Estimating the impact of changes in HbA1c, body weight and insulin injection regimen on health related quality-of-life: a time trade off study

Abstract

BackgroundThere are limited data on the potential short-term benefits associated with reductions in HbA1c levels, and understanding any immediate improvements in health related quality-of-life (HRQoL) through better glycaemic control may help inform diabetes management decisions. This time-trade-off (TTO) study investigated the short-term impact on HRQoL associated with three different aspects of diabetes management; HbA1c change, body weight change, and the complexity of treatment regimen.MethodsThe study was designed in three stages: Stage 1) Qualitative telephone interviews with people with type 2 diabetes (T2D) in Denmark who had experienced a decrease in their HbA1c level. Stage 2) A validation survey with people with T2D in Denmark to obtain quantifiable knowledge on the short-term effects of a change in HbA1c levels. Stage 3) TTO survey using health states based on results from stage 2. Respondents were either adults with T2D (Sweden) or from the general public (UK and Denmark) and were separately asked to evaluate seven health states through an internet-based survey.ResultsResults from 4060 respondents were available for the TTO analysis (UK n = 1777; Denmark n = 1799, Sweden n = 484). ‘Well-controlled diabetes’ was associated with utilities of 0.85–0.91 and ‘not well-controlled diabetes’ with utilities of 0.71–0.80 in all countries. Difference in utilities per HbA1c percentage point was smallest in Sweden and largest in Denmark (between 0.025–0.034 per HbA1c percentage point respectively). The treatment management health state associated with the lowest disutility was the once-daily insulin regimen. The disutility associated with per kg of weight change ranged from 0.0041–0.0073.ConclusionsChanges in HbA1c levels, insulin regimen and body weight are all likely to affect HRQoL for patients with T2D. A change in HbA1c is likely to have a short-term impact in addition to the effect on the development of long term diabetes complications. A treatment which has a simple regimen with fewer injections, and/or the need for less planning, and that causes weight loss or less weight gain, compared with other treatments, will have a positive impact on HRQoL.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-016-0411-0) contains supplementary material, which is available to authorized users.

Cost Effectiveness of Insulin Degludec Plus Liraglutide (IDegLira) in a Fixed Combination for Uncontrolled Type 2 Diabetes Mellitus in Sweden

“…Several of these utilities have been used previously, whereas others (patient utility relative to HbA 1c reduction and treatment complexity, respectively) were developed specifically for the purpose of this study [58]. The utility score of HbA 1c reduction we used is very close to an equivalent score obtained for type 1 diabetes mellitus [59].…”

Evaluation of the application of the Diabetes Quality of Life Questionnaire in patients with diabetes mellitus

“…DM costs go beyond the direct and indirect costs of the disease to include intangible costs such as pain, anxiety, and worsening of quality of life (QoL). QoL has a great impact on the life of diabetic patients as well as a direct relationship with the maintenance of glycemic control (3,4).…”

Oral semaglutide versus injectable glucagon-like peptide-1 receptor agonists: a cost of control analysis

“…Previous studies have shown that there is a preference for avoidance of injections (both daily and weekly) 38,39 . Oral administration may remove a barrier to treatment intensification, with fear of injection often cited as a reason for therapeutic inertia [40][41][42][43][44] .…”