Macrovascular Risk and Diagnostic Criteria for Type 2 Diabetes: Implications for the use of FPG and HbA1c for cost-effective screening

OBJECTIVE To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared to standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. RESEARCH DESIGN AND METHODS Data were from 4,827 participants during the first 9 years of the study from 2001 to 2012. Information on Health Utility Index-2 and -3, SF-6D, and Feeling Thermometer [FT]), cost of delivering the interventions, and health expenditures were collected during the study. CE was measured by incremental cost-effectiveness ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 US dollars. RESULTS <a>Over the </a>9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.17 and 0.16, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs, to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. Conclusions Whether ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions.

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Validation of Tokyo Guidelines 2007 and Tokyo Guidelines 2013/2018 Criteria for Acute Cholangitis and Predictors of In-Hospital Mortality

Visceral Medicine ◽

10.1159/000516424 ◽

2021 ◽

pp. 1-9

Author(s):

Ramkumar Mohan ◽

Stefanie Wei Lynn Goh ◽

Guan Wei Tan ◽

Yen Pin Tan ◽

Sameer P. Junnarkar ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Hospital Mortality ◽

Diagnostic Criteria ◽

Glasgow Coma Score ◽

Acute Cholangitis ◽

Tokyo Guidelines

Background: Acute cholangitis (AC) is a common emergency with a significant mortality risk. The Tokyo Guidelines (TG) provide recommendations for diagnosis, severity stratification, and management of AC. However, validation of the TG remains poor. This study aims to validate TG07, TG13, and TG18 criteria and identify predictors of in-hospital mortality in patients with AC. Methods: This is a retrospective audit of patients with a discharge diagnosis of AC in the year 2016. Demographic, clinical, investigation, management and mortality data were documented. We performed a multinomial logistic regression analysis with stepwise variable selection to identify severity predictors for in-hospital mortality. Results: Two hundred sixty-two patients with a median age of 75.9 years (IQR 64.8–82.8) years were included for analysis. TG13/TG18 diagnostic criteria were more sensitive than TG07 diagnostic criteria (85.1 vs. 75.2%; p < 0.006). The majority of the patients (n = 178; 67.9%) presented with abdominal pain, pyrexia (n = 156; 59.5%), and vomiting (n = 123; 46.9%). Blood cultures were positive in 95 (36.3%) patients, and 79 (83.2%) patients had monomicrobial growth. The 30-day, 90-day, and in-hospital mortality numbers were 3 (1.1%), 11 (4.2%), and 15 (5.7%), respectively. In multivariate analysis, type 2 diabetes mellitus (OR = 12.531; 95% CI 0.354–116.015; p = 0.026), systolic blood pressure <100 mm Hg (OR = 10.108; 95% CI 1.094–93.395; p = 0.041), Glasgow coma score <15 (OR = 38.16; 95% CI 1.804–807.191; p = 0.019), and malignancy (OR = 14.135; 95% CI 1.017–196.394; p = 0.049) predicted in-hospital mortality. Conclusion: TG13/18 diagnostic criteria are more sensitive than TG07 diagnostic criteria. Type 2 diabetes mellitus, systolic blood pressure <100 mm Hg, Glasgow coma score <15, and malignant etiology predict in-hospital mortality in patients with AC. These predictors could be considered in acute stratification and treatment of patients with AC.

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Country-Specific Prevalence and Incidence of Youth-Onset Type 2 Diabetes: A Narrative Literature Review

Annals of Nutrition and Metabolism ◽

10.1159/000510499 ◽

2020 ◽

Vol 76 (5) ◽

pp. 289-296 ◽

Cited By ~ 1

Author(s):

Jane L. Lynch ◽

Margarita Barrientos-Pérez ◽

Mona Hafez ◽

Muhammad Yazid Jalaludin ◽

Margarita Kovarenko ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diagnostic Criteria ◽

