Introduction: Severe hypoglycemic events (SHE) represent a clinical and economic burden in patients with diabetes. Nasal glucagon (NG) is a novel treatment for SHEs with similar efficacy, but with a usability advantage over injectable glucagon (IG) that may translate to improved economic outcomes. The economic implications of this usability advantage on SHErelated spending in Spain were explored in this analysis.Methods: A cost-offset and budget impact analysis (BIA) was conducted using a decision tree model, adapted for the Spanish setting. The model calculated average costs per SHE over the SHE treatment pathway following a treatment attempt with IG or NG. Analyses were performed separately in three populations with insulin-treated diabetes: children and adolescents (4-17 years) with type 1 diabetes (T1D), adults with T1D and adults with type 2 diabetes (T2D), with respective population estimates applied in BIA. Treatment probabilities were assumed to be equal for IG and NG, except for treatment success following glucagon administration. Epidemiologic and cost data were obtained from Spanish-specific sources. BIA results were presented at a 3-year time horizon. Results: On a per SHE level, NG was associated with lower costs compared to IG (children and adolescents with T1D, EUR 820; adults with T1D, EUR 804; adults with T2D, EUR 725). Lower costs were attributed to reduced costs of professional medical assistance in patients treated with NG. After 3 years, BIA showed that relative to IG, the introduction of NG was projected to reduce SHE-related spending by EUR 1,158,969, EUR 142,162,371, and EUR 6,542,585 in children and adolescents with T1D, adults with T1D, and adults with insulintreated T2D, respectively. Conclusions: In Spain, the usability advantage of NG over IG translates to potential cost savings per SHE in three populations with insulin-

No abstract

Introduction Insulin lispro 200 U/ml (IL200) is a rapid-acting concentrated insulin used for the treatment of adults with diabetes requiring daily doses of > 20 units of rapid-acting insulin. The aim of this study was to describe the clinical/demographic and treatment characteristics of patients who initiated insulin IL200 therapy in Spain in a real-world setting (PROFILE-IL200). Methods This retrospective observational study based on the IQVIA database included adult (≥ 18 years) patients with type 1 (T1D) or type 2 (T2D) diabetes who initiated IL200 between June 2015 and December 2019. Demographic and clinical characteristics were analyzed descriptively. Results Main characteristics for the T1D/T2D groups ( N = 65/167) were as follows: male, 63.1/55.7%; mean (standard deviation [SD]) age, 46.5 (15.5)/62.6 (12.8) years; time since first diabetes record, 6.6 (4.2)/7.9 (2.9) years; body mass index (BMI), 30.9 (5.8)/33.1 (5.5) kg/m 2 ; glycated hemoglobin, 8.3 (2.1)/8.8 (1.8)%; and diabetes-associated comorbidity, 55.4/92.8%. Among patients with T1D/T2D and a prior diagnosis ( N = 54/164), 96.3/90.2% had received previous insulin (rapid insulin in 81.5/62.2%), and 13.0/97.6% had received previous noninsulin antihyperglycemic therapy. The mean (SD) total insulin dose before IL200 initiation for T1D/T2D was 98.0 (73.9)/95.2 (59.8) U/day; IL200 was initiated at a dose of 56.3 (43.8)/51.5 (34.3) U/day, with basal insulin in 86.2/83.2% of the patients. IL200 was first prescribed by an endocrinologist or a primary care physician in 48.7% and 46.6% of patients, respectively. Conclusions PROFILE-IL200 described the profile of patients treated with IL200 in clinical practice in Spain. Patients were middle-aged, with poor glycemic control, high BMI and associated comorbidities, and received high doses of insulin at IL200 initiation. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-022-01264-6.

Background: The real-world effectiveness of insulin therapy is influenced by poor treatment persistence. An international cross-sectional survey of people with type 2 diabetes mellitus (T2DM) was conducted to assess experiences before, during, and after basal insulin initiation, and to describe reasons for early nonpersistence with insulin therapy. A sub-analysis based on the Spanish cohort and notable between-group comparisons are presented. Patients and methods: Responders to an online survey in seven countries were classified as continuers (no gap in insulin treatment ≥7 days), interrupters (interrupted therapy for ≥7 days within first 6 months, then restarted) and discontinuers (stopped insulin therapy within first 6 months and did not restart before the survey). Data from the Spanish subpopulation were analysed in combination and separately for the three persistence pattern groups. Results: Of 942 global respondents, 150 (50 continuers, 50 interrupters, 50 discontinuers) were from Spain, with a mean age of 36 years and a mean of 6 years since first T2DM diagnosis. Reasons contributing to insulin continuation were improved glycaemic control (70%) followed by improved physical feeling and the convenience of insulin relative to other diabetes treatments (both 46%). Common reasons for interruption were weight gain (46%), hypoglycaemia and the inconvenience of using insulin (both 40%). Most common reasons for discontinuation were weight gain and pain from injections (both 40%) followed by the dislike/ fear of needles (34%). Conclusion: The benefits of basal insulin therapy motivated continuers to persist with the treatment, whereas experienced or anticipated side effects and injection concerns contributed to interruption and discontinuation. Understanding factors affecting persistence patterns among Spanish patients with T2DM may help clinicians improve successful continuation of basal insulin therapy.

No abstract

No abstract

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are a class of drugs with potent glucoselowering activity. Additionally, some GLP-1 RAs have demonstrated cardiovascular and renal benefits. Current guidelines recommend their use in patients with type 2 diabetes (T2D) at high risk of or with established cardiovascular disease (CVD), regardless of glycaemic control, with lifestyle modification and metformin. However, several studies have recently highlighted the limited number of patients with T2D benefiting from these medications worldwide. Given the huge burden of CVD among patients with T2D, efforts should be made to bring clinical practice closer to expert guidelines. This review describes the current situation of GLP-1 RA use in Spain and the reasons behind the gap between guidelines and realworld practice and suggests possible solutions.