Editorial

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3 pages, 200 KiB

Open AccessEditorial

Current Obstacles (With Solutions) in Type 2 Diabetes Management, Alongside Future Directions

by Andrej Belančić, Sanja Klobučar and Dario Rahelić

Diabetology 2023, 4(3), 376-378; https://doi.org/10.3390/diabetology4030031 - 05 Sep 2023

Cited by 1 | Viewed by 1265

Abstract

Dear Reader, [...] Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

Research

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14 pages, 3293 KiB

Open AccessArticle

Utilizing the Glucose and Insulin Response Shape of an Oral Glucose Tolerance Test to Predict Dysglycemia in Children with Overweight and Obesity, Ages 8–18 Years

by Timothy J. Renier, Htun Ja Mai, Zheshi Zheng, Mary Ellen Vajravelu, Emily Hirschfeld, Diane Gilbert-Diamond, Joyce M. Lee and Jennifer L. Meijer

Diabetology 2024, 5(1), 96-109; https://doi.org/10.3390/diabetology5010008 - 01 Mar 2024

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Abstract

Common dysglycemia measurements including fasting plasma glucose (FPG), oral glucose tolerance test (OGTT)-derived 2 h plasma glucose, and hemoglobin A1c (HbA1c) have limitations for children. Dynamic OGTT glucose and insulin responses may better reflect underlying physiology. This analysis assessed glucose and insulin curve [...] Read more.

Common dysglycemia measurements including fasting plasma glucose (FPG), oral glucose tolerance test (OGTT)-derived 2 h plasma glucose, and hemoglobin A1c (HbA1c) have limitations for children. Dynamic OGTT glucose and insulin responses may better reflect underlying physiology. This analysis assessed glucose and insulin curve shapes utilizing classifications—biphasic, monophasic, or monotonically increasing—and functional principal components (FPCs) to predict future dysglycemia. The prospective cohort included 671 participants with no previous diabetes diagnosis (BMI percentile ≥ 85th, 8–18 years old); 193 returned for follow-up (median 14.5 months). Blood was collected every 30 min during the 2 h OGTT. Functional data analysis was performed on curves summarizing glucose and insulin responses. FPCs described variation in curve height (FPC1), time of peak (FPC2), and oscillation (FPC3). At baseline, both glucose and insulin FPC1 were significantly correlated with BMI percentile (Spearman correlation r = 0.22 and 0.48), triglycerides (r = 0.30 and 0.39), and HbA1c (r = 0.25 and 0.17). In longitudinal logistic regression analyses, glucose and insulin FPCs predicted future dysglycemia (AUC = 0.80) better than shape classifications (AUC = 0.69), HbA1c (AUC = 0.72), or FPG (AUC = 0.50). Further research should evaluate the utility of FPCs to predict metabolic diseases. Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

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11 pages, 542 KiB

Open AccessArticle

Evaluating the Use of Web-Based Technologies for Self-Management among Arabic-Speaking Immigrants Living with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Saudi Arabia

by Anwar Althubyani, Clarice Tang, Jency Thomas and Sabrina Gupta

Diabetology 2024, 5(1), 85-95; https://doi.org/10.3390/diabetology5010007 - 28 Feb 2024

Viewed by 937

Abstract

This study aimed to investigate the use of and willingness to adopt web-based technology for self-management of type 2 diabetes among Arabic-speaking immigrants in Saudi Arabia. Conducted in Taif in 2022, it involved participants with type 2 diabetes mellitus, utilizing a study-specific questionnaire [...] Read more.

This study aimed to investigate the use of and willingness to adopt web-based technology for self-management of type 2 diabetes among Arabic-speaking immigrants in Saudi Arabia. Conducted in Taif in 2022, it involved participants with type 2 diabetes mellitus, utilizing a study-specific questionnaire to gather data on demographics, disease specifics, and attitudes towards using this technology for diabetes management. Out of the 109 individuals who responded, 91 completed the survey and reported accessing web-based technology and an average usage of two hours per day. The primary use was for social media (90.1%) and information searching (73.6%). The study found a high willingness to use web-based technology for dietary planning (85.7%), physical activity monitoring (94.5%), and communication with healthcare providers (93.41%). Notably, younger participants, those with higher education, and married individuals showed more inclination towards using such technology, as indicated by significant correlations (p < 0.001, CI = 0.03–0.38; p < 0.039, CI = 1.06–10.26; p = 0.024, CI = 1.23–19.74). Over half of the participants (56%) considered web-based technology beneficial for diabetes management, with many finding it time-saving (61.5%). In conclusion, a significant proportion of participants demonstrated a strong preference for integrating web-based technology into their diabetes self-management routines. This preference was particularly evident in key areas such as diet, physical activity, and glucose monitoring. These findings underscore the potential of web-based technologies in supporting effective diabetes management among Arabic-speaking immigrants, highlighting the need for targeted interventions that leverage these digital tools. Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