Incidence Rates ◽

National Guidelines ◽

Incidence Data ◽

Epidemiology Data ◽

The Usa ◽

The Uk ◽

Country Specific

Background: With increased awareness of type 2 diabetes (T2D) in children and adolescents, an overview of country-specific differences in epidemiology data is needed to develop a global picture of the disease development. Summary: This study examined country-specific prevalence and incidence data of youth-onset T2D published between 2008 and 2019, and searched for national guidelines to expand the understanding of country-specific similarities and differences. Of the 1,190 articles and 17 congress abstracts identified, 58 were included in this review. Our search found the highest reported prevalence rates of youth-onset T2D in China (520 cases/100,000 people) and the USA (212 cases/100,000) and lowest in Denmark (0.6 cases/100,000) and Ireland (1.2 cases/100,000). However, the highest incidence rates were reported in Taiwan (63 cases/100,000) and the UK (33.2 cases/100,000), with the lowest in Fiji (0.43 cases/100,000) and Austria (0.6 cases/100,000). These differences in epidemiology data may be partly explained by variations in the diagnostic criteria used within studies, screening recommendations within national guidelines and race/ethnicity within countries. Key Messages: Our study suggests that published country-specific epidemiology data for youth-onset T2D are varied and scant, and often with reporting inconsistencies. Finding optimal diagnostic criteria and screening strategies for this disease should be of high interest to every country. Trial Registration: Not applicable.

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Study on prediction of type 2 diabetes mellitus in undergraduate MBBS students: a cross-section study in a tertiary health center, Kolkata

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175717 ◽

2017 ◽

Vol 6 (1) ◽

pp. 184

Author(s):

Murari M. Mandal ◽

Shobhit Garg ◽

R. N. Mishra ◽

Swanya P. Maharana

Keyword(s):

Type 2 Diabetes ◽

Screening Tool ◽

Risk Group ◽

Cost Effective ◽

High Risk Group ◽

Hip Circumference ◽

Moderate Risk ◽

Cross Sectional ◽

Random Blood Sugar

Background: Diabetes, is now a leading cause of morbidity and mortality worldwide. Prevalence of type-2 diabetes in children and adolescents is rapidly increasing worldwide. Adolescence and early youth period has pivotal importance for young people with diabetes risk when they usually start learning about how to take responsibility. With this background, present study was done to find out the proportion of various risk factors and future risk of developing diabetes among MBBS undergraduates in Kolkata.Methods: This study was a cross-sectional institution based study done from 1st June to 18th June 2017. Data was collected by interviewing each respondent with the help of structured pre-designed pre-tested schedule, after which clinical examination for height, weight, waist and hip circumference, blood pressure and RBS were done. Out of 150 undergraduates, 130 agreed to participate. Data was analysed with R software.Results: Mean age of the students was 20.45years. 48.5% of them were either overweight or obese. Nearly half of them had waist circumference and waist hip ratio in risk group. Only 65 were normotensive and 7 had high random blood sugar (≥140 mg/dl). 6 students were in high risk group according to both IDRS (≥60) and ADA (≥5) risk score. 66 students were in moderate risk (30-50) group as per IDRS risk score.Conclusions: The simple and cost-effective IDRS could serve as a screening tool health worker to identify at risk individuals at the earliest and enable primary prevention by encouraging these students to modify their life-style.

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Comorbidities and Diabetes Type 2

Advances in Medical Technologies and Clinical Practice - Optimizing Health Monitoring Systems With Wireless Technology ◽

10.4018/978-1-5225-6067-8.ch005 ◽

2021 ◽

pp. 46-61

Author(s):

Chinedu I. Ossai ◽

Nilmini Wickramasinghe ◽

Steven Goldberg

Keyword(s):

