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Diabetes costs represent a large burden to both patients and the health care system. However, few studies that examine the economic consequences of diabetes have distinguished between the two major forms, type 1 and type 2 diabetes, despite differences in underlying pathologies. Combining the two diseases implies that there is no difference between...
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... that this sample is only representative of the civilian noninstitutionalized population, leaving out patients with T1D in nursing homes or the military since MEPS does not collect information on these populations. Table 2 reports the size of MEPS sample. By combining data from 1999 (when the DCS began) to 2005 (the most recent year with available NHIS data), the total sample consists of 194,115 person-years. ...
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Citations
... 2 In Brazil, it is projected that the prevalence of diabetes will rise from 8.5% to 9.9% within the next three decades; and T1DM represents 10-15% of all Diabetes Mellitus (DM) etiologies. 1 The economic burden per case of DM is greater for T1DM than for type 2 diabetes (T2DM) and data suggest that the annual direct and indirect costs secondary to T1DM amount to US$ 14.4 billion. 3 T1DM develops due to a combination of genetic susceptibility and environmental factors, leading to autoimmunity, inflammation, and destruction of insulin-producing pancreatic β-cells. 4 The presence of one or more specific autoantibodies, such as insulin autoantibodies (IAA), glutamic acid decarboxylase antibodies (GAD), protein tyrosine phosphatase islet antigen-2 (IA2), and zinc transporter 8 (ZnT8) is a hallmark of T1DM. ...
Background
The incidence of Type 1 Diabetes Mellitus (T1DM) is on the rise. Since there is no curative treatment, it is urgent to look for therapies that can delay disease progression and protect pancreatic β-cells. Dipeptidyl peptidase-4 inhibitors (DPP-4i) have shown potential in modulating inflammation and preventing β-cell destruction. This protocol describes an upcoming trial to evaluate the effectiveness of the DPP-4i alogliptin in delaying the progression of stage 2 (presymptomatic) to stage 3 (symptomatic) T1DM.
Patients and Methods
We propose a two-year, two-arm, multicenter, randomized, open-label clinical trial targeting Brazilian patients aged 18 to 35 with stage 2 T1DM. The study, facilitated by the custom-developed “PRE1BRAZIL” web application, aims to enroll 130 participants. They will be randomly assigned in a 1:1 ratio to either a treatment group (alogliptin 25 mg daily plus regular clinical and laboratory assessments) or a control group (regular assessments only). The primary outcome is the rate of progression to stage 3 T1DM. Secondary outcomes include changes in A1c levels, glucose levels during a 2-hour oral glucose tolerance test (OGTT), C-peptide levels, exogenous insulin requirements, Insulin-Dose Adjusted A1c (IDAA1c), and the incidence of diabetic ketoacidosis (DKA) in those advancing to stage 3.
Discussion
This protocol outlines the first randomized clinical trial (RCT) to investigate the impact of a DPP-4i in the presymptomatic stage of T1DM. The trial is designed to provide critical insights into the role of DPP-4i in the secondary prevention of T1DM. Utilizing the “PRE1BRAZIL” web application is expected to enhance participant enrollment and reduce operational costs.
Registration
Brazilian Registry of Clinical Trials.
... The management of diabetes-related complications represents a significant economic burden around the world. [31][32][33] Additionally, data suggest the costs attributed to T1DM are disproportionately higher than that of Type 2 Diabetes, accounting for the size of the respective populations. 31 Given the favourable long-term outcomes of islet transplant and globally reduced insulin requirement, a detailed cost-effectiveness analysis would be of interest, particularly as there is very limited published literature on this to date. ...
... [31][32][33] Additionally, data suggest the costs attributed to T1DM are disproportionately higher than that of Type 2 Diabetes, accounting for the size of the respective populations. 31 Given the favourable long-term outcomes of islet transplant and globally reduced insulin requirement, a detailed cost-effectiveness analysis would be of interest, particularly as there is very limited published literature on this to date. ...
Aims
Pancreatic islet allotransplantation is an effective therapy for type 1 diabetes mellitus, restoring glycaemic control and hypoglycaemic awareness in patients with recurrent severe hypoglycaemia. Insulin independence following transplant is being increasingly reported; however, this is not a primary endpoint in the UK. Having surpassed 10 years of islet transplantation in Scotland, we aimed to evaluate the impact of insulin independence following transplant on metabolic outcomes and graft survival.
Methods
We conducted a retrospective analysis on data collected prospectively between 2011 and 2022. Patients who underwent islet transplantation in Scotland up to the 31st January 2020 were included. Primary endpoint was graft survival (stimulated C‐peptide >50 pmol/L). Secondary endpoints included GOLD score, HbA1c, C‐peptide and insulin requirement. Outcomes were compared between patients who achieved insulin independence at any point following transplant versus those who did not.
Results
60 patients were included. 74.5% experienced >50 severe hypoglycaemic episodes in the year preceding transplant. There was a 55.0% decrease in insulin requirement following transplant and 30.0% achieved insulin independence. Mean graft survival time was 9.0 years (95% CI 7.2–10.9) in patients who achieved insulin independence versus 4.4 years (95% CI 3.4–5.3) in patients who did not. Insulin independence was associated with significantly improved graft function, glycaemic control and hypoglycaemic awareness at 1 year.
Conclusions
This is the largest UK single‐centre study on islet transplant to date. Our findings demonstrate significantly improved outcomes in patients who achieved insulin independence following islet transplantation.
... Type 1 diabetes (T1D) is an autoimmune disorder that destroys insulin-producing pancreatic b cells. 1 Although therapy has greatly improved over the past century, 2 morbidity and mortality as well as costs and impacts on quality of life remain burdensome for affected individuals. [3][4][5][6] There is a clear need for safe, effective disease-modifying therapies that address underlying pathologic etiologies. Such therapies might not only improve residual endogenous insulin secretion, which is associated with improved disease outcomes, 7 but also, when given early enough in the disease process, have the potential to delay T1D onset and the need for exogenous insulin. ...
In preclinical models, α-difluoromethylornithine (DFMO), an ornithine decarboxylase (ODC) inhibitor, delays the onset of type 1 diabetes (T1D) by reducing β cell stress. However, the mechanism of DFMO action and its human tolerability remain unclear. In this study, we show that mice with β cell ODC deletion are protected against toxin-induced diabetes, suggesting a cell-autonomous role of ODC during β cell stress. In a randomized controlled trial (ClinicalTrials.gov: NCT02384889) involving 41 recent-onset T1D subjects (3:1 drug:placebo) over a 3-month treatment period with a 3-month follow-up, DFMO (125–1,000 mg/m²) is shown to meet its primary outcome of safety and tolerability. DFMO dose-dependently reduces urinary putrescine levels and, at higher doses, preserves C-peptide area under the curve without apparent immunomodulation. Transcriptomics and proteomics of DFMO-treated human islets exposed to cytokine stress reveal alterations in mRNA translation, nascent protein transport, and protein secretion. These findings suggest that DFMO may preserve β cell function in T1D through islet cell-autonomous effects.
... Type 1 diabetes (T1D) is a chronic autoimmune disease that affects the individual throughout their lifetime, contributing to a large healthcare burden [1]. While both genetics and environment are involved in the etiology of the disease, their exact roles have not been elucidated. ...
Given the differential risk of type 1 diabetes (T1D) in offspring of affected fathers versus affected mothers and our observation that T1D cases have differential DNA methylation near the imprinted DLGAP2 gene compared to controls, we examined whether methylation near DLGAP2 mediates the association between T1D family history and T1D risk. In a nested case–control study of 87 T1D cases and 87 controls from the Diabetes Autoimmunity Study in the Young, we conducted causal mediation analyses at 12 DLGAP2 region CpGs to decompose the effect of family history on T1D risk into indirect and direct effects. These effects were estimated from two regression models adjusted for the human leukocyte antigen DR3/4 genotype: a linear regression of family history on methylation (mediator model) and a logistic regression of family history and methylation on T1D (outcome model). For 8 of the 12 CpGs, we identified a significant interaction between T1D family history and methylation on T1D risk. Accounting for this interaction, we found that the increased risk of T1D for children with affected mothers compared to those with no family history was mediated through differences in methylation at two CpGs (cg27351978, cg00565786) in the DLGAP2 region, as demonstrated by a significant pure natural indirect effect (odds ratio (OR) = 1.98, 95% confidence interval (CI): 1.06–3.71) and nonsignificant total natural direct effect (OR = 1.65, 95% CI: 0.16–16.62) (for cg00565786). In contrast, the increased risk of T1D for children with an affected father or sibling was not explained by DNA methylation changes at these CpGs. Results were similar for cg27351978 and robust in sensitivity analyses. Lastly, we found that DNA methylation in the DLGAP2 region was associated ( P < 0.05 ) with gene expression of nearby protein-coding genes DLGAP2, ARHGEF10, ZNF596, and ERICH1. Results indicate that the maternal protective effect conferred through exposure to T1D in utero may operate through changes to DNA methylation that have functional downstream consequences.