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11 pages, 1292 KiB

Open AccessArticle

A Comparative Analysis of Machine Learning Models for the Detection of Undiagnosed Diabetes Patients

by Simon Lebech Cichosz, Clara Bender and Ole Hejlesen

Diabetology 2024, 5(1), 1-11; https://doi.org/10.3390/diabetology5010001 - 03 Jan 2024

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Abstract

Introduction: Early detection of type 2 diabetes is essential for preventing long-term complications. However, screening the entire population for diabetes is not cost-effective, so identifying individuals at high risk for this disease is crucial. The aim of this study was to compare the [...] Read more.

Introduction: Early detection of type 2 diabetes is essential for preventing long-term complications. However, screening the entire population for diabetes is not cost-effective, so identifying individuals at high risk for this disease is crucial. The aim of this study was to compare the performance of five diverse machine learning (ML) models in classifying undiagnosed diabetes using large heterogeneous datasets. Methods: We used machine learning data from several years of the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018 to identify people with undiagnosed diabetes. The dataset included 45,431 participants, and biochemical confirmation of glucose control (HbA1c) were used to identify undiagnosed diabetes. The predictors were based on simple and clinically obtainable variables, which could be feasible for prescreening for diabetes. We included five ML models for comparison: random forest, AdaBoost, RUSBoost, LogitBoost, and a neural network. Results: The prevalence of undiagnosed diabetes was 4%. For the classification of undiagnosed diabetes, the area under the ROC curve (AUC) values were between 0.776 and 0.806. The positive predictive values (PPVs) were between 0.083 and 0.091, the negative predictive values (NPVs) were between 0.984 and 0.99, and the sensitivities were between 0.742 and 0.871. Conclusion: We have demonstrated that several types of classification models can accurately classify undiagnosed diabetes from simple and clinically obtainable variables. These results suggest that the use of machine learning for prescreening for undiagnosed diabetes could be a useful tool in clinical practice. Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

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14 pages, 2285 KiB

Open AccessArticle

Global Trends in Risk Factors and Therapeutic Interventions for People with Diabetes and Cardiovascular Disease: Results from the WHO International Clinical Trials Registry Platform

by Musawenkosi Ndlovu, Phiwayinkosi V. Dludla, Ndivhuwo Muvhulawa, Yonela Ntamo, Asanda Mayeye, Nomahlubi Luphondo, Nokulunga Hlengwa, Albertus K. Basson, Sihle E. Mabhida, Sidney Hanser, Sithandiwe E. Mazibuko-Mbeje, Bongani B. Nkambule and Duduzile Ndwandwe

Diabetology 2023, 4(4), 560-573; https://doi.org/10.3390/diabetology4040050 - 08 Dec 2023

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Abstract

This study presents a comprehensive analysis of 898 clinical trials conducted between 1999 and 2023, focusing on the interplay of metabolic syndrome, cardiovascular diseases (CVDs), and type 2 diabetes mellitus (T2D). This study draws upon data sourced from the International Clinical Trials Registry [...] Read more.

This study presents a comprehensive analysis of 898 clinical trials conducted between 1999 and 2023, focusing on the interplay of metabolic syndrome, cardiovascular diseases (CVDs), and type 2 diabetes mellitus (T2D). This study draws upon data sourced from the International Clinical Trials Registry Platform (ICTRP) until August 2023. The trials were predominantly interventional (67%) or observational (33%). A geographical distribution reveals that while the United States registered approximately 18% of the trials, other regions like Australia, the United Kingdom, and multicounty trials made substantial contributions. Most studies (84%) included both male and female participants, with adults aged 18 to 65 years predominantly represented. The trials aimed at treatment (21%) and prevention (21%), emphasizing the dual focus on addressing existing CVD risk and preventing its development. Notably, CVDs (29%), T2D (8%), and the coexistence of both (21%) constituted the primary conditions of interest. Key interventions encompassed lifestyle and behavioral modifications, dietary supplementation, and drug therapies, with metformin and statins leading in pharmacological treatments. Interestingly, additional interventions such as glucagon-like peptide-1 agonists and dipeptidyl peptidase IV inhibitors are gaining recognition for their potential in managing metabolic syndrome-related conditions. Moreover, the report highlights a growing focus on inflammation, body mass index, blood pressure, body weight, and major adverse cardiovascular events as primary outcomes. Overall, the study highlights the importance of ICTRP as the source of data for clinical trials targeting metabolic syndrome, CVDs, and T2D and the growing recognition of diverse intervention strategies to address this critical global health concern. Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

