National Consensus Statement on the Management of Type 2 Diabetes Mellitus in Nepal

Shrestha, Dina; Shrestha, Pradeep Krishna; Sharma, Sanjib Kumar; Bhattarai, Jyoti; Shrestha, Hari Kumar; Pradhan, Ajay; Shakya, Amit

doi:10.3126/jdean.v3i1.24072

Cited by 7 publications

(3 citation statements)

References 33 publications

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“…However, international guidelines are well established but are missing in the implementation of health care facilities of Nepal. 40 Therefore, the present study provides useful insights for policy makers and health care providers with regard to the future resource use and costs to manage T2D. However, more evidence is needed to obtain a broader picture of the direct and indirect cost of health care resource use among diabetes patients in the wider community.…”

Section: Discussionmentioning

confidence: 91%

Estimating the Health Care Expenditure to Manage and Care for Type 2 Diabetes in Nepal: A Patient Perspective

Dahal,

Rawal,

Ademi

et al. 2023

MDM Policy & Practice

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Background. This study aimed to estimate the health care expenditure for managing type 2 diabetes (T2D) in the community setting of Nepal. Methods. This is a baseline cross-sectional study of a heath behavior intervention that was conducted between September 2021 and February 2022 among patients with T2D ( N = 481) in the Kavrepalanchok and Nuwakot districts of Nepal. Bottom-up and micro-costing approaches were used to estimate the health care costs and were stratified according to residential status and the presence of comorbid conditions. A generalized linear model with a log-link and gamma distribution was applied for modeling the continuous right-skewed costs, and 95% confidence intervals were obtained from 10,000 bootstrapping resampling techniques. Results. Over 6 months the mean health care resource cost to manage T2D was US $22.87 per patient: 61% included the direct medical cost (US $14.01), 15% included the direct nonmedical cost (US $3.43), and 24% was associated with productivity losses (US $5.44). The mean health care resource cost per patient living in an urban community (US $24.65) was about US $4.95 higher than patients living in the rural community (US $19.69). The health care costs per patient with comorbid conditions was US $22.93 and was US $22.81 for those without comorbidities. Patients living in rural areas had 16% lower health care expenses compared with their urban counterparts. Conclusion. T2D imposes a substantial financial burden on both the health care system and individuals. There is a need to establish high-value care treatment strategies for the management of T2D to reduce the high health care expenses. Highlights More than 60% of health care expenses comprise the direct medical cost, 15% direct nonmedical cost, and 24% patient productivity losses. The costs of diagnosis, hospitalization, and recommended foods were the main drivers of health care costs for managing type 2 diabetes. Health care expenses among patients living in urban communities and patients with comorbid conditions was higher compared with those in rural communities and those with without comorbidities. The results of this study are expected to help integrate diabetes care within the existing primary health care systems, thereby reducing health care expenses and improving the quality of diabetes care in Nepal.

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Section: Discussionmentioning

confidence: 91%

Estimating the Health Care Expenditure to Manage and Care for Type 2 Diabetes in Nepal: A Patient Perspective

Dahal,

Rawal,

Ademi

et al. 2023

MDM Policy & Practice

View full text Add to dashboard Cite

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“…If the goals are unmet, the therapy should be escalated to next phase and/or insulin should be added or intensified as required b ADA/EASD [60]In dual therapy along with metforminIn triple therapy along with metformin and SU, TZD or insulinIn combination injectable therapy with metformin and basal insulin–Non-insulin antidiabetic pharmacotherapy in patients with established CVD: a position paper of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy [61]A few SGLT2i (empagliflozin and canagliflozin) and GLP-1 RAs (liraglutide and semaglutide) reduced CV events in adequately powered studies with contemporary concomitant CV treatment in patients with established CVD (mainly stable CHD with the exclusion of recent ACS) and hence may be considered as the preferred treatment choiceWhen the aforementioned preferred treatments (with selected SGLT2i and GLP-1 RA) are not sufficient to achieve therapeutic goals or are contraindicated, agents such as thiazolidinedione-pioglitazone, GLP1 RA-exenatide and dipeptidyl peptidase inhibitors which have established neutral or potentially beneficial effects on CV events in adequately powered, contemporary trials may be preferredAntidiabetic pharmacotherapy should be chosen on the basis of beneficial effects on CV events in phase 3 and post-marketing trials and as per EMA; improvement of glycaemic control and reduction of CV morbidity and mortality should be major goals in the treatment of T2DMIDF [62]In dual therapy if weight loss is a priority and if the drug is affordableIn triple therapy instead of basal insulin along with 2 glucose-lowering drugs if weight loss has been insufficientPatients should not remain longer than 3 to 6 months with HbA1c above target before adding a second glucose-lowering drugNICE [63]In combination with metformin and SU if triple therapy with metformin and 2 other OADs is not effective, not tolerated or contraindicatedContinued only if the person with T2DM has had a beneficial metabolic response (a reduction of at least 1% in HbA1c and a weight loss of at least 3% of initial body weight in 6 months)In combination with insulin, only with specialist care advice and ongoing support from a consultant-led multidisciplinary team–RSSDI [64]As an add-on to metformin in obese T2DM patients in addition to lifestyle changesAs second-line or third-line option for the management of uncontrolled hyperglycaemiaAs second-line therapy in overweight/obese patients with metformin inadequacy and as first-line therapy in patients with metformin intoleranceAs an add-on to insulin therapy if glycaemic goals are unmet with reasonably high doses of insulin or if unacceptable weight gain or hypoglycaemia occursGLP-1 RAs with proven CV benefit, e.g. liraglutide, should be considered to reduce the risk of major adverse CV eventsDEAN [65]As a third-line agent to metformin (+ lifestyle modification) and SU/DPP4 inhibitor/α-glucosidase inhibitor if glycaemic target is not achieved in 2 months…”

