A Relative Cost of Control Analysis of IDegLira versus Other Forms of Basal Insulin Intensification in Mexico.

OBJECTIVES: Achieving glycemic control in patients with type 2 diabetes is important as it reduces the risk of complications and their related clinical and economic burden. Yet therapeutic inertia due to the fear of hypoglycemia, complex treatment regimens, weight gain, and therapy costs, among others, limits achieving glycemic control. This analysis aims to assess the short-term cost of control (cost per patient achieving treatment goals) with insulin degludec/liraglutide (IDegLira) versus other forms of basal insulin intensification (insulin glargine titration, basal-bolus therapy, and the combination of insulin glargine and lixisenatide: IGlarLixi) in type 2 diabetes patients not controlled with basal insulin in the Mexican private setting. METHODS: The proportion of patients achieving treatment goals was obtained from DUAL V and DUAL VII studies (full trial population) and a indirect treatment comparison analyzing IDegLira versus IGlarLixi. Annual cost of treatment was estimated using unitary costs from IQVIA's Pharmaceutical Market Mexico (PMM) audit and wholesale acquisition costs (both from December 2021). The cost of control was estimated by dividing the annual cost of treatment by the proportion of patients achieving the corresponding treatment goal: glycated hemoglobin (HbA1C) < 7.0%, HbA1C < 7.0% without weight gain, HbA1C < 7.0% without hypoglycemia, and HbA1C < 7.0% without hypoglycemia and weight gain. One-way sensitivity analyses were conducted to assess how variations in the model inputs impacted cost-effectiveness outcomes. RESULTS: The proportion of patients achieving treatment goals was higher for IDegLira versus other forms of basal insulin intensification in all endpoints assessed. The annual cost of treatment with IDegLira was similar to the cost of treatment versus IGlarLixi or versus basal-bolus therapy ($54,659 versus $55,831 MXN and $51,008 versus $52,987 MXN, respectively), and higher in comparison with insulin glargine titration ($52,186 versus $40,194 MXN). The cost of controlling one patient with IDegLira was lower than any other form of basal insulin intensification, for all treatment goals. CONCLUSION: When integrating the greater clinical efficacy of IDegLira with its annual cost, it can be shown that within 1 year, IDegLira is the best option in terms of value for money for payers in a private healthcare setting in Mexico in comparison with other forms of basal insulin intensification. Thus, investing in IDegLira not only represents a greater clinical benefit, but also an economical one for payers.

Patients' Preference Between DPP4i and SGLT2i for Type 2 Diabetes Treatment: A Cross-Sectional Evaluation.

Purpose: Despite newer type 2 diabetes (T2D) medications, patients do not always achieve metabolic targets, remaining at risk for cardiorenal complications. Therapeutic decisions are generally made by the healthcare team without considering patients' preferences. We aimed to evaluate patients' T2D treatment preference in two Latin-American countries between two different oral medication profiles, one resembling dipeptidyl peptidase-4 inhibitors (DPP4i) and another resembling sodium-glucose cotransporter-2 inhibitors (SGLT2i). Patients and Methods: In this cross-sectional, multicenter study from June to September 2020, patients with T2D from Argentina and Mexico (n = 390) completed a discrete choice experiment questionnaire to identify preferences between DPP4i (medication profile A) and SGLT2i (medication profile B). The reason behind patients' choice, and the association between their baseline characteristics and their preference were evaluated using logistic regression methods. Results: Most participants (88.2%) preferred SGLT2i's profile. Participants with older age (p = 0.0346), overweight or obesity (p < 0.0001), high blood pressure (BP; p < 0.0001), high total cholesterol (p = 0.0360), and glycosylated hemoglobin (HbA1c) <7% (p = 0.0001) were more likely to choose SGLT2i compared with DPP4i's profile. The most and least important reasons to choose either drug profile were HbA1c reduction and genital infection risk, respectively. The likelihood of selecting the SGLT2i's profile significantly increased in participants with increased body mass index (BMI; odds ratio [OR] = 8.9, 95% confidence interval [CI]: 3.5-22.5, p < 0.05), high BP (OR = 4.9, 95% CI: 1.9-12.4, p < 0.05), and lower education level (OR = 3.6, 95% CI: 1.0-12.6, p < 0.05). Conclusion: Latin-American patients with T2D preferred medication with a profile resembling SGLT2i over one resembling DPP4i as a treatment option. A patient-centered approach may aid the healthcare team in decision-making for improved outcomes.

