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Every person with diabetes walks a tight rope battling two devils.
The devil of high and the devil of low sugars. Both devils can cause a person to fall and suffer the consequences .
The devil of lows has an immediate impact on a persons life and is associated , a higher death rate especially in older people and higher cost of care. The devil of high sugars is silent working behind the scenes causing damage to a persons eyes, kidneys, nerves and heart over many years. The treatment of diabetes is about trying to find the best path between these two devils.
A number of studies have shown an increase in the risk of hypoglycemia as patients work to achieve a target goal of 7 for their A1c.
The DCCT* found a tripling of the incidence of hypoglycemia in Patients with Type 1 Diabetes as they got closer to their target goal of A1c 7.
The UKPDS* study found similar results in patients with Type 2 Diabetes. This study also revealed that the risk of hypoglycemia was 4 to 6 times greater in patients talking insulin compared to
sulfonylureas.There was no significant risk of hypoglycemia with glucophage (metformin)
A more recent study , ACCORD *, found a higher mortality rate , especially, in older people struggling to achieve near normal A1c'S closer to 6. The higher mortality rate and hypoglycemia resulted in stopping this portion of the study.
Postgrad Med. 2012 Jan;124(1):124-32.
Hypoglycemia, treatment discontinuation, and costs in patients with type 2 diabetes mellitus on oral antidiabetic drugs.
Principal Scientist, Takeda Pharmaceuticals International, Inc., Deerfield, IL.
Objective: To investigate the rate and impact of hypoglycemic events among patients with type 2 diabetes mellitus (T2DM) receiving different classes of oral antidiabetic drugs (OADs). Research Design and Methods: Adult patients with T2DM were extracted from the Ingenix IMPACT claims database. The mean number of health care visits due to hypoglycemic events per patient-year was estimated. Multivariate regression models were used to: 1) assess the risk factors for experiencing a hypoglycemic event; 2) assess the effect of experiencing hypoglycemic events on antidiabetic treatment discontinuation; and 3) compare 12-month post-index date costs between patients with and without hypoglycemic events. Results: 212 061 patients with T2DM were included in the analysis. The estimated frequency of hypoglycemia-related health care visits was 0.054 per patient-year. Insulin use was associated with increased risk of developing hypoglycemia, followed by use of sulfonylureas and other OADs (eg, meglitinide and α-glucosidase inhibitors).
The impacts of thiazolidinediones, metformin, and dipeptidyl peptidase-4 on hypoglycemia risk were relatively small. Having a hypoglycemic event was associated with significantly increased risk of antidiabetic treatment discontinuation.
Patients with hypoglycemia showed significantly higher annual all-cause and diabetes-related health care costs than patients without hypoglycemia (adjusted Δ = +$5024 and +$3747, respectively; both P < 0.0001). Conclusion: Different OAD classes were associated with different levels of risk for hypoglycemic events. Hypoglycemia was associated with a higher risk of antidiabetic treatment discontinuation and significantly increased health care costs.
The cost of caring for someone who is having problems with hypoglycemia is more than the cost of care for a person without hypoglycemia.. We now have medications that will lower blood sugars allowing people to achieve A1c levels shown to reduce the risk of complications and in some cases preserve Beta cell function without the risk of hypoglycemia. The high cost of hypoglycemia in human suffering and money may push diabetes treatment more rapidly toward the use of medications with little or no risk of hypoglycemia. These medications include Glucophage ( metformin ) , GLP -1 Agonist and DPP-4 inhibitors. See yesterdays discussion for more details about these medications .
*Diabetes Control and Complication Trial Group. “The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus.” New England Journal of Medicine 329 (September 30, 1993): 977–986. [DCCT]
*UK Prospective Diabetes Study (UKPDS) Group 33. “Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes.” Lancet 352 (September 12, 1998): 837–853.
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