Karamat Muhammad Ali, Dar Shujah, Bellary Srikanth, Tahrani Abd A
Department of Diabetes and Endocrinology, Diabetes Centre, Heartlands Hospital, Birmingham, UK.
Institute of Metabolism and Systems, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.
Diabetes Ther. 2018 Apr;9(2):839-849. doi: 10.1007/s13300-018-0400-x. Epub 2018 Mar 16.
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.
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.
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.
In patients with T1D, switching to degludec was associated with an improvement in HbA and reductions in basal insulin dose, severe hypoglycemia, and DKA. When used in appropriate patients, degludec could lead to significant cost savings.
Novo Nordisk.
评估在采用基础-餐时胰岛素治疗方案且反复发生低血糖和/或低血糖无意识症的1型糖尿病（T1D）患者中，从另一种基础胰岛素转换为德谷胰岛素（degludec）的实际临床益处和成本影响。
纳入年龄≥18岁、采用基础-餐时胰岛素治疗方案且已转换为德谷胰岛素加餐时胰岛素至少6个月的T1D患者。患者必须因反复发生低血糖和/或低血糖无意识症而转换为德谷胰岛素。
42例患者有6个月的随访数据。6个月时，糖化血红蛋白（HbA）中位数（四分位间距）显著降低，从8.6（8.0 - 9.3）%[70（64 - 78）mmol/mol]降至8.4（7.9 - 8.9）%[68（63 - 74）mmol/mol]；p<0.05。基础胰岛素每日中位数剂量从30.0（14.7 - 45.0）单位显著降至25.5（14.0 - 30.2）单位；p<0.0001。医院记录数据显示，严重低血糖发作频率从开始使用德谷胰岛素前6个月的8次降至开始使用后6个月的2次。同期，糖尿病酮症酸中毒（DKA）发作次数从开始使用德谷胰岛素前的2次降至开始使用后无发作。没有患者报告转换为德谷胰岛素后治疗满意度恶化。考虑到所需基础剂量的减少和低血糖发作频率的降低，我们估计将此类患者从其他基础胰岛素转换为德谷胰岛素可显著节省直接医疗成本。
在T1D患者中，转换为德谷胰岛素与HbA改善、基础胰岛素剂量降低、严重低血糖和DKA减少相关。在合适的患者中使用时，德谷胰岛素可显著节省成本。
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