Enhancing Choices Regarding the Administration of Insulin Among Patients With Diabetes Requiring Insulin Across Countries and Implications for Future Care

Frontiers in Pharmacology

Stephen M. Campbell²  Johanna C. Meyer³  Amos Massele⁴  Israel Abebrese Sefah⁵  Ileana Mardare⁶  Brian Godman⁷ 

[1] Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates;Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom;Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa;Pharmacology and Therapeutics Department, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania;Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana;Public Health and Management Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, Bucharest, Romania;Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom;

关键词: Africa;    cost-effectiveness;    central and eastern European countries;    evidence-based decisions;    hypoglycaemia;    insulin pumps;   

DOI  :  10.3389/fphar.2021.794363

来源: DOAJ

【 摘 要 】

There are a number of ongoing developments to improve the care of patients with diabetes across countries given its growing burden. Recent developments include new oral medicines to reduce cardiovascular events and death. They also include new modes to improve insulin administration to enhance adherence and subsequent patient management thereby reducing hypoglycaemia and improving long-term outcomes. In the case of insulins, this includes long-acting insulin analogues as well as continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion systems, combined with sensor-augmented pump therapy and potentially hybrid closed-loops. The benefits of such systems have been endorsed by endocrine societies and governments in patients with Type 1 diabetes whose HbA1c levels are not currently being optimised. However, there are concerns with the low use of such systems across higher-income countries, exacerbated by their higher costs, despite studies suggesting their cost-effectiveness ratios are within accepted limits. This is inconsistent in higher-income countries when compared with reimbursement and funding decisions for new high-priced medicines for cancer and orphan diseases, with often limited benefits, given the burden of multiple daily insulin injections coupled with the need for constant monitoring. This situation is different among patients and governments in low- and low-middle income countries struggling to fund standard insulins and the routine monitoring of HbA1c levels. The first priority in these countries is to address these priority issues before funding more expensive forms of insulin and associated devices. Greater patient involvement in treatment decisions, transparency in decision making, and evidence-based investment decisions should help to address such concerns in the future.

【 授权许可】

Unknown