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Diabetes Management
therapy, overcoming fears and therapeutic barriers to initiating therapy as baseline HbA
1c
≥8.5%, it was $34,916). Total lifetime costs were compared
early as needed is essential for reducing the vascular comorbidities of this with efficacy rates in both arms as a ratio, which revealed that the lifetime
highly prevalent disease in patients of all ages. cost per patient treated successfully to target HbA
1c
levels of <7.0% and
≤6.5% were $80,523 and $93,242 lower with BIAsp 70/30 than with glargine,
In an analysis of data from the PREDICTIVE study, long-term health economic respectively. Thus long-term treatment with BIAsp 70/30 was projected to
outcomes associated with insulin aspart versus human soluble insulin in be cost-effective for patients with type 2 diabetes insufficiently controlled on
type 2 diabetes patients on basal–bolus therapy in Sweden, Spain, Italy, and OAD therapy alone compared with glargine.
63
Poland were determined.
61
The findings showed that insulin aspart was
superior to human soluble insulin in both Sweden and Spain and would be Conclusion
considered cost-effective in Italy, with an incremental cost-effectiveness A number of new clinical tools are available for the treatment of type 2
ratio of €18,597 per quality-adjusted life-year (QALY) gained, but would not diabetes, including basal, prandial, and pre-mixed insulin analogs and
be considered cost-effective in Poland. A further study aimed to evaluate new insulin delivery devices. There is no denying that legitimate
the long-term clinical and economic outcomes derived from insulin detemir concerns regarding insulin use exist, but insulin is often necessary to
and NPH insulin in combination with mealtime insulin aspart in patients with reach blood glucose goals. Healthcare providers can reduce the
type 1 diabetes at centers in Belgium, France, Germany, Italy, and Spain.
62
perceived negative aspects of insulin by addressing patient concerns
Insulin detemir produced cost savings in Belgium, Germany, and Spain. In and barriers and providing information to support insulin use and
France and Italy, lifetime costs were slightly greater with the detemir arm, improve metabolic control. As diabetes progresses, decreasing glycemic
and incremental cost-effectiveness ratios were €519 per QALY gained and control necessitates treatment intensification. Options for this initially
€3,256 per QALY gained, respectively. Insulin detemir was therefore include the addition of basal insulin to OADs; this often uses long-acting
considered more likely to be used as a treatment strategy than NPH in insulins to provide a more consistent efficacy. Alternatively, an
Belgium, Germany, and Spain, but is highly cost-effective in France and Italy automated pump dosing system can be used to provide a constant
in patients with type 1 diabetes. delivery. Basal dosing regimens can be intensified with the addition of
prandial bolus insulin doses, a strategy that has been shown to markedly
The INITIATE clinical trial demonstrated improvements in HbA
1c
with BIAsp reduce HbA
1c
levels. Another alternative to multiple injected insulin
70/30 versus glargine in patients poorly controlled on OAD therapy.
55
Data doses is to use a pre-mixed preparation. Various pre-mixed insulin
from this study were projected over 35 years to account for the effects on analogs are commercially available and provide simultaneous coverage
life expectancy (LE), quality-adjusted life expectancy (QALE), cumulative of fasting and prandial glucose. The availability of multiple treatment
incidence of diabetes-related complications, and direct medical costs regimens and insulin types allows for treatment to be tailored to specific
(based on 2004 costs in US$). Results showed that the improvements in patient needs. Studies using both pre-mixed and basal–bolus regimens
glycemic control were projected to lead to gains in LE (0.19±0.24 years) and have demonstrated that intensification improves quality of life,
QALE (0.19±0.17 years) favoring BIAsp 70/30 versus glargine. Treatment with decreases complications, and slightly increases LE. Analysis of these
BIAsp 70/30 was also associated with reductions in the cumulative criteria has shown that such approaches are cost-effective. Treatment
incidence of diabetes-related complications, notably in renal and retinal intensification should therefore be considered for all patients with
conditions. The incremental cost-effectiveness ratio was $46,533 per QALY progressing diabetes to both decrease the worsening disease burden
gained with pre-mixed insulin aspart 70/30 versus glargine (for patients with and reduce the high long-term costs of treatment and care. n
1. Garber AJ, Diabetes Obes Metab, 2009;11(Suppl. 5):14–18. 23. Peyrot M, et al., Diabetes Care, 2005;(28):2673–9. 45. Monnier L, Colette C, Diabetes Metab, 2006;32(1):7–13.
2. Vasudevan AR, et al., Treat Endocrinol, 2006;5(5):273–86. 24. Nichols GA, et al., J Gen Intern Med, 2007;22:453–8. 46. Sheldon B, et al., Diabetes Obes Metab, 2009;11(1):5–19.
