Quality of life of patients with type 1 diabetes using insulin analoge glargine compared to NPH insulin: a systematic review and policy implications

Paulo HRF Almeida, Thales BC Silva, Francisco de Assis Acurcio, Augusto A Guerra Júnior, Vania E Araújo, Leonardo M Diniz, Brian Godman, Alessandra M Almeida, Juliana Alvares

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

INTRODUCTION: Insulin analogue glargine (GLA) has been available as one of the therapeutic options for patients with type 1 diabetes mellitus to enhance glycemic control. Studies have shown that a decrease in the frequency of hypoglycemia episodes improves the Quality of Life (QoL) of diabetic patients. However, there are appreciable acquisition cost differences between different insulins. Consequently, a need to assess their impact on QoL to provide future guidance to health authorities. METHOD: A Systematic review (SR) of multiple databases including Medline, LILACS, Cochrane and EMBASE databases with several combinations of agreed terms involving randomized controlled trials (RCTs) and cohorts, as well as manual searches and gray literature was undertaken. The primary outcome measure was a change in QoL. The quality of the studies and the risk of bias was also assessed. RESULTS: Eight studies were eventually included in the systematic review out of 634 publications. Eight different QoL instruments were used (2 generic, 2 mixed and 4 specific), in which the Diabetes Treatment Satisfaction Questionnaire (DTSQs) was the most used. The systematic review did not consistently show any significant difference overall in QoL scores whether as part of subsets or combined into a single score with the use of GLA versus NPH insulin. Only in patients’ satisfaction measured by DTSQ was a better result consistently seen with GLA versus NPH insulin but not using the WED scale. However, none of the cohort studies scored a maximum on the Newcastle-Ottawa scale for quality and they generally were of moderate quality with bias in the studies. CONCLUSION: There was no consistent difference in QoL or patient reported outcomes when the findings from the eight studies were collated. In view of this, we believe the current price differential between GLA and NPH insulin in Brazil cannot be justified by these findings.
LanguageEnglish
Pages377-389
Number of pages13
JournalThe Patient - Patient-Centered Outcomes Research
Volume11
Issue number4
Early online date10 Jan 2018
DOIs
Publication statusPublished - 31 Aug 2018

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Isophane Insulin
Type 1 Diabetes Mellitus
Quality of Life
Databases
Insulins
Insulin Glargine
Patient Satisfaction
Hypoglycemia
Brazil
Publications
Cohort Studies
Therapeutics
Randomized Controlled Trials
Outcome Assessment (Health Care)
Costs and Cost Analysis
Health

Keywords

  • insulin glargine
  • Brazil
  • diabetes mellitus

Cite this

Almeida, Paulo HRF ; Silva, Thales BC ; de Assis Acurcio, Francisco ; Guerra Júnior, Augusto A ; Araújo, Vania E ; Diniz, Leonardo M ; Godman, Brian ; Almeida, Alessandra M ; Alvares, Juliana. / Quality of life of patients with type 1 diabetes using insulin analoge glargine compared to NPH insulin : a systematic review and policy implications. In: The Patient - Patient-Centered Outcomes Research. 2018 ; Vol. 11, No. 4. pp. 377-389.
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abstract = "INTRODUCTION: Insulin analogue glargine (GLA) has been available as one of the therapeutic options for patients with type 1 diabetes mellitus to enhance glycemic control. Studies have shown that a decrease in the frequency of hypoglycemia episodes improves the Quality of Life (QoL) of diabetic patients. However, there are appreciable acquisition cost differences between different insulins. Consequently, a need to assess their impact on QoL to provide future guidance to health authorities. METHOD: A Systematic review (SR) of multiple databases including Medline, LILACS, Cochrane and EMBASