Economic evaluation of the treatment of type 2 diabetes with insulin glargine based on the LAPTOP trial.

In the LAPTOP trial, combination therapy with once-daily insulin glargine + oral antidiabetic agents glimepiride and metformin (BOT) was compared to twice-daily premixed insulin (CT). BOT was safer and more effective than CT. Cost analysis of both regimens were compared over a 1-year period. Analyses were performed from the perspective of the German statutory health insurance. Costs per patient per year were on average 236euro lower for BOT than for CT therapy. Economic advantage for BOT was robust to variation of expenses within a range of at least +/-20%. Insulin utilisation and prices were the major cost drivers, followed by costs associated with monitoring of blood glucose levels. Cost analysis of the LAPTOP trial suggest that BOT is more cost effective alternative to CT.

Antihypertensive therapy with verapamil SR plus trandolapril versus atenolol plus chlorthalidone on glycemic control.

BACKGROUND: There is evidence that diuretics and beta blockers impair glucose tolerance, whereas calcium channel blockers and angiotensin converting enzyme blockers lack this metabolic effect. We compared the effect of a combination therapy with a nondihydropyridine calcium channel blocker plus an angiotensin converting enzyme inhibitor and a beta blocker plus a diuretic on hemoglobin A(1c) (Hb A(1c)) in patients with type 2 diabetes and mild-to- moderate hypertension. METHODS: A total of 463 hypertensive outpatients with non-insulin treated type 2 diabetes on stable antidiabetic therapy for at least 3 months and with HbA(1c) between 6.5% and 10% were recruited. In a randomized, double blind trial patients were treated for 20 weeks with fixed combinations of verapamil sustained release (SR) plus trandolapril and of atenolol plus chlorthalidone following a 2-week placebo run-in period. The main outcome measures were HbA(1c), fasting plasma glucose, and fructosamine levels as well as systolic and diastolic blood pressure. RESULTS: HbA(1c) remained stable at 7.9% after administration of verapamil SR plus trandolapril and increased from 7.8% to 8.6% with atenolol plus chlorthalidone; the differences between treatment groups were significant at 4, 12, and 20 weeks of treatment and at last visit (P <.0001). Mean blood pressure fell from 169/96 to 150/85 and from 168/95 to 145/83 mm Hg after administration of verapamil SR plus trandolapril and atenolol plus chlorthalidone, respectively. Both combinations were well tolerated. CONCLUSIONS: HbA(1c) and other parameters of short- and long-term glycemic control were in a more favorable range after antihypertensive treatment with verapamil SR plus trandolapril as compared with atenolol plus chlorthalidone.

[Epidemiology of diabetes mellitus: prevalence, incidence, pathogenesis, and prognosis]. / Epidemiologie des Diabetes mellitus: Häufigkeit, Pathogenese, Prognose.

According to the WHO definition the term diabetes mellitus covers a group of metabolic diseases characterized by elevated blood glucose levels. The two main representatives of this group are type 1 and type 2 diabetes. All forms of diabetes have in common that, due to hyperglycemia, complications (vascular damage in particular) can occur, which are responsible for the high rate of morbidity as well as the excess mortality of the group of persons affected. In all populations--Germany included--the overwhelming majority of diabetics are subjects with type 2 diabetes. Type 2 diabetes is almost 20 times more common than type 1 diabetes, i.e. almost 90% of all diabetic persons can be assigned to the type 2 diabetes category. The rest can be split up into 5-7% type 1 diabetics and 2%-5% of persons suffering from secondary forms of diabetes (pancreatic and hepatic diseases). Positive antibody tests in older diabetic persons suggest that type 2 diabetes may not be a uniform disease and that in almost 10% of cases an autoimmune disease might be the cause of diabetes in old age (LA-DA diabetes). The data of the diabetes register of the former German Democratic Republic (East Germany) together with representative samples obtained from the federal states that comprised West Germany indicate a diabetes prevalence of about 5% in the adult population of Germany. Once the new WHO diagnostic criteria for diabetes mellitus are used and an early-diagnosis procedure (the oral glucose tolerance test) is widely applied the prevalence is expected to be shown to be higher. What is more, the global trend toward higher figures for type 1 and type 2 diabetes can also be observed in Germany. Whereas the pathogenesis of type 1 diabetes results from the autoimmune destruction of beta cells, leading to insulin deficiency, in type 2 diabetes insulin resistance as well as impaired insulin secretion are present; mechanisms that interact closely in the development of glucose intolerance. Strong genetic and environmental factors operate with regard to both types. The reduction of the life expectancies for type 1 and type 2 diabetes is contingent upon the appearance of micro- and/or macrovascular complications. At the top of the mortality statistics are patients suffering from cardiovascular and/or kidney diseases. However, by applying metabolic control and by means of other intervention strategies the prognoses for diabetic patients can be improved significantly.

Detecting type 2 diabetes by a single post-challenge blood sample.

In the recent American Diabetes Association (ADA)/WHO recommendations, the oral glucose tolerance test (OGTT) was replaced by the measurement of a single fasting glucose concentration with a decision limit for the detection of type 2 diabetes mellitus (DM) reduced. This proposal, however, misses all cases of isolated post-prandial hyperglycaemia. Therefore, a study was undertaken to develop a post-challenge, one-sample mode of diagnosis. OGTT was performed in 240 high-risk subjects who were suspected to suffer from type 2 DM. Glucose concentrations were determined at 30 min intervals in the capillary blood, venous blood and plasma, and insulin was determined in venous plasma only. The test results were classified in non-disease and disease group according to the decision limits recommended by ADA/WHO. Furthermore, the early insulin response and an insulin sensitivity index were used to determine new cut-off values. These were identified as the concentrations demonstrating the highest diagnostic efficiency and were lower than the WHO limits. The 2 h post-load plasma concentration led to higher efficiency at a cut-off value of 9.0 mmol/l glucose (162 mg/dl) compared to concentrations of samples taken in the fasting state, at an earlier time of the OGTT, or in venous and capillary blood. Under this condition, 72 diabetic patients (35%) were detected in the study group (n = 207), whereas only 36 (17%) were found with one sample in the fasting state and 53 (26%) with two samples using the ADA/WHO criteria. Therefore, a single venous plasma sample taken after 2 h post-glucose challenge appeared to be most efficient for the early detection of DM.