[Integrated Care Protocol: Chronic complications of diabetes mellitus 2]. / Protocolo de Atención Integral: complicaciones crónicas de diabetes mellitus 2.

BACKGROUND: According to the International Diabetes Federation, 18% of Mexican adults live with diabetes and it is expected that by 2030 it will occupy the seventh place in the world in number of cases. In the population covered by the Mexican Institute of Social Security, diabetes is the second cause of mortality, years lost due to premature death, years lived with disability and years of healthy life lost, placing it as one of the costliest diseases. OBJECTIVE: Address in a timely and integrated manner chronic complications of type 2 diabetes mellitus, by implementing coordinated actions by multidisciplinary health team in the 3 levels of care. MATERIAL AND METHODS: The process of developing the Integrated Care Protocols consisted of: 1) Prioritization of the health problem, 2) Formation of an interdisciplinary working group, 3) Development of content and systematic search for information 4) Analysis, review and discussion of interventions, 5) Review and validation by regulatory areas, 6) Dissemination and implementation. CONCLUSIONS: Adequate glycemic control, blood pressure, lipids and a healthy lifestyle are the key to delaying the presence of micro and macrovascular complications of DM2. However, the progression of the disease will eventually be inevitable, it will confront the health personnel and the patient with some of the complications. In this sense, timely detection and treatment to delay them becomes the main function of the health worker.

INTRODUCCIÓN: de acuerdo con la Federación Internacional de Diabetes, en México el 18% de los adultos viven con diabetes, y se espera que para el 2030 ocupe el séptimo lugar mundial en número de casos. En la población cubierta por el Instituto Mexicano del Seguro Social, la diabetes es la segunda causa de mortalidad, así como de años perdidos por muerte prematura, de años vividos con discapacidad y de años de vida saludable perdidos, colocándola como una de las enfermedades más costosas. OBJETIVO: atender de manera oportuna e integral las complicaciones crónicas de la diabetes mellitus tipo 2 (DM2), mediante la implementación articulada de las acciones a cargo de equipo multidisciplinario de salud en los tres niveles de atención. MATERIAL Y MÉTODOS: el proceso de desarrollo de los Protocolos de Atención Integral consistió en: 1) Priorización del problema de salud, 2) Conformación de grupo de trabajo interdisciplinario, 3) Desarrollo del contenido y búsqueda sistemática de información 4) Análisis, revisión y discusión de las intervenciones, 5) Revisión y validación por las áreas normativas y 6) Difusión e implementación. CONCLUSIONES: el adecuado control glucémico, del presión arterial y lípidos, así como un estilo de vida saludable son la clave para retrasar la presencia de complicaciones micro y macrovasculares de la DM2. Sin embargo, la progresión de la enfermedad eventualmente será inevitable, enfrentará al personal de salud y al paciente a alguna de las complicaciones. En este sentido, la detección oportuna y el tratamiento para retrasarlas se convierte en la principal función del trabajador de la salud.

Tres desafortunados enemigos de la salud de la población / Three unfortunate enemies of the health of the population

Resumen Tres enfermedades con alta prevalencia en la población adulta, especialmente en México, son la diabetes mellitus tipo 2, la hipertensión arterial y la hiperuricemia-gota; entre ellas comparten características fisiopatológicas que favorecen su aparición como Aceptado: 11 de junio 2019 un conjunto en los pacientes y cuyos tratamientos van frecuentemente de la mano, lo que ha permitido que en las siguientes líneas puedan describirse tales enfermedades Correspondencia como los tres desafortunados enemigos de la salud de la población. Manuel González Ortiz.

Abstract Three diseases with a high prevalence in the adult population, especially in Mexico, are type 2 diabetes mellitus, arterial hypertension and hyperuricemia-gout; they share among them pathophysiological characteristics that favor their appearance as a group in the patients and whose treatments are frequently in the same way, the above-mentioned has allowed that in the following lines can be described such diseases as the three to;35(4):596-608. unfortunate enemies of the health of the population.