3. Vaag AA, Endocr Pract, 2006;12(Suppl. 1):89–92. 25. Brunton S, Diabetes Technol Ther, 2008;(10):247–56. 47. Lindholm A, Best Pract Res Clin Gastroenterol,
4. UK Prospective Diabetes Study Group, Lancet, 26. Bohannon NJ, Postgrad Med, 1999;15;106(5):57–8, 61–4, 68. 2002;16(3):475–92.
1998;(352):837–53. 27. Siddiqui NI, et al., Mymensingh Med J, 2008;17(1):102–10. 48. Hollander P, et al., Clin Ther, 2008;30(11):1976–87.
5. DCCT Research Group, N Engl J Med, 1993;(329):977–86. 28. Molife C, et al., Diabetes Technol Ther, 2009;11(8):529–38. 49. Fajardo Montanana C, et al., Diabetes Care,
6. UK Prospective Diabetes Study Group, Lancet, 29. Devries JH, Diabetes Metab Res Rev, 2007;23(6):441–54. 2005;28(7):1769–78.
1998;352:854–65. 30. Garber AJ, et al., Diabetes Obes Metab, 2007;9(5):630–39. 50. Raskin P, et al., Diabetic Medicine, 2006;23(Suppl. 4):341,
7. Nathan DM, et al., N Engl J Med, 2005;(353):2643–53. 31. Ilag LL, et al., Clin Ther, 2007;29:Spec No:1254-70. abstract P947.
8. Hu FB, Drugs Today (Barc), 2002;38(11):769–75. 32. American Association of Clinical Endocrinologists Diabetes 51. Lankisch MR, et al., Diabetes Obes Metab, 2008;10(12):
9. Ford ES, Diabetes Care, 2005;28(7):1769–78. Mellitus Clinical Practice Guidelines Task Force. Available at: 1178–85.
10. Prentki M, Nolan CJ, J Clin Invest, 2006;116:1802–12. www.aace.com/pub/pdf/guidelines/ DMGuidelines2007.pdf 52. American Diabetes Association, Diabetes Care, 2004;27
11. Hartge MM, et al., Diabetes Vasc Dis Res, 2007;(4):84–8. 33. Rosenstock J, et al., Diabetologia, 2008;(51):408–16. (Suppl. 1).
12. Ceriello A, et al., Metabolism, 1999;(48):1503–8. 34. King AB, Diabetes Obes Metab, 2009;(11):69–71. 53. Edelman SV, et al., Abstract 428-P, 69th ADA scientific
13. Monnier L, et al., JAMA, 2006;(295):1681–7. 35. AACE/ACE Consensus Statement, Endocrine Pract, sessions, June 2009.
14. Steppel JH, Horton ES, Curr Diab Rep, 2004;4(3):169–75. 2009;15:540–59. 54. Rolla AR, Rakel RE, Clin Ther, 2005;27(8):1113–25.
15. Holman RR, et al., N Engl J Med, 2008;(359):1577–89. 36. Hermansen K, et al., Diabetes Care, 2006;(29):1269–74 55. Herz M, et al.. Clin Ther. 2002 Jan;24(1):73-86.
16. Monnier L, et al., Endocr Pract, 2006;12(Suppl. 1):42–6. 37. Haak T, et al., Diabetes Obes Metab, 2005;(7):56–64. 56. Kilo C, et al., J Diabetes Complications, 2003;17:307–13.
17. Tibaldi J, South Med J, 2009;(102):60–66. 38. Raslova K, et al., Diabetes Res Clin Pract, 2004;(66):193–201. 57. Gumprecht J, et al., Int J Clin Pract, 2009;639(6):966–72.
18. American Diabetes Association, Diabetes Care, 39. Raslova K, et al., Clin Drug Invest, 2007;(27):279–85. 58. Garber AJ, et al., Diabetes Obes Metab, 2006;(8):58–66.
2009;(32 Suppl. 1):S13–S61. 40. Yki-Jarvinen H, et al., Diabetes Care, 2000;(23):1130–36. 59. Liebl A, et al., Diabetes Obes Metab, 2009;(11):45–52.
19. Jellinger PS, et al., Endocr Pract, 2007;13(3):260–68. 41. Dornhorst A, et al., Diabetes Obes Metab, 2008;(10):75–81. 60. Rosenstock J, et al., Diabetes Care, 2008;31:20–25.
20. DPP Research Group, N Engl J Med, 2002;(346):393–403. 42. Meneghini L, et al., Diabetes Obes Metab, 2007;(9):902–13 61. Palmer JL, et al., Curr Med Res Opin, 2008;24(5):1417–28.
21. Weng J, et al., Lancet, 2008;(371):1753–60. 43. Fajardo Montanana C, et al., Diabet Med, 2008;(25):916–23. 62. Gschwend MH, et al., J Med Econ, 2009;12(2):114–23.
22. Alvarsson M, et al., Diabetes Obes Metab, 2008;(10):421–9. 44. Meneghini LF, et al., Diabetes Obes Metab, 2007;9(3):418–27. 63. Ray JA, et al., Diab Obes Metab, 2007;9(1):103–13.
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