... The results indicate that the means for the treated and control groups in the matched sample are close but not exact. This is expected, given that matching relies on propensity scores that are weighted based on each covariate's importance (Tao et al., 2010). For instance, 76% of the married respondents in the matched sample are in the treatment group (received financial advice), while 77% of them belong to the control group (no financial advice). ...
This study examines the effects of financial advice on college-saving decisions using data sets from the 2009 and 2012 U.S. National Financial Capability Study. After controlling for self-selection bias through propensity score matching, the findings show that receiving financial advice is associated positively with the likelihood of saving for children’s college education. Other findings reveal that seeking specific types of financial advice relating to savings/investment, insurance, and tax planning is positively associated with a household’s decision to allocate money for their children’s postsecondary education. The ensuing discussion highlights that policies incentivizing households to seek financial advice could promote college savings and contribute to reduction in student loan dependence.
... Data related to the burden of T1D on the health sector and economy is scarce and mistakenly reported together with the costs of type 2 diabetes. Tao et al. showed annual T1D costs in the United States (US) of around 14.4-14.9 billion US dollars [4]. ...
Background
Knowledge of diabetes by the graduate physicians had been reported to be deficient in many aspects of diagnosis and management of type 1 diabetes (T1D). This will reflect on patient care and quality of health services especially in limited-resources countries. Our aim was to assess knowledge of basic management of T1D in new medical graduates in Jordan.
Methods
A questionnaire was developed to collect information concerning demographics and knowledge and was distributed in paper form and online using google forms. The knowledge was assessed using 28 questions on different aspects of the disease.
Results
A total of 358 new medicine graduates responded to the survey and female respondents were significantly higher than male respondents. Average number of lectures concerning diabetes during the medical school years was 3.92 ± 1.37. High knowledge scores were on pathophysiology of T1D, hypoglycemia, and certain aspects of diabetic ketoacidosis. Female gender, higher number of persons with T1D the participant had encountered during medical school, and good or excellent expected degree of self-knowledge of diabetes were associated with high knowledge score, p values = 0.01, 0.009, and < 0.001, respectively. Female gender and good or excellent expected degree of knowledge of diabetes predicted high knowledge score, p value = 0.008, and < 0.001, respectively.
Conclusion
Gaps in knowledge of new medical graduates in certain T1D subjects exist. This can be corrected by many strategies including changes in curricula, elective courses, more clinical exposure, and interprofessional education. These measures must be evaluated for their short and long-term benefits.
... The estimated global direct health expenditure on DM in 2019 is USD 760 billion and is expected to grow to a projected USD 825 billion by 2030 and USD 845 billion by 2045 [3]. Although there is no evidence of the economic burden of type 1 diabetes mellitus in Chile or even in the Latin American region, evidence from the United States suggests that it is considerable, reaching USD 14.4 billion each year in terms of direct medical costs and indirect costs [4]. ...
Objective:
To estimate the budget impact of covering the FreeStyle Libre Flash Continuous Glucose Monitoring System (FSL) for type 1 Diabetes Mellitus patients (T1DM), compared to self-monitoring of blood glucose (SMBG), from the perspective of public and private third-party payers in Chile.
Methods:
A budget impact model was developed to estimate the cost difference between SMBG and FSL over five years. Two FSL coverage schemes were assessed. Input parameters were retrieved from the literature review and complemented by expert opinion. Healthcare costs were estimated by a micro-costing approach and reported in USD.
Results:
For a public sector third-party payer, incorporating FSL implied a cost increase up to USD 0.013 per member per month (PMPM) for the fifth year under the broad coverage scheme and a net saving of 0.0001 PMPM (all years) under the restricted coverage scheme. From a private sector third-party payer, incorporating FSL implied savings up to USD 0.028 PMPM (fifth year) for the broad coverage scheme and up to USD 0.012 PMPM (fifth year) for the restricted scheme.
Conclusion:
Incorporating the FSL for T1DM patients was associated with a marginal incremental cost for the public sector third-party payer and cost savings in Chile's private healthcare sector.
