Clinical and Cost Implications of Insulin Degludec in Patients with Type 1 Diabetes and Problematic Hypoglycemia: A Quality Improvement Project.

Karamat, Muhammad Ali and Dar, Shujah and Bellary, Srikanth and Tahrani, Abd A (2018) Clinical and Cost Implications of Insulin Degludec in Patients with Type 1 Diabetes and Problematic Hypoglycemia: A Quality Improvement Project. Diabetes therapy : research, treatment and education of diabetes and related disorders, 9 (2). pp. 839-849. ISSN 1869-6961. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: https://link.springer.com/article/10.1007%2Fs13300...

Abstract

INTRODUCTION

To assess the real-life clinical benefits and cost implications of switching from another basal insulin to insulin degludec (degludec) in patients with type 1 diabetes (T1D) on basal-bolus regimens with recurrent hypoglycemia and/or hypoglycemia unawareness.

METHODS

Patients with T1D who were aged ≥ 18 years, were on a basal-bolus regimen, and had switched to degludec plus bolus insulin for at least 6 months were included. Patients had to have switched to degludec as a result of recurrent hypoglycemia and/or hypoglycemia unawareness.

RESULTS

Six months of follow-up data were available for 42 patients. At 6 months, there was a significant reduction in median (interquartile range) HbA, from 8.6 (8.0-9.3)% [70 (64-78) mmol/mol] to 8.4 (7.9-8.9)% [68 (63-74) mmol/mol]; p < 0.05. Median daily basal insulin dose reduced significantly from 30.0 (14.7-45.0) to 25.5 (14.0-30.2) units; p < 0.0001. Data from hospital records showed reductions in the frequency of episodes of severe hypoglycemia from eight in the 6 months preceding degludec initiation to two in the 6 months following initiation. In the same period, diabetic ketoacidosis (DKA) episodes reduced from two before degludec initiation to no episodes after initiation. No patients reported worsening treatment satisfaction after switching to degludec. Considering the reductions in the basal dose required and the frequency of hypoglycemia episodes, we estimate that switching such patients to degludec from other basal insulins could provide significant savings in direct healthcare costs.

CONCLUSION

In patients with T1D, switching to degludec was associated with an improvement in HbAand reductions in basal insulin dose, severe hypoglycemia, and DKA. When used in appropriate patients, degludec could lead to significant cost savings.

FUNDING

Novo Nordisk.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WK Endocrine system. Endocrinology
Divisions: Ambulatory Care > Diabetes
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Depositing User: Mrs Caroline Tranter
Date Deposited: 10 Apr 2018 13:27
Last Modified: 10 Apr 2018 13:27
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1630

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