Therapie des Typ-1-Diabetes

Boehm, Bernhard O.; Dreyer, M.; Fritsche, Andreas; Fuechtenbusch, Martin; Goelz, Stefan; Martin, Stéphan; Haak, Thomas

doi:10.1055/s-0042-110814

Cited by 5 publications

(8 citation statements)

References 9 publications

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“…It should also be noted that patients were selected for switch completely at random in the model; in clinical practice, this is improbable to happen. It is likely that physicians would elect to switch specific patients from MDI to CSII according to medical guidelines, 7 for example patients who are at high risk of hypoglycemic hospitalizations or complications related to a raised A1C, given that these patients could be expected to benefit more from CSII than others. An analysis was therefore performed which considered a higher (doubled) rate of SHEH for both MDI and CSII (the rate of CDEs was unchanged).…”

Section: Discussionmentioning

confidence: 99%

“…3 Maintaining a near normal blood glucose range is essential to the health and daily well-being of the patient, whereas an inadequately controlled glucose level can result in acute complications such as hypoglycemia or diabetic ketoacidosis, and to chronic complications over time (microvascular and macrovascular complications). 4-6 A near normal blood glucose range, hence, being adequately controlled, implies to maintain a defined A1C level of <7.5% without the emergence of SHEs, referred to German guidelines; 7 patients who do not meet this definition are considered to be inadequately controlled. This, always under consideration of the individual’s needs, resources and preferences in terms of the course of their diabetes.…”

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confidence: 99%

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Event and Cost Offsets of Switching 20% of the Type 1 Diabetes Population in Germany From Multiple Daily Injections to Continuous Subcutaneous Insulin Infusion

Zöllner

Ziegler²,

Stüve

et al. 2016

J Diabetes Sci Technol

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Background: Most patients with type 1 diabetes (T1D) administer insulin by multiple daily injections (MDI). However, continuous subcutaneous insulin infusion (CSII) therapy has been shown to improve glycemic control compared with MDI. Objective: The objective was to determine the key medical event and cost offsets generated over a 4-year period by introducing CSII to T1D patients who have inadequately controlled glucose metabolism on MDI in Germany. Methods: A decision-analytic budget impact model, simulating a treatment switch scenario, was developed. In the base case, all T1D patients received MDI, while in the switch scenario, 20% of the eligible T1D population, randomly selected, moved to CSII. The model focused on 2 medical endpoints and their corresponding cost offsets: severe hypoglycemic events requiring hospitalization (SHEH) and complication-borne diabetic events (CDEs) avoided. Event rates and costs were taken from the literature and official sources, adopting a health insurance perspective. Results: Compared with the base case, treating 20% of patients with CSII in the switch scenario resulted in 47 864 fewer SHEH and 5543 fewer CDEs. This led to total cost offsets of €183 085 281 within the 4-year time horizon. Of these, 92% were driven by avoided SHEH. Compared to an expected budget impact (cost increase) of 83%, only treatment costs considered, the total impact of the switch scenario amounted merely to a 24.5% increase in costs (reduction by 58.5% points; a factor of 3.4). Conclusion: The use of CSII resulted in fewer SHEH and CDEs compared to MDI. The incurred CSII implementation costs are hence offset to a substantial degree by cost savings in complication treatment.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Event and Cost Offsets of Switching 20% of the Type 1 Diabetes Population in Germany From Multiple Daily Injections to Continuous Subcutaneous Insulin Infusion

Zöllner

Ziegler²,

Stüve

et al. 2016

J Diabetes Sci Technol

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“…Following the international and national guidelines, the most important goals for the treatment of both forms of diabetes are self-management of the disease and an optimal quality of diabetes control (good HbA1c and the prevention of a high amplitude of daily blood-glucose excursions) (10)(11)(12)(13)(14)(15). Briefly, most important for the treatment are patient education and the management of blood glucose.…”