Section: Overview Of Glp-1 Ra Recommendations For T2dm Management Fromentioning

confidence: 99%

Consensus Recommendations on GLP-1 RA Use in the Management of Type 2 Diabetes Mellitus: South Asian Task Force

et al. 2019

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The advent of incretin mimetics such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has enriched the armamentarium for diabetes management owing to their glycaemic as well as extra-glycaemic benefits. The approval status and availability of this class of drugs vary widely across the globe. Being a relatively newer class of drug with numerous benefits, several national and international guidelines are working towards addressing clinical questions pertaining to the optimal use of GLP-1 RAs for the management of diabetes. Although the newer class of drugs are associated with significant benefits such as patient-centric approach, these drugs demand the providers to be vigilant and knowledgeable about the medication. The South Asian population is at higher risk of type 2 diabetes mellitus (T2DM) because of their genetic predisposition and lifestyle changes. Hence, prevention and management of T2DM and its associated complications in this population are of paramount importance. The current report aims to present an overview of Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.8850866.

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“…Hypothyroidism is more common among thyroid disorders with a female preponderance. 2,3 Studies have suggested a strong association between hypothyroidism and low vitamin D levels. [4][5][6] Given that both thyroid hormones and vitamin D bind to the same family of steroid/nuclear hormone receptors and share similar response elements on gene promoters, it is highly likely that thyroid hormones and vitamin D might be intricately linked.…”

Section: Introductionmentioning

confidence: 99%

Serum Vitamin D Levels in Euthyroid and Hypothyroid Females Visiting a Tertiary Care Center of Western Nepal

Tamang,

Pokhrel,

Shrestha

et al. 2023

JCMC

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Background: Thyroid function and vitamin D levels may be intricately related. The purpose of the current study was to investigate the relationship between thyroid hormones and vitamin D levels in females attending a tertiary care center in western Nepal. Methods: This hospital-based cross-sectional study enrolled 300 women advised to get a thyroid function test (TFT) were included in the study population. They were grouped as euthyroid and hypothyroid based on the TFT status and their serum vitamin D concentrations were measured. Vitamin D levels were classified as normal, deficient, and insufficient using the standard criteria. Statistical tests like Chi-square analysis, Mann-Whitney U test, Kruskal Wallis test, and Spearman’s correlation analysis were performed. Finally, a multiple linear regression analysis was done to adjust for the effects of confounding variables. Results: Majority of the study population (n=214, 71%) had insufficient serum vitamin D levels. The median Vitamin D levels were significantly lower in hypothyroid group as compared to the euthyroid group (16.88 vs. 25.01 ng/ml, p <0.001). Similarly, serum Vitamin D levels were negatively associated with obesity, winter and spring seasons, and vegetarian diet. After adjustment for the confounders, the Vitamin D levels were significantly lower in hypothyroid population than the euthyroid group (P<0.001). Conclusions: In conclusion, majority of our study participants had insufficient vitamin D, whose concentration further dropped with decreasing thyroid hormone levels. This could have potentially adverse clinical implications.

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National Consensus Statement on the Management of Type 2 Diabetes Mellitus in Nepal

Abstract: The full National Consensus Statement on the Management of Type 2 Diabetes Mellitus in Nepal is included here.

Cited by 7 publications

References 33 publications

Estimating the Health Care Expenditure to Manage and Care for Type 2 Diabetes in Nepal: A Patient Perspective

Estimating the Health Care Expenditure to Manage and Care for Type 2 Diabetes in Nepal: A Patient Perspective

Consensus Recommendations on GLP-1 RA Use in the Management of Type 2 Diabetes Mellitus: South Asian Task Force

Serum Vitamin D Levels in Euthyroid and Hypothyroid Females Visiting a Tertiary Care Center of Western Nepal

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