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10 pages, 247 KiB

Open AccessArticle

The Quality of Life of Caregivers of People with Type 2 Diabetes Estimated Using the WHOQOL-BREF Questionnaire

by Vilma Kolarić, Valentina Rahelić and Zrinka Šakić

Diabetology 2023, 4(4), 430-439; https://doi.org/10.3390/diabetology4040037 - 11 Oct 2023

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Abstract

Type 2 diabetes (T2D) poses a growing global health challenge, impacting patients’ and their caregivers’ well-being. This study investigates the influence of T2D complications on caregivers’ quality of life (QoL) using the WHOQOL-BREF questionnaire, accounting for factors like age, disease duration, and control. [...] Read more.

Type 2 diabetes (T2D) poses a growing global health challenge, impacting patients’ and their caregivers’ well-being. This study investigates the influence of T2D complications on caregivers’ quality of life (QoL) using the WHOQOL-BREF questionnaire, accounting for factors like age, disease duration, and control. The research involved 382 T2D patients and 300 caregivers from Vuk Vrhovac University Clinic for Diabetes, Endocrinology, and Metabolic Diseases. The WHOQOL-BREF questionnaire assessed caregivers’ QoL across physical, psychological, social, and environmental domains. Complications, including retinopathy, neuropathy, and kidney disease, were examined for their effects on QoL. Patients’ age impact, gender differences, and disease duration were analyzed. T2D complications had varying impacts on different QoL domains. Caregivers of patients with multiple complications showed significant social functioning impairment. Those without complications reported lower psychological health. Age correlated with poorer physical health scores. Female caregivers rated higher in psychological and environmental health. Disease duration and T2D control had no significant impact on caregiver QoL. Caregivers’ concerns included medication adherence and worry about their partner’s health. This study illustrates the delicate interplay between T2D patients and caregivers, highlighting the multifaceted effects of chronic illness. Comprehensive healthcare techniques that address emotional and social components in addition to medical care are critical for improving the well-being of both patients and their caregivers. The findings contribute to a broader understanding of T2D care dynamics, advocating for empathetic and all-encompassing healthcare practices. Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

17 pages, 3121 KiB

Open AccessEditor’s ChoiceArticle

3D-Printed Insoles for People with Type 2 Diabetes: An Italian, Ambulatory Case Report on the Innovative Care Model

by Marco Mancuso, Rocco Bulzomì, Marco Mannisi, Francesco Martelli and Claudia Giacomozzi

Diabetology 2023, 4(3), 339-355; https://doi.org/10.3390/diabetology4030029 - 17 Aug 2023

Cited by 1 | Viewed by 1855

Abstract

3D-printed insoles are increasingly used for the management of foot pathologies, and the recent literature reports on various experimental studies dealing with either whole foot orthoses or pads fabricated through 3D-printing processes. In the case of diabetic foot disease, the main aim is [...] Read more.

3D-printed insoles are increasingly used for the management of foot pathologies, and the recent literature reports on various experimental studies dealing with either whole foot orthoses or pads fabricated through 3D-printing processes. In the case of diabetic foot disease, the main aim is to deliver more effective solutions with respect to the consolidated processes to reduce compressive risk forces at specific plantar foot sites. Clinical studies are, however, still limited, at least in peer-review journals. Additionally, in Italy, the manufacturing process of these medical devices has not been formally integrated yet into the list of care processes approved for reimbursement by the public healthcare service. Within the Italian DIAPASON project (DIAbetic PAtients Safe ambulatiON), a feasibility pilot study has been conducted in the territory on 21 patients with diabetic foot complications to assess the pros and cons of an innovative process. The process, which relies on in-shoe pressure measurements and on a patented 3D modeling and printing procedure, includes the prescription, design, manufacturing and testing of 3D-printed personalized insoles. The process has been tested in an ambulatory setting and showed the potential to be also implemented in community settings. In this paper, we report a case study on a single volunteer, and we describe and comment on how the whole process has been proven safe and suitable for the purpose. Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

