Enhancing choices regarding the administration of insulin among patients with diabetes requiring insulin across countries and implications for future care
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Date
2022-01-14
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Frontiers in Pharmacology
Abstract
There are a number of ongoing developments to improve the care of patients with diabetes
across countries given its growing burden. Recent developments include new oral medicines
to reduce cardiovascular events and death. They also include new modes to improve insulin
administration to enhance adherence and subsequent patient management thereby reducing
hypoglycaemia and improving long-term outcomes. In the case of insulins, this includes long-
acting insulin analogues as well as continuous glucose monitoring (CGM) systems and
continuous subcutaneous insulin infusion systems, combined with sensor-augmented pump
therapy and potentially hybrid closed-loops. The benefits of such systems have been
endorsed by endocrine societies and governments in patients with Type 1 diabetes
whose HbA1c levels are not currently being optimised. However, there are concerns with
the low use of such systems across higher-income countries, exacerbated by their higher
costs, despite studies suggesting their cost-effectiveness ratios are within accepted limits.
This is inconsistent in higher-income countries when compared with reimbursement and
funding decisions for new high-priced medicines for cancer and orphan diseases, with often
limited benefits, given the burden of multiple daily insulin injections coupled with the need for
constant monitoring. This situation is different among patients and governments in low- and
low-middle income countries struggling to fund standard insulins and the routine monitoring of
HbA1c levels. The first priority in these countries is to address these priority issues before
funding more expensive forms of insulin and associated devices. Greater patient involvement
in treatment decisions, transparency in decision making, and evidence-based investment
decisions should help to address such concerns in the future.
Keywords: Africa, cost-effectiveness, central and eastern European countries, evidence-based decisions,
hypoglycaemia, insulin pumps, patient choices, type 1 diabetes
Description
Keywords
Africa, Cost-effectiveness, Type 1 diabetes
Citation
Mardare, I., Campbell, S.M., Meyer, J.C., Sefah, I.A., Massele, A. and Godman, B., 2022. Enhancing choices regarding the administration of insulin among patients with diabetes requiring insulin across countries and implications for future care. Frontiers in Pharmacology, 12, p.794363.