Section: Modern Treatmentmentioning

confidence: 99%

Technology in Diabetes Treatment: Update and Future

Schiel¹,

Bambauer²,

Steveling

2018

Artificial Organs

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Worldwide the number of people with diabetes mellitus is increasing. There are estimations that diabetes is one of the leading causes of death. The most important goals for the treatment of diabetes are self‐management of the disease and an optimal quality of diabetes control. In the therapy new technologies, like real‐time continuous interstitial glucose monitoring, continuous subcutaneous insulin infusion (CSII), electronic tools for the monitoring of therapeutic approaches, automated bolus calculators for insulin and electronic tools for education and information of patients, have become widespread and play important roles. All these efforts are related to the interaction between patients, caregivers, scientists or researchers and industry. The presentation of different aspects of new technological approaches in the present article should give more information about different technologies. However, because of the rather quickly appearance of new technologies, the presentation can only be a spotlight. Further studies are mandatory to analyze the effects and long‐term benefits of each technology and electronic device.

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“…They not only have to learn how to replace insulin properly [ 1 ], but also to self-administer treatment reliably, as they need to care for themselves alone between visits to their doctor commonly at intervals of 6 to 12 weeks. To shoulder the task of being ‘his own nurse, doctor’s assistant, chemist’ [ 2 ] and even physician, and to meet the metabolic goals set [ 3 , 4 ], patients have to continuously maintain motivation for multiple daily interventions. These include insulin injections and blood glucose [BG] self-measurements to keep their BG within the desired range, i.e.…”

Section: Introductionmentioning

confidence: 99%

“…These include insulin injections and blood glucose [BG] self-measurements to keep their BG within the desired range, i.e. HbA 1c below 53 to 58 mmol/mol, if insulin reactions [ 4 ] and diabetes-related complications are to be avoided [ 5 ]. To provide comprehensive self-care type 1 diabetes patients are also required to document BG values, food intake, administered insulin doses, and bouts of exercise [ 6 , 7 ], as well as blood pressure (BP), which taken together, may well overstretch individual motivation to comply.…”

Section: Introductionmentioning

confidence: 99%

Type 1 diabetes care: Improvement by standardization in a diabetes rehabilitation clinic. An observational report

Haslacher¹,

Fallmann²,

Waldhäusl³

et al. 2018

PLoS ONE

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BackgroundT1D treatment requires informed self-responsible patients, who, however, frequently miss their therapeutic goals, providing considerable potential for improvement.MethodsThis observational report evaluates T1D patients [N = 109], aged ≥18 years (range 22–82), poorly controlled at home, at and 3 weeks after their admission to our diabetes rehabilitation clinic [DRC], where they were offered standardized, but unmonitored life-style modification.ResultsAt admission, patients displayed elevated HbA1c values (66 mmol/mol [57; 81]), a high prevalence of co-morbidities (88%), lipodystrophies due to monolocal insulin injections (42%), a low rate of influenza (16%) and pneumococcal (7%) immunization, and underuse of lipid-lowering drugs (-38%). Standardization of life-style improved glucose (p<0.0001) and lipid metabolism (LDL/HDL ratio p<0.01) permitting reduction of insulin dose and reduction of add-on glucose-lowering drugs (GLDs) other than metformin. Outcome was independent of the mode of insulin treatment strategy and more marked at initially high HbA1c, with DRC-costs/d less than 25% of those encountered at standard hospitals.ConclusionType 1 diabetes care requires i) insulin treatment, food intake and life style to be handled in concert, ii) this need cannot be replaced by arbitrary addition of add-on GLDs, and iii) training to this end is 75% cheaper at a DRC than in standard hospitals.

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Therapie des Typ-1-Diabetes

Cited by 5 publications

References 9 publications

Event and Cost Offsets of Switching 20% of the Type 1 Diabetes Population in Germany From Multiple Daily Injections to Continuous Subcutaneous Insulin Infusion

Event and Cost Offsets of Switching 20% of the Type 1 Diabetes Population in Germany From Multiple Daily Injections to Continuous Subcutaneous Insulin Infusion

Technology in Diabetes Treatment: Update and Future

Type 1 diabetes care: Improvement by standardization in a diabetes rehabilitation clinic. An observational report

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