... In addition to potential health consequences, substance use for individuals with T1D may add a significant financial burden. Each year, T1D results in an estimated national cost of $14.4 billion [15], and a lifetime economic burden of $813 billion [16]. The majority of this economic burden comes from inpatient medical care [15,16]. ...
... Each year, T1D results in an estimated national cost of $14.4 billion [15], and a lifetime economic burden of $813 billion [16]. The majority of this economic burden comes from inpatient medical care [15,16]. Furthermore, the costs of substance use are also significant. ...
Purpose of Review
Substance use is a major public health problem in adolescents and young adults (AYA) and is particularly dangerous for AYA with type 1 diabetes (T1D) due to additional health consequences related to T1D. Rates of substance use among AYA with T1D are difficult to ascertain. Currently, we aim to provide a summary of published rates of substance use, over the last 10 years, among AYA with T1D in the USA.
Recent Findings
This review included a database search, abstract screening, and synthesizing of articles published in the last 10 years that reported rates of substance use among AYA with T1D. We also compared rates to national survey data from the Center for Disease Control and Substance Abuse and Mental Health Services Administration.
Of 138 articles, 123 abstracts were excluded due to non-relevance or because they were conducted outside of the USA; 15 articles were evaluated, and 8 provided original data on AYA with T1D. These 8 studies were summarized and compared to nationwide survey data. Most of the published rates of substance use among AYA with T1D were similar to national survey data for alcohol, tobacco, and marijuana. Rates of illicit drug use were lower among AYA with T1D.
Summary
Despite additional health consequences, alcohol, tobacco, and marijuana use is about as prevalent among AYA with T1D as in the general US population. These findings emphasize the importance of conducting more research in this area, developing effective interventions, and incorporating prevention into standard clinical practices.
... 4 Further, the wider impact of diabetes on healthcare systems and health economics is an important driver to target better glycemic outcomes to prevent future complications. 5,6 Diabetes registries have shown steady improvement in median HbA1c levels in recent decades, yet only a minority of young people attain current glycemic targets. 7 The improvements that have been demonstrated can be attributed to multiple factors, including how healthcare teams set and communicate glycemic targets, improved therapeutics (insulin analogs, CGM), highly skilled and knowledgeable workforce, and, recently, the use of automated insulin delivery systems. ...
... Few prior studies have examined the cost of type 1 diabetes in the U.S., and these studies were mainly focused on estimating the total medical cost attributable to type 1 diabetes in people aged #65 years (8,9). Medical costs of Medicare beneficiaries with type 1 diabetes likely differ from the costs derived from a younger population because of differences in the type of health insurance, duration of diabetes, and health profiles of the study population. ...
OBJECTIVE
To estimate medical costs associated with 17 diabetes complications and treatment procedures among Medicare beneficiaries aged ≥65 years with type 1 diabetes.
RESEARCH DESIGN AND METHODS
With use of the 2006–2017 100% Medicare claims database for beneficiaries enrolled in fee-for-service plans and Part D, we estimated the annual cost of 17 diabetes complications and treatment procedures. Type 1 diabetes and its complications and procedures were identified using ICD-9/ICD-10, procedure, and diagnosis-related group codes. Individuals with type 1 diabetes were followed from the year when their diabetes was initially identified in Medicare (2006–2015) until death, discontinuing plan coverage, or 31 December 2017. Fixed-effects regression was used to estimate costs in the complication occurrence year and subsequent years. The cost proportion of a complication was equal to the total cost of the complication, calculated by multiplying prevalence by the per-person cost divided by the total cost for all complications. All costs were standardized to 2017 U.S. dollars.
RESULTS
Our study included 114,879 people with type 1 diabetes with lengths of follow-up from 3 to 10 years. The costliest complications per person were kidney failure treated by transplant ($77,809 in the occurrence year and $13,556 in subsequent years), kidney failure treated by dialysis ($56,469 and $41,429), and neuropathy treated by lower-extremity amputation ($40,698 and $7,380). Sixteen percent of the total medical cost for diabetes complications was for treating congestive heart failure.
CONCLUSIONS
Costs of diabetes complications were large and varied by complications. Our results can assist in cost-effectiveness analysis of treatments and interventions for preventing or delaying diabetes complications in Medicare beneficiaries aged ≥65 years with type 1 diabetes.