Type 2 Diabetes ◽

High Risk ◽

Logit Model ◽

Diabetes Type 2 ◽

Cost Effective ◽

Diabetes Type ◽

High Quality ◽

Chi Square ◽

Very High

The prevalence of diabetes type 2 among the population and the increasing rate of new diagnoses as well as other co-morbidities make it imperative that we develop a richer understanding of type 2 diabetes. An Australian survey of diabetes type 2 people for different co-morbidities was carried out to obtain information about the possible connections of the co-morbidities with type 2 diabetes. The analysis is done with the logit model and Pearson's chi-square and the results indicate that gender, age of the patients, and the duration of the diabetes type 2 diagnosis play a significant role in the exposure of individuals to different comorbidities. The influence of the duration of diagnosis and age of the patients is limited in comparison to the gender, which has females at a very high risk of developing the studied co-morbidities compared to males. The findings can improve diabetes type 2 management to boost high quality, proactive, and cost-effective caregiving for the patients.

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PDB66 - INSULIN GAP IN TYPE 2 DIABETES: IS IT COST EFFECTIVE TO INTENSIFY TREATMENT? EVIDENCE FROM PORTUGAL USING REAL WORLD DATA

Value in Health ◽

10.1016/j.jval.2018.09.771 ◽

2018 ◽

Vol 21 ◽

pp. S129

Author(s):

F. Fiorentino ◽

R. Ascenção ◽

J. Costa ◽

M. Gouveia ◽

M. Borges

Keyword(s):

Type 2 Diabetes ◽

Real World ◽

Cost Effective ◽

Real World Data ◽

World Data

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PDB81 - DAPAGLIFLOZIN IS COST-EFFECTIVE COMPARED TO DPP-4 INHIBITORS IN THE TREATMENT OF TYPE 2 DIABETES MELLITUS IN THE NETHERLANDS

Value in Health ◽

10.1016/j.jval.2018.09.786 ◽

2018 ◽

Vol 21 ◽

pp. S132

Author(s):

S.P. Van Olst ◽

S. Nekeman ◽

N. van der Linden ◽

C.A. Uyl-de Groot

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

The Netherlands ◽

Cost Effective

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Liraglutide cost effective in type 2 diabetes with CV implications

PharmacoEconomics & Outcomes News ◽

10.1007/s40274-018-5478-x ◽

2018 ◽

Vol 817 (1) ◽

pp. 21-21

Keyword(s):

Type 2 Diabetes ◽

Cost Effective

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A systematic review of economic evaluations in non-insulin antidiabetic treatments for patients with type 2 diabetes mellitus

Global & Regional Health Technology Assessment Italian Northern Europe and Spanish ◽

10.1177/2284240319876574 ◽

2019 ◽

Vol 2019 ◽

pp. 228424031987657 ◽

Cited By ~ 1

Author(s):

Néboa Zozaya ◽

Margarita Capel ◽

Susana Simón ◽

Alfonso Soto-González

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Management Strategies ◽

Cost Effective ◽

Cost Utility ◽

Economic Evaluations ◽

Life Years ◽

Comparative Results

The approval of new non-insulin treatments has broadened the therapeutic arsenal, but it has also increased the complexity of choice for the treatment of type 2 diabetes mellitus (DM2). The objective of this study was to systematically review the literature on economic evaluations associated with non-insulin antidiabetic drugs (NIADs) for DM2. We searched in Medline, IBECS, Doyma and SciELO databases for full economic evaluations of NIADs in adults with DM2 applied after the failure of the first line of pharmacological treatment, published between 2010 and 2017, focusing on studies that incorporated quality-adjusted life years (QALYs). The review included a total of 57 studies, in which 134 comparisons were made between NIADs. Under an acceptability threshold of 25,000 euros per QALY gained, iSLGT-2 were preferable to iDPP-4 and sulfonylureas in terms of incremental cost-utility. By contrast, there were no conclusive comparative results for the other two new NIAD groups (GLP-1 and iDPP-4). The heterogeneity of the studies’ methodologies and results hindered our ability to determine under what specific clinical assumptions some NIADs would be more cost-effective than others. Economic evaluations of healthcare should be used as part of the decision-making process, so multifactorial therapeutic management strategies should be established based on the patients’ clinical characteristics and preferences as principal criteria.

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