glycemic control with multiple daily injections (MDI). Combining CSII with continuous glucose monitoring (CGM) in sensor-augmented pump therapy (SAP) with a low glucose-suspend (LGS) feature may further improve glycemic control and reduce the frequency of hypoglycemia. A cost-effectiveness analysis of SAP?+?LGS vs CSII plus self-monitoring of blood glucose (SMBG) was performed to determine the health economic benefits of SAP?+?LGS in type 1 diabetes patients using CSII in the UK.

Methods:

Cost-effectiveness analysis was performed using the CORE diabetes model. Treatment effects were sourced from the literature, where SAP?+?LGS was associated with a projected HbA_1c reduction of ?1.49% vs ?0.62% for CSII, and a reduced frequency of severe hypoglycemia. The time horizon was that of patient lifetimes; future costs and clinical outcomes were discounted at 3.5% and 1.5% per annum, respectively.

Results:

Projected outcomes showed that SAP?+?LGS was associated with higher mean quality-adjusted life expectancy (17.9 vs 14.9 quality-adjusted life years [QALYs], SAP?+?LGS vs CSII), and higher life expectancy (23.8 vs 21.9 years), but higher mean lifetime direct costs (GBP 125,559 vs GBP 88,991), leading to an incremental cost-effectiveness ratio (ICER) of GBP 12,233 per QALY gained for SAP?+?LGS vs CSII. Findings of the base-case analysis remained robust in sensitivity analyses.

Conclusions/interpretation:

For UK-based type 1 diabetes patients with poor glycemic control, the use of SAP?+?LGS is likely to be cost-effective compared with CSII plus SMBG.