Resource use and outcomes associated with initiation of injectable therapies for patients with type 2 diabetes mellitus

Abstract

Introduction:Management of type 2 diabetes mellitus (T2DM) often requires intervention with oral and injectable therapies. Across National Health Service (NHS) England, injectable therapies may be initiated in secondary, intermediate or primary care. We wished to understand resource utilization, pathways of care, clinical outcomes, and experience of patients with T2DM initiated on injectable therapies.Method:We conducted three service evaluations of initiation of injectable therapies (glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or basal insulin) for T2DM in primary, secondary and intermediate care. Evaluations included retrospective review of medical records and service administration; prospective evaluation of NHS staff time on each episode of patient contact during a 3-month initiation period; patient-experience survey for those attending for initiation. Data from each evaluation were analysed separately and results stratified by therapy type.Results:A total of 133 patients were included across all settings; 54 were basal-insulin initiations. After initiation, the mean HbA1c level fell for both types of therapies, and weight increased for patients on basal insulin yet fell for patients on GLP-1 RA. The mean cost of staff time per patient per initiation was: £43.81 for GLP-1 RA in primary care; £243.49 for GLP-1 RA and £473.63 for basal insulin in intermediate care; £518.99 for GLP-1 RA and £571.11 for basal insulin in secondary care. Patient-reported questionnaires were completed by 20 patients, suggesting that patients found it easy to speak to the diabetes team, had opportunities to discuss concerns, and felt that these concerns were addressed adequately.Conclusion:All three services achieved a reduction in HbA1c level after initiation. Patterns of weight gain with basal insulin and weight loss with GLP-1 RA were as expected. Primary care was less resource-intensive and costly, and was driven by lower staff costs and fewer clinic visits.

Healthcare resource utilization and related financial costs associated with glucose lowering with either exenatide or basal insulin: A retrospective cohort study

“…However, the CHOICE study took place in several European countries excluding the UK and included secondary care contacts . In a study carried out by Brice and colleagues, initiation with a GLP‐1 receptor agonist was less costly than with a BI because of lower staff costs and fewer clinic visits . Mean cost for GLP‐1 receptor agonists was £43.81 in primary care, £243.49 in intermediate care and £518.99 in secondary care, whereas mean cost for BI was £473.63 in intermediate care and £571.11 in secondary care …”

“…11 In a study carried out by Brice and colleagues, initiation with a GLP-1 receptor agonist was less costly than with a BI because of lower staff costs and fewer clinic visits. 30…”

“…Mean cost for GLP-1 receptor agonists was £43.81 in primary care, £243.49 in intermediate care and £518.99 in secondary care, whereas mean cost for BI was £473.63 in intermediate care and £571.11 in secondary care 30. …”

Perceptions of general practitioners on initiation and intensification of type 2 diabetes injectable therapies. A quantitative study in the United Kingdom

“…This was also the opinion of specialists in this study who suggested education of PCPs on insulin initiation and easy-to-follow guidelines as focal points that may lead to more initiations in primary care. The perceived complexity may also be a factor for the increased time taken to initiate insulin therapy [8]. This iterates that appropriate education and guidance could further support GPs and potentially reduce the time and lower comfort level with insulin initiation in primary care.…”

Effect of procyanidine on VEGFR-2 expression and transduction pathway in rat endothelial progenitor cells under high glucose conditions

“…Diabetes mellitus is a metabolic disorder, with features including high blood sugar and insulin deficiency-induced impaired glucose tolerance and/or islet dysfunction (Brice et al, 2015). Diabetic vascular disease is the leading cause of death and disability in diabetic patients; 30-40% of the patients are subject to at least one vascular complications after 10 years (Tavintharan et al, 2014).…”