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18 pages, 9487 KiB

Open AccessArticle

Biological Evidence of Improved Wound Healing Using Autologous Micrografts in a Diabetic Animal Model

by Mariza Brandão Palma, Elisa Paolin, Ismaela Maria Ferreira de Melo, Francisco De Assis Leite Souza, Álvaro Aguiar Coelho Teixeira, Leucio Duarte Vieira, Fabio Naro, Antonio Graziano and Anísio Francisco Soares

Diabetology 2023, 4(3), 294-311; https://doi.org/10.3390/diabetology4030026 - 28 Jul 2023

Cited by 1 | Viewed by 1639 | Correction

Abstract

Background: Tissue healing consists of four main phases: coagulation, inflammation, proliferation, and remodeling. In diabetic patients, this process is stagnant in the inflammatory stage, leading to chronic wounds. The aim of this study is to evaluate in an animal model the biological evidence [...] Read more.

Background: Tissue healing consists of four main phases: coagulation, inflammation, proliferation, and remodeling. In diabetic patients, this process is stagnant in the inflammatory stage, leading to chronic wounds. The aim of this study is to evaluate in an animal model the biological evidence related to the use of the Rigenera^® technology (Turin Italy), an innovative mechanical procedure to isolate autologous micrografts (AMG). Methods: Fifty male Wistar rats were divided into four groups: control (C), control treated with micrografts (CM), diabetic (DB), and diabetic treated with micrografts (DBM). The experimental setup involved: the quantification of the total collagen and elastic fibers; histopathological analysis; immunohistochemical analysis for collagen type I (COL1), collagen type III (COL3), vascular endothelial growth factor (VEGF-A), and interleukin 4 (IL4) and 10 (IL10); evaluation of the oxidative stress; measurement of gluthatione (GSH); and, finally, an enzyme-linked immunosorbent assay (ELISA) on tumor necrosis factor-α (TNF-α). Results: The AMG technology induces a faster healing process: VEGF-A, IL4, IL10, and GSH increased, while TNF-α and oxidative stress decreased. Conclusions: Animals treated with micrografts showed more favorable results for healing compared to those that did not receive treatment, demonstrating a positive participation of the micrografts in the treatment of difficult-to-heal wounds. Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

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Review

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15 pages, 1390 KiB

Open AccessReview

Importance of Dyslipidaemia Treatment in Individuals with Type 2 Diabetes Mellitus—A Narrative Review

by Dominik Strikić, Andro Vujević, Dražen Perica, Dunja Leskovar, Kristina Paponja, Ivan Pećin and Iveta Merćep

Diabetology 2023, 4(4), 538-552; https://doi.org/10.3390/diabetology4040048 - 04 Dec 2023

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Abstract

Type 2 diabetes mellitus (T2DM) is a common metabolic disease characterised by insulin resistance and elevated blood glucose levels, affecting millions of people worldwide. T2DM individuals with dyslipidaemia have an increased risk of cardiovascular disease (CVD). A complex interplay of risk factors such [...] Read more.

Type 2 diabetes mellitus (T2DM) is a common metabolic disease characterised by insulin resistance and elevated blood glucose levels, affecting millions of people worldwide. T2DM individuals with dyslipidaemia have an increased risk of cardiovascular disease (CVD). A complex interplay of risk factors such as hyperglycaemia, dyslipidaemia, hypertension, obesity, inflammation, and oxidative stress favour the development of atherosclerosis, a central mechanism in the pathogenesis of cardiovascular disease. Dyslipidaemia, a hallmark of T2DM, is characterised by elevated triglycerides, decreased high-density lipoprotein (HDL) cholesterol and the presence of small, dense low-density lipoprotein (LDL) particles, all of which promote atherosclerosis. In this article, we have attempted to present various treatment strategies that include pharmacological interventions such as statins, ezetimibe, PCSK9 inhibitors, fibrates, and omega-3 fatty acids. We have also tried to highlight the pivotal role of lifestyle modifications, including physical activity and dietary changes, in improving lipid profiles and overall cardiovascular health in T2DM individuals. We have also tried to present the latest clinical guidelines for the management of dyslipidaemia in T2DM individuals. In conclusion, the treatment of dyslipidaemia in T2DM individuals is of great importance as it lowers lipid particle levels, slows the progression of atherosclerosis, and ultimately reduces susceptibility to cardiovascular disease. Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

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12 pages, 624 KiB

Open AccessReview

Prevention of Type 2 Diabetes: The Role of Intermittent Fasting

by Bright Test and Jay H. Shubrook

Diabetology 2023, 4(4), 507-518; https://doi.org/10.3390/diabetology4040044 - 13 Nov 2023

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Abstract

Despite the progress in treatment options and improved understanding of pathophysiology, type 2 diabetes remains one of the costliest and most harmful global chronic diseases. The current guidelines encourage physicians to fight an uphill battle and react to an incubated disease state that [...] Read more.

