Insulin for diabetes: 100 years of therapy

2022 ◽  
Vol 33 (1) ◽  
pp. 10-13
Author(s):  
Peter Jennings ◽  
Martha Stewart
Keyword(s):  
Type 1 Diabetes ◽  
Sentence Type ◽  
Glucose Monitoring ◽  
100Th Anniversary ◽  
Death Sentence ◽  
Martha Stewart ◽  
Cell Transplants ◽  
Insulin Use

This month is the 100th anniversary of insulin use in humans. Peter Jennings and Martha Stewart provide an overview of how this advancement improved care for people living with diabetes January 2022 marks 100 years since insulin was first successfully used to treat diabetes in humans. Everyone with type 1 diabetes – except those who have received pancreas or islet-cell transplants – and more than half of people with type 2 diabetes use insulin to manage their diabetes. Instead of being seen as a death sentence, type 1 diabetes is now seen as a long-term condition that can be self-managed for people with access to insulin and glucose monitoring technology. However, many people living with diabetes around the world are still unable to access affordable insulin, technologies and the support needed to self-manage their diabetes.

scholarly journals Long-term Cost-Effectiveness of Dexcom G6 Real-Time Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Patients With Type 1 Diabetes in the U.K.

2020 ◽  
Author(s):  
Stéphane Roze ◽  
John Isitt ◽  
Jayne Smith-Palmer ◽  
Mehdi Javanbakht ◽  
Peter Lynch
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Cost Effectiveness ◽  
Real Time ◽  
Glucose Monitoring ◽  
Baseline Hba1c ◽  
Self Monitoring ◽  
Quality Adjusted Life

<b>Objective</b> <p>A long-term health economic analysis was performed to establish the cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) (Dexcom G6) versus self-monitoring of blood glucose (SMBG) alone in UK-based patients with type 1 diabetes. </p> <p><b>Methods</b></p> <p>The analysis utilized the IQVIA CORE Diabetes Model. Clinical input data were sourced from the DIAMOND trial in adults with type 1 diabetes; simulations were performed separately in the overall population of patients with baseline HbA1c ≥7.5% (58 mmol/mol); and a secondary analysis was performed in patients with baseline HbA1c ≥8.5% (69 mmol/mol). The analysis was performed from the NHS healthcare payer perspective over a lifetime time horizon. </p> <p><b>Results</b></p> <p>In the overall population, G6 RT-CGM was associated with a mean incremental gain in quality-adjusted life expectancy of 1.49 quality-adjusted life years (QALYs) versus SMBG (mean [standard deviation; SD] 11.47 [2.04] QALYs versus 9.99 [1.84] QALYs). Total mean (SD) lifetime costs were also GBP 14,234 higher with RT-CGM (GBP 102,468 [35,681] versus GBP 88,234 [39,027]) resulting in an ICER of GBP 9,558 per QALY gained. Sensitivity analyses revealed that the findings were sensitive to changes in the quality of life benefit associated with reduced fear of hypoglycemia and avoidance of fingerstick testing as well as the HbA1c benefit associated with RT-CGM use. </p> <p><b>Conclusions</b></p> <p>For UK-based type 1 diabetes patients, the G6 RT-CGM device is associated with significant improvements in clinical outcomes and, over patient lifetimes, is a cost-effective disease management option relative to SMBG, based on a willingness-to-pay threshold of GBP 20,000 per QALY gained. </p>

scholarly journals Long-term Cost-Effectiveness of Dexcom G6 Real-Time Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Patients With Type 1 Diabetes in the U.K.

2020 ◽  
Author(s):  
Stéphane Roze ◽  
John Isitt ◽  
Jayne Smith-Palmer ◽  
Mehdi Javanbakht ◽  
Peter Lynch
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Cost Effectiveness ◽  
Real Time ◽  
Glucose Monitoring ◽  
Baseline Hba1c ◽  
Self Monitoring ◽  
Quality Adjusted Life

<b>Objective</b> <p>A long-term health economic analysis was performed to establish the cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) (Dexcom G6) versus self-monitoring of blood glucose (SMBG) alone in UK-based patients with type 1 diabetes. </p> <p><b>Methods</b></p> <p>The analysis utilized the IQVIA CORE Diabetes Model. Clinical input data were sourced from the DIAMOND trial in adults with type 1 diabetes; simulations were performed separately in the overall population of patients with baseline HbA1c ≥7.5% (58 mmol/mol); and a secondary analysis was performed in patients with baseline HbA1c ≥8.5% (69 mmol/mol). The analysis was performed from the NHS healthcare payer perspective over a lifetime time horizon. </p> <p><b>Results</b></p> <p>In the overall population, G6 RT-CGM was associated with a mean incremental gain in quality-adjusted life expectancy of 1.49 quality-adjusted life years (QALYs) versus SMBG (mean [standard deviation; SD] 11.47 [2.04] QALYs versus 9.99 [1.84] QALYs). Total mean (SD) lifetime costs were also GBP 14,234 higher with RT-CGM (GBP 102,468 [35,681] versus GBP 88,234 [39,027]) resulting in an ICER of GBP 9,558 per QALY gained. Sensitivity analyses revealed that the findings were sensitive to changes in the quality of life benefit associated with reduced fear of hypoglycemia and avoidance of fingerstick testing as well as the HbA1c benefit associated with RT-CGM use. </p> <p><b>Conclusions</b></p> <p>For UK-based type 1 diabetes patients, the G6 RT-CGM device is associated with significant improvements in clinical outcomes and, over patient lifetimes, is a cost-effective disease management option relative to SMBG, based on a willingness-to-pay threshold of GBP 20,000 per QALY gained. </p>

scholarly journals Coincidence of juvenile idiopathic arthritis and type 1 diabetes: a case-based review

