The cost-effectiveness and budget impact of stepwise addition of bolus insulin in the treatment of type 2 diabetes: evaluation of the FullSTEP trial

Saunders, Rhodri; Lian, Jean; Karolicki, Boris; Valentine, William J.

doi:10.3111/13696998.2014.959590

Cited by 8 publications

(37 citation statements)

References 29 publications

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“…Few studies have evaluated the cost‐effectiveness of adding prandial therapy to a basal insulin regimen among US patients with T2D in real‐world treatment settings. As expected, the basal‐plus regimen has been associated with improved quality of life and reduced costs compared with full basal‐bolus therapy . Relative to premixed analog regimens, basal‐bolus insulin therapy was associated with better glycemic control at a lower cost .…”

Section: Choosing Glp‐1 Ras Dpp‐4 Inhibitors Sglt2 Inhibitors or Asupporting

confidence: 52%

“…As expected, the basal-plus regimen has been associated with improved quality of life and reduced costs compared with full basal-bolus therapy. 118 Relative to premixed analog regimens, basal-bolus insulin therapy was associated with better glycemic control at a lower cost. 119 Add-on therapy with a GLP-1 RA has been shown to be associated with significantly fewer hospitalizations (hypoglycemia related, diabetes related, or all cause) and lower total all-cause costs compared with the addition of RAI to basal insulin, although pharmacy costs are higher.…”

Section: Cost-effectivenessmentioning

confidence: 99%

See 1 more Smart Citation

Improving postprandial hyperglycemia in patients with type 2 diabetes already on basal insulin therapy: Review of current strategies

Umpiérrez

Bailey

Carcia

et al. 2017

Journal of Diabetes

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A large number of patients with type 2 diabetes (T2D) on basal insulin do not reach their HbA1c goals and require additional therapy to address postprandial hyperglycemia. Guidelines from expert bodies have outlined several approaches to accomplish postprandial glucose (PPG) control, and recent literature suggests several more. This article provides strategies for primary care physicians caring for patients with T2D who do not achieve glycemic control with basal insulin alone. Current treatment guidelines and strategies for improving PPG control are reviewed, including the efficacy, safety, and cost-effectiveness of rapid-acting insulin (RAI) analogs, premixed insulin, glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), dipeptidyl peptidase 4 inhibitors, sodium-glucose cotransporter 2 inhibitors, and α-glucosidase inhibitors. Other approaches, such as combinations of newer basal insulin plus RAI and a fixed-ratio combination of basal insulin and a GLP-1 RA, are also described.

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Section: Choosing Glp‐1 Ras Dpp‐4 Inhibitors Sglt2 Inhibitors or Asupporting

confidence: 52%

Section: Cost-effectivenessmentioning

confidence: 99%

Improving postprandial hyperglycemia in patients with type 2 diabetes already on basal insulin therapy: Review of current strategies

Umpiérrez

Bailey

Carcia

et al. 2017

Journal of Diabetes

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“…Several trials have compared the cost effectiveness of insulin aspart with that of RHI [ 159 – 161 ] or assessed the health economic implications of intensifying treatment with insulin aspart [ 162 , 163 ].…”

Section: Health Economicsmentioning

confidence: 99%

“…This was attributed to a decrease in the number of in-patient visits (0.50 visits/patient/year; p < 0.05, for a cost savings of US$3019/patient) and also to reductions in HbA 1c (0.5 %; p = 0.001) and use of OADs (56 vs 64 %; p < 0.0001) [ 162 ]. Cost effectiveness of step-wise addition of bolus insulin aspart compared with full basal–bolus therapy in T2D was also evaluated in the FullSTEP trial [ 163 ]. Outcomes at end of trial such as hypoglycemic event rates, the proportion of patients achieving HbA 1c targets, and SMBG were incorporated into the models.…”

Section: Health Economicsmentioning

confidence: 99%

Insulin Aspart in the Management of Diabetes Mellitus: 15 Years of Clinical Experience

Hermansen

Bohl

Schioldan

2015

Drugs

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Limiting excessive postprandial glucose excursions is an important component of good overall glycemic control in diabetes mellitus. Pharmacokinetic studies have shown that insulin aspart, which is structurally identical to regular human insulin except for the replacement of a single proline amino acid with an aspartic acid residue, has a more physiologic time–action profile (i.e., reaches a higher peak and reaches that peak sooner) than regular human insulin. As expected with this improved pharmacokinetic profile, insulin aspart demonstrates a greater glucose-lowering effect compared with regular human insulin. Numerous randomized controlled trials and a meta-analysis have also demonstrated improved postprandial control with insulin aspart compared with regular human insulin in patients with type 1 or type 2 diabetes, as well as efficacy and safety in children, pregnant patients, hospitalized patients, and patients using continuous subcutaneous insulin infusion. Studies have demonstrated that step-wise addition of insulin aspart is a viable intensification option for patients with type 2 diabetes failing on basal insulin. Insulin aspart has shown a good safety profile, with no evidence of increased receptor binding, mitogenicity, stimulation of anti-insulin antibodies, or hypoglycemia compared with regular human insulin. In one meta-analysis, there was evidence of a lower rate of nocturnal hypoglycemia compared with regular human insulin and, in a trial that specifically included patients with a history of recurrent hypoglycemia, a significantly lower rate of severe hypoglycemic episodes. The next generation of insulin aspart (faster-acting insulin aspart) is being developed with a view to further improving on these pharmacokinetic/pharmacodynamic properties.

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“…From the applied research perspective, the assessed costs of hypoglycemia can become an element of health technology assessment reports in diabetes. More and more cost-effectiveness studies already include hypoglycemia, often as its crucial element [7][8][9][10][11] . Finally, managing the cost of DM care is complicated, as the patterns of resource usage are very heterogeneous (see, e.g.…”

Section: Introductionmentioning

confidence: 99%

Cost of severe hypoglycaemia in nine European countries

Jakubczyk

Lipka²,

Paweska³

et al. 2016

Journal of Medical Economics

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The cost-effectiveness and budget impact of stepwise addition of bolus insulin in the treatment of type 2 diabetes: evaluation of the FullSTEP trial

Abstract: SWA of bolus insulin should be considered a beneficial and cost-saving alternative to FBB therapy for the intensification of treatment in type 2 diabetes.

Cited by 8 publications

References 29 publications

Improving postprandial hyperglycemia in patients with type 2 diabetes already on basal insulin therapy: Review of current strategies

Improving postprandial hyperglycemia in patients with type 2 diabetes already on basal insulin therapy: Review of current strategies

Insulin Aspart in the Management of Diabetes Mellitus: 15 Years of Clinical Experience

Cost of severe hypoglycaemia in nine European countries

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