Despite the progress in treatment options and improved understanding of pathophysiology, type 2 diabetes remains one of the costliest and most harmful global chronic diseases. The current guidelines encourage physicians to fight an uphill battle and react to an incubated disease state that has been propelled forward by clinical inertia. The authors completed a literature search of PubMed, ScienceDirect, and NIH, searching with the terms intermittent fasting, type 2 diabetes, and prediabetes, and excluded studies related to religion-based fasting. There is emerging evidence that intermittent fasting could be an option to aid in weight loss, reduce hepatic steatosis, and lower the level of biomarkers such as fasting glucose while improving insulin resistance. If incorporated into the lives of patients with risk factors for type 2 diabetes, intermittent fasting could prove to be a cost-effective and efficient tool for preventing this insidious disease. This clinical review examines current evidence supporting the implementation of this lifestyle to prevent the onset or exacerbation of type 2 diabetes and the hurdles that must still be overcome for physicians to confidently prescribe this to their patients. Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

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9 pages, 250 KiB

Open AccessReview

Recent Advances in Psychotherapeutic Treatment and Understanding of Alexithymia in Patients with Obesity and Diabetes Mellitus Type 2

by Filip Mustač, Tin Galijašević, Eva Podolski, Andrej Belančić, Martina Matovinović and Darko Marčinko

Diabetology 2023, 4(4), 481-489; https://doi.org/10.3390/diabetology4040041 - 31 Oct 2023

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Abstract

Alexithymia is the inability to describe one’s own feelings and is being increasingly researched. According to contemporary psychodynamic theories, negative emotions cannot be adequately named and externalized, but remain trapped in the body. Recent research shows the connection of alexithymia with numerous somatic [...] Read more.

Alexithymia is the inability to describe one’s own feelings and is being increasingly researched. According to contemporary psychodynamic theories, negative emotions cannot be adequately named and externalized, but remain trapped in the body. Recent research shows the connection of alexithymia with numerous somatic diseases. Diabetes mellitus type 2 and obesity represent great challenges in treatment, and the psychological profiles in these diseases are being studied more and more often. Therefore, alexithymia enters the focus of some research as a factor that could play a significant role in these diseases, namely as the one that makes a difference. The aim of this paper is a review of the literature with the purpose of understanding the current knowledge about the interconnection between alexithymia, obesity and type 2 diabetes mellitus. Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

16 pages, 306 KiB

Open AccessReview

Diabetes Mellitus—Digital Solutions to Improve Medication Adherence: Scoping Review

by Nikol Georgieva, Viktor Tenev, Maria Kamusheva and Guenka Petrova

Diabetology 2023, 4(4), 465-480; https://doi.org/10.3390/diabetology4040040 - 19 Oct 2023

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Abstract

Medication adherence (MA) is a major problem. On average 50% of chronic disease management medications are not taken as prescribed While digital healthcare tools like mobile apps offer benefits such as informative messages and prescription management, they must be personalized and offer support [...] Read more.

Medication adherence (MA) is a major problem. On average 50% of chronic disease management medications are not taken as prescribed While digital healthcare tools like mobile apps offer benefits such as informative messages and prescription management, they must be personalized and offer support across all medication phases to effectively address individual patient factors and optimize adherence, with room for further improvements. This scoping review examined the impact of digital health technologies on MA in adults with diabetes as well as their benefits and barriers. Using PubMed and Scopus databases, 11 out of 385 studies (2.86%) from January 2017 to August 2023 met the criteria for digital health interventions in diabetes MA, assessed through the Chronic Care Model. The Chronic Care Model (CCM) is a patient-centered, evidence-based framework designed to improve the care and outcomes for chronic illness patients, consisting of six core elements and enhanced by eHealth tools that facilitate self-management and support through digital innovations. The results demonstrate the effectiveness of digital health technology in improving medication adherence among adults with diabetes. Specific digital interventions, including mobile apps like Gather and Medisafe, SMS text messaging, telemonitoring, and tailored care management have demonstrated effectiveness in enhancing MA. These interventions have shown positive outcomes, including enhanced glycemic control and increased patient engagement. Some of the limitations, which these technologies face, are the poor usability, digital illiteracy among the patients, low rates of sustainability and low accessibility among the elderly population. Digital health technology shows promise in enhancing medication adherence among adults with diabetes, as revealed in this scoping review. However, ongoing research is necessary to fine-tune these interventions for improved outcomes and the overall well-being of individuals with diabetes. Additional improvement of the technologies and adaptation to the diverse population might be a good field for exploration. Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