2022 ◽  
Author(s):  
Maciej Szabłowski ◽  
Michał Andrzej Okruszko ◽  
Katarzyna Pochodowicz ◽  
Paweł Abramowicz ◽  
Jerzy Konstantynowicz ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Juvenile Idiopathic Arthritis ◽  
Autoimmune Diseases ◽  
Metabolic Control ◽  
Pediatric Population ◽  
Treatment Options ◽  
Glucose Monitoring ◽  
Control Of Diabetes

AbstractThe study was aimed to review a rare coexistence of type 1 diabetes (T1D) and juvenile idiopathic arthritis (JIA) regarding different clinical approaches to the management and treatment options. Medical complications of the two autoimmune disorders in children and adolescents have been evaluated, particularly in those treated with glucocorticosteroids (GCS) and insulin. A review of the literature regarding reports on concomitant T1D and JIA was conducted using resources available in Medline, Google Scholar, and Web of Science databases, with a specific focus on the combination of T1D and JIA in a pediatric population. The review was extended by our analysis of two patients treated in a single center for this comorbidity. Eligible reports of four cases were found, and including our two original records, a total of six pediatric patients (5 females) were analyzed, of which three had also other autoimmune diseases (thyroiditis, coeliac disease, autoimmune hepatitis), whereas four had been treated with a long-term GCS, and two were receiving biological therapy (etanercept or adalimumab). Only one of them had good metabolic control of diabetes. Diabetes in childhood may coexist with other autoimmune diseases, including rheumatologic conditions. Hyperglycemia can worsen JIA therapy by induction and maintaining inflammation. Using modern diabetes technologies (like personal insulin pumps and continuous glucose monitoring) helps to minimize the deteriorating effect of JIA exacerbations and the rheumatoid treatment on metabolic control of diabetes.

scholarly journals Sustained Intensive treatment and Long-term Effects on HbA1c Reduction (SILVER Study) by CGM in persons with type 1 diabetes treated with MDI

2020 ◽  
Author(s):  
Marcus Lind ◽  
Arndís F. Ólafsdóttir ◽  
Irl B. Hirsch ◽  
Jan Bolinder ◽  
Sofia Dahlqvist ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Treatment Satisfaction ◽  
Glucose Monitoring ◽  
Well Being ◽  
Diabetes Distress ◽  
Control Treatment ◽  
Long Term Effects ◽  
Self Monitoring

Objective: Continuous Glucose Monitoring (CGM) reduces HbA1c and time spent in hypoglycemia in persons with type 1 diabetes treated with multiple daily insulin injections (MDI) when evaluated over shorter time periods. It is unclear to what extent CGM improves and helps to maintain glucose control, treatment satisfaction, diabetes distress, hypoglycemic concerns and overall well-being over longer periods of time <p><br> Research design and methods: The GOLD trial was a randomized crossover trial performed over 16 months of CGM treatment in persons with type 1 diabetes treated with MDI. Persons completing the trial (n=141) were invited to participate in the current SILVER extension study in which 107 patients continued CGM treatment over 1 year along with the support of a diabetes nurse every 3 months. <br> <br> </p> <p>Results: The primary endpoint, change in HbA1c over 1.0-1.5 years CGM use compared with previous self-monitoring of blood glucose (SMBG) during GOLD, showed a decrease in HbA1c of 0.35% (95% CI 0.19-0.50), p<0.001. Time spent in hypoglycemia <3.0 mmol/l (54 mg/dl) and <4.0 mmol/l (72 mg/dl) decreased from 2.1% to 0.6% (p<0.001) and from 5.4% to 2.9% (p<0.001), respectively. Overall well-being (WHO-5, p=0.009), treatment satisfaction (DTSQ, p<0.001) and hypoglycemic confidence (p<0.001) increased, while hypoglycemic fear (HFS-Worry, p=0.016) decreased and diabetes distress tended to decrease (PAID, p=0.06). From randomization and screening in GOLD, HbA1c was lowered by 0.45% (p<0.001) and 0.68% (p<0.001) after 2.3 and 2.5 years, respectively. <br> <br> Conclusions: The SILVER study supports beneficial long-term effects from CGM on HbA1c, hypoglycemia, treatment satisfaction, well-being and hypoglycemic confidence in persons with T1D managed with MDI. </p>

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