Self-reported frequency and impact of non-severe hypoglycemic events in insulin-treated diabetic patients in Denmark

Glycaemic variability may contribute to the pathophysiology of diabetes complications independently of the average level of blood glucose and increases the barriers to achieving such mean goals as well as the risk of hypoglycaemia. Continuous glucose monitoring (CGM) has the potential to identify and address glycaemic variability. Achieving effective use of the extensive data generated by CGM within a routine diabetes consultation is challenging, particularly where glycaemic variability is high. Expert groups have called for more standardisation of the analysis and reporting of glycaemic data. The Ambulatory Glucose Profile (AGP) is an internationally recognised, consensus-approved visual representation which simply summarises glycaemic data and its descriptive statistics in a clinically meaningful format, thus providing a solution to this unmet need. The AGP collates and presents several days of glucose records in a single projection, presenting a visual trace for the median glucose level, with its 25-75th and 10-90th percentiles, according to a 'modal' day. In this way, the AGP provides a straightforward and visual means of identifying times of increased risk of hypoglycaemia or hyperglycaemia that, in turn, provides a robust platform for the diabetes healthcare professional and the person with diabetes to explore, discuss and resolve the underlying reasons for suboptimal diabetes control. Br J Diabetes 2017;17:26-33

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“…31 Hypoglycaemia unawareness was also reported by almost half of a cohort of patients with insulin-treated type 2 diabetes. 32 …”

Section: Glycaemic Control Diabetes Complications and Glycaemic Varimentioning

confidence: 99%

Ambulatory glucose profile (AGP): utility in UK clinical practice

2017

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“…27 A Danish survey reported the annual rate for non-severe hypoglycemic events in insulin-treated diabetic patients. 28 In this study, the mean annual rate for non-severe hypoglycemic events was 99 in type 1 diabetes and 27 in type 2 diabetes per patient. Type 1 diabetes patients reported approximately 22 nocturnal non-severe hypoglycemic events per year and type 2 diabetes patients reported 8 nocturnal non-severe hypoglycemic events per year.…”

Section: Discussionmentioning

confidence: 53%

Non-Severe Hypoglycemia Risk Difference Between Sulfonylurea and Sodium-Glucose Cotransporter-2 Inhibitors (Sglt2-I) as an Add-On to Metformin in Randomized Controlled Trials

Farahani

2017

JPTCP

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“…Similarly, changing the discount rate did not have a significant impact on the ICER. The rate of hypoglycemia applied to the model had a larger impact on the results, with the higher published rates from Denmark [35, 36] resulting in a lower ICER (71,012 DKK) compared to the base case.…”

Section: Resultsmentioning

confidence: 99%

“…In this model, the mean population rates of hypoglycemia from published studies were used in the base case and sensitivity analysis [18, 35, 36] to more closely reflect the rates observed in routine clinical practice versus clinical trials (where patients at high risk of severe hypoglycemia are excluded). The UKHSG rates used in the base-case analysis [18] were a conservative estimate compared with the rates in a Danish population used for a sensitivity analysis, where the rates of non-severe daytime and nocturnal hypoglycemia were higher [35, 36]. Hypoglycemia disutilities from a global (US, UK, Germany, Sweden) TTO study were applied to the base-case model [32] and those from a UK setting in a sensitivity analysis [37].…”

Section: Discussionmentioning

confidence: 99%

“…Hypoglycemia event rates for Denmark from a recent multinational observational study were included as a sensitivity analysis, which reported severe, non-severe daytime, and nocturnal rates of 0.3, 13.6, and 8.3 events per PYE, respectively, for insulin-treated patients (classified as T2DM ‘other’ which included mixed insulins comparable to the present study) [35, 36]. …”

Section: Methodsmentioning

confidence: 99%

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Cost-Effectiveness of Insulin Degludec/Insulin Aspart Versus Biphasic Insulin Aspart in Patients with Type 2 Diabetes from a Danish Health-Care Perspective

2016

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IntroductionTo evaluate the cost-effectiveness of the co-formulation insulin degludec/insulin aspart (IDegAsp) versus biphasic insulin aspart (BIAsp 30), both administered twice daily, in patients with type 2 diabetes mellitus (T2DM), using a short-term cost-effectiveness model.MethodsData from two phase 3a treat-to-target clinical trials were used to populate a simple and transparent short-term cost-effectiveness model. The costs and effects of treatment with IDegAsp versus BIAsp 30 were calculated over a 5-year period, from a Danish health-care cost perspective. One-way and probabilistic sensitivity analyses were conducted to assess the degree of uncertainty and robustness of the results.ResultsThe base-case incremental cost-effectiveness ratio (ICER) of 81,507.91 Danish Kroner (DKK) per quality-adjusted life year (QALY) demonstrates that IDegAsp is a cost-effective treatment compared with BIAsp 30, over a 5-year time horizon. One-way sensitivity analyses show that the ICERs remain within an acceptable range when the rates of hypoglycemia, unit cost of hypoglycemia, disutilities of hypoglycemic events, and the time horizon are varied, ranging from 71,012 DKK to 209,446 DKK. The probabilistic sensitivity analysis demonstrates that the probability that IDegAsp is cost-effective relative to BIAsp 30 is 99.50%, assuming a cost-effectiveness threshold of 250,000 DKK per QALY.ConclusionThis short-term cost-effectiveness model shows that IDegAsp is a cost-effective treatment compared with BIAsp 30 for patients with T2DM. This result is primarily driven by significant reductions in severe hypoglycemia and insulin dose observed with IDegAsp versus BIAsp 30. Sensitivity analyses demonstrate the robustness of these results.FundingNovo Nordisk A/S, Søborg, Denmark.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-016-0195-6) contains supplementary material, which is available to authorized users.

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Self-reported frequency and impact of non-severe hypoglycemic events in insulin-treated diabetic patients in Denmark

Cited by 10 publications

References 25 publications

Ambulatory glucose profile (AGP): utility in UK clinical practice

Ambulatory glucose profile (AGP): utility in UK clinical practice

Non-Severe Hypoglycemia Risk Difference Between Sulfonylurea and Sodium-Glucose Cotransporter-2 Inhibitors (Sglt2-I) as an Add-On to Metformin in Randomized Controlled Trials

Cost-Effectiveness of Insulin Degludec/Insulin Aspart Versus Biphasic Insulin Aspart in Patients with Type 2 Diabetes from a Danish Health-Care Perspective

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