Other

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8 pages, 266 KiB

Open AccessBrief Report

Educating Medical Students on How to Prescribe Anti-Hyperglycaemic Drugs: A Practical Guide

by Erik M. Donker, Andrej Belančić, Joost D. Piët, Dinko Vitezić, Jelle Tichelaar and on behalf of the Clinical Pharmacology and Therapeutics Teach the Teacher (CP4T) Program and the Early Career Pharmacologists of the European Association for Clinical Pharmacology and Therapeutics (EACPT)

Diabetology 2023, 4(4), 499-506; https://doi.org/10.3390/diabetology4040043 - 07 Nov 2023

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Abstract

In the light of the rapidly increasing global incidence of, and therapeutic arsenal for, diabetes type 2, this brief report underscores the need for advancements in clinical pharmacology and therapeutics (CPT) education with regard to diabetes type 2. We advocate for the comprehensive [...] Read more.

In the light of the rapidly increasing global incidence of, and therapeutic arsenal for, diabetes type 2, this brief report underscores the need for advancements in clinical pharmacology and therapeutics (CPT) education with regard to diabetes type 2. We advocate for the comprehensive training of medical students and junior doctors in line with current guidelines, and emphasize the importance of teaching how to draw up individualized treatment plans based on patients’ specific risk factors and conditions, such as cardiovascular risks, weight, and risk of hypoglycaemia. Within the curriculum, traditional teaching approaches should be replaced by innovative methods such as problem-based learning, which has been shown to be more effective in developing prescribing knowledge and skills. The inclusion of real-world experience and interprofessional learning via so-called student-run clinics is also recommended. Subsequently, innovative assessment methods like the European Prescribing Exam and objective structured clinical examinations (OSCE) are highlighted as essential for evaluating knowledge and practical skills. By adopting these educational advances, medical education can better equip future practitioners to adequately manage the complex pharmacological treatment of diabetes. Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

13 pages, 682 KiB

Open AccessSystematic Review

A Systematic Review of Economic Evaluations of Insulin for the Management of Type 2 Diabetes

by Elvira Meni Maria Gkrinia, Andrea Katrin Faour, Andrej Belančić, Jacques Bazile, Emma Marland and Dinko Vitezić

Diabetology 2023, 4(4), 440-452; https://doi.org/10.3390/diabetology4040038 - 13 Oct 2023

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Abstract

Diabetes is a chronic, metabolic disease characterized by hyperglycemia, which occurs as a result of inadequate production or utilization of insulin. Type 2 diabetes (T2D) is the most common type of diabetes with estimates projecting a prevalence of more than 1 billion people [...] Read more.

Diabetes is a chronic, metabolic disease characterized by hyperglycemia, which occurs as a result of inadequate production or utilization of insulin. Type 2 diabetes (T2D) is the most common type of diabetes with estimates projecting a prevalence of more than 1 billion people living with T2DM by 2050. Hence, it was decided to conduct a systematic literature review of health economic evaluations of insulin, the most common medication used for the treatment of the disease, to inform policy. Pharmacoeconomic analyses, written in English and published after 2016, were considered for inclusion. PubMed/Medline, Global Health, Embase and Health Management Consortium were searched separately between 5 July 2023 and 17 July 2023. Grey literature articles were searched on ISPOR and the Cost-Effectiveness Analysis Registry during the same period. After the exclusion criteria were applied, 21 studies were included. Using the BMJ checklist, a quality appraisal was performed on all included studies. Data extraction was performed manually. Regarding evidence synthesis, data were heterogenous and are presented based on study type. The results showed a variety of treatment combinations being available for the treatment of diabetes, with insulin degludec/DegLira and semaglutide being cost-effective despite their high cost, due to the effectiveness of managing the disease. Research around the cost-effectiveness or cost-utility of insulin has potential to progress further, to ensure informed policy-making in the future. Full article

(This article belongs to the Special Issue Management of Type 2 Diabetes: Current Insights and Future Directions)

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