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Aims Glucagon‐like peptide‐1 (GLP‐1) receptor agonists are appealing as glucose‐lowering therapy for individuals with type 2 diabetes mellitus (T2DM) as they also reduce body weight and are associated with low rates of hypogly...
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Aims Glucagon‐like peptide‐1 (GLP‐1) receptor agonists are appealing as glucose‐lowering therapy for individuals with type 2 diabetes mellitus (T2DM) as they also reduce body weight and are associated with low rates of hypoglycaemia. This analysis assessed the long‐term cost‐effectiveness of semaglutide 0.5 and 1 mg vs dulaglutide 1.5 mg (two once‐weekly GLP‐1 receptor agonists) from a UK healthcare payer perspective, based on the head‐to‐head SUSTAIN 7 trial, to inform healthcare decision making. Materials and Methods Long‐term outcomes were projected using the IQVIA CORE Diabetes Model (version 9.0). Baseline cohort characteristics, changes in physiological parameters and adverse event rates were derived from the 40‐week SUSTAIN 7 trial. Costs to a healthcare payer were assessed, and these captured pharmacy costs and costs of complications. Utilities were taken from published sources. Results Once‐weekly semaglutide 0.5 and 1 mg were associated with improvements in quality‐adjusted life expectancy of 0.04 and 0.10 quality‐adjusted life years, respectively, compared with dulaglutide 1.5 mg. Clinical benefits were achieved at reduced costs, with lifetime cost savings of GBP 35 with once‐weekly semaglutide 0.5 mg and GBP 106 with the once‐weekly semaglutide 1 mg, resulting from fewer diabetes‐related complications due to better glycaemic control. Therefore, both doses of once‐weekly semaglutide were considered dominant vs dulaglutide 1.5 mg (improving outcomes and reducing costs). Conclusions Compared with treatment with dulaglutide, once‐weekly semaglutide represents a cost‐effective option for treating individuals in the UK with T2DM who are not achieving glycaemic control with metformin, projected to both improve clinical outcomes and reduce costs.
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Abstract Aims Basal–bolus therapy is associated with greater treatment burden and lower adherence compared with more simplified regimens. This post hoc analysis studied the difference between insulin degludec/liraglutide (IDegLir...
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Abstract Aims Basal–bolus therapy is associated with greater treatment burden and lower adherence compared with more simplified regimens. This post hoc analysis studied the difference between insulin degludec/liraglutide (IDegLira) and basal–bolus therapy on number of injections, dose adjustments and patient outcomes in the DUAL VII trial. Materials and methods DUAL VII was a 26‐week, open‐label trial in which patients with uncontrolled type 2 diabetes who were using metformin and insulin glargine 100?units/mL (20–50?U) were randomized 1:1 to IDegLira (N = 252) or basal–bolus (insulin glargine U100?+?insulin aspart ≤4 times/day) (N = 254). This post hoc analysis reports the observed mean number of injections and cumulative dose adjustments during 26?weeks of treatment. Patient‐reported outcomes (Treatment‐Related Impact Measure – Diabetes [TRIM‐D] and Short Form‐36 Health Survey version 2 [SF‐36v2]) were collected at scheduled visits and change from baseline scores calculated. Results The clinical benefits (non‐inferior HbA1c reductions, weight benefit, less hypoglycaemia) of IDegLira vs basal–bolus therapy were achieved with fewer cumulative dose adjustments (16.6 vs 217.2, respectively) and fewer injections (1 vs ≥3 per day, respectively). Patients treated with IDegLira experienced significant improvements across all TRIM‐D domains compared with those undergoing basal–bolus therapy. The SF‐36v2 showed improvements in both treatment arms with no significant difference between arms in the physical component summary, but there was a significant improvement in patients treated with IDegLira in the mental component summary ( P =?.0228). Conclusions These findings, combined with the DUAL VII results, suggest that IDegLira, through a more simplified regimen versus basal–bolus therapy, may help improve patient adherence and improve patient outcomes related to diabetes management, treatment burden and mental health, which in turn may assist in the timely achievement of glycaemic control in clinical practice.
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Summary Background Little data exist on the referral patterns and effectiveness of lipid clinics. Methods An audit was conducted in four clinics of 100 consecutive referrals each. Data were recorded on referral criteria, cardiovas...
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Summary Background Little data exist on the referral patterns and effectiveness of lipid clinics. Methods An audit was conducted in four clinics of 100 consecutive referrals each. Data were recorded on referral criteria, cardiovascular disease ( CVD ) risk factors, drug history, investigations, diagnoses, therapies, results and referrals. Results Patients were aged 56?±?14?years, 47% were male and 87% were primary prevention. Risk factors included smoking (16%), type 2 diabetes (13%) and hypertension (13%). Referrals were made for hypercholesterolaemia (68%), diagnosis of FH (31%), statin intolerance (23%) and hypertriglyceridaemia (23%). Initial total cholesterol ( TC ) was 7.65?±?2.64?mmol/L, triglycerides ( TG ) 2.17 (0.41‐76.9?mmol/L) mmol/L, HDL ‐C 1.53?±?0.71?mmol/L, LDL ‐C 4.57?±?1.66?mmol/L with non‐ HDL ‐C 5.90?±?2.09?mmol/L. Criteria for FH were met in 21% with genetic testing in 13% and lipid cascade testing in 30% of index cases. Triglycerides >20?mmol/L were present in 4%. The diagnosis was changed in 21%: hypercholesterolaemia (7%), mixed hyperlipidaemia (7%) and hypertriglyceridaemia (7%). Hepatic steatosis was identified in 14.5%. Lipoprotein(a) levels >125?nmol/L occurred in 41% in one clinic. Therapy changes included altered statins (40%), addition of a fibrate (11%) or ezetimibe (8%). These reduced TC by 1.92?mmol/L (19%; P ?=?0.0001), LDL ‐C 1.07?mmol/L (15%; P ?=?0.02), non‐ HDL ‐C 1.50?mmol/L (16%; P ?<?0.001), and TG 2.3 (?4 to 38) mmol/L (16%; P ?<?0.001) with 11% extra achieving TG <5?mmol/L while HDL ‐C increased by 7% ( P ?=?0.37). Conclusions Lipid clinics have diverse functions including diagnosis of FH , managing severe hypercholesterolaemia, mixed hyperlipidaemia and statin intolerance. Effectiveness criteria of average reductions of 1.5?mmol/L in TC or non‐ HDL ‐C, 1?mmol/L in LDL ‐C and 2?mmol/L in TG would be reasonable for newly referred patients.
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