New drug treatments versus structured education programmes for type 2 diabetes: comparing cost-effectiveness

Aim:To determine the association between structured diabetes self-management education (DSME) and glycaemic control in persons living with diabetes (PLD) in low-and middle-income countries (LMICs).Methods: PubMed, Embase and Cochrane databases were searched up to June 2020 for intervention studies on the effect of structured DSME on glycaemic control in PLD in LMICs (PROSPERO registration CRD42020164857). The primary outcome was reduction in glycated haemoglobin. Included studies were assessed for risk of bias (RoB) with the Cochrane RoB tool for randomised trials. Findings were summarized in a narrative synthesis.Results: Out of 154 abstracts retrieved and screened for eligibility, nine studies with a total of 1389 participants were included in the review. The structured DSME interventions were culturally tailored and were delivered in-person. They were associated with reductions in glycated haemoglobin in all studies: mean/ median reduction ranged between 0.5% and 2.6% relative to baseline. Conclusions:There is a dearth of literature on the association between structured DSME and glycaemic control among PLD in LMICs. The evidence available suggests that in LMICs; particularly in sub-Saharan Africa, structured DSME is associated with reduction in glycated haemoglobin. We recommend further intervention studies on the effects of structured DSME in LMICs.

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“…Medications reduce HbA 1c between 0.60% and 1.48% 27 . Compared with pharmacological therapies, DSME has been shown to be cost‐effective 28 …”

Section: Discussionmentioning

confidence: 99%

Structured diabetes self‐management education and glycaemic control in low‐ and middle‐income countries: A systematic review

Lamptey

Amoakoh-Coleman

et al. 2022

Diabet Med

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“…A study conducted by Kunthi et al[5] suggested that screening of subpopulations using risk scores can rule in high risk patients and the diagnosis can be confirmed by measurements of fasting plasma glucose or HbA1c concentrations or tests for oral glucose tolerance. Screening of the individuals who are at the risk of developing disease will prevent the long term microvascular as well as macrovascular complications.…”

Section: Benefit Of Dm Screeningmentioning

confidence: 99%

Do we need to screen every patient in intensive care unit for diabetes in community with high prevalence of diabetes?

Dutt

Kashyap

Surani

2019

WJD

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Diabetes mellitus (DM) is marked as global health care challenge with almost 10% of the United States population being diagnosed with DM. A sizeable percentage of patients are oblivious of their disease, in spite of easily accessibility knowledge about its early signs and symptoms and rapid diagnostic modalities. Critically ill patients with undiagnosed DM are likely to have an increased mortality as compared to intensive care unit (ICU) patients with diagnosed DM. DM may have adverse effect on ICU patients causing organ failure and complications. Early Screening of patients at the risk of developing disease may prevent long term complications. Early screening and management may be beneficial as controlled DM patients have similar morbidity as non DM patients in ICU. An intense glycaemic and blood pressure control improves retinopathy and albuminuria, but may not affect the macrovascular outcomes.

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“…Lifestyle strategies are also more cost-effective. 8 Nevertheless, healthcare systems especially those that are insurance-based have identified reduced uptake to education programmes and other factors responsible are physician reluctance to refer and individuals to attend such courses based on current uptake data [66]. On that basis, it may seem simpler to prescribe a pharmacological agent to reduce risk although this must be balanced against potential harm due to adverse effects and also the recognised difficulties around medication adherence and clinical inertia to optimise the dose [67].…”

Section: Future Directions Of Carementioning

confidence: 99%

Pharmaceutical Interventions for Diabetes Prevention in Patients at Risk

Chatterjee

Davies

Khunti

2017

Am J Cardiovasc Drugs

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With the rising incidence and prevalence rates of type 2 diabetes globally, it is imperative that diabetes prevention strategies are implemented to stem the flow of new cases. Successful interventions include both lifestyle modification and pharmaceutical agents, and large, multicentre, randomised, controlled studies in different populations have identified the benefits of both. However, translating positive trial outcomes to the real world is particularly challenging, as lifestyle interventions require regular reinforcement from healthcare professionals to be maintained. Pharmaceutical therapies may therefore play an adjunctive role in combination with lifestyle to prevent diabetes. Population-based strategies are also necessary to reduce sedentary behaviour and obesity. Well-established glucose-lowering therapies such as metformin, sulphonylureas, thiazolidinediones and insulin and newer agents such as incretin therapies and sodium glucose co-transporter 2 inhibitors have all been investigated in randomised controlled trials for diabetes prevention with varying success. Non-glucose-lowering therapies such as orlistat and renin angiotensin system blockers can prevent diabetes, whereas statins are associated with slightly increased risk. Diabetes prevention strategies should carefully consider the use of these agents according to individual patient circumstances and phenotypic profile.

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New drug treatments versus structured education programmes for type 2 diabetes: comparing cost-effectiveness

Cited by 7 publications

References 11 publications

Structured diabetes self‐management education and glycaemic control in low‐ and middle‐income countries: A systematic review

Structured diabetes self‐management education and glycaemic control in low‐ and middle‐income countries: A systematic review

Do we need to screen every patient in intensive care unit for diabetes in community with high prevalence of diabetes?

Pharmaceutical Interventions for Diabetes Prevention in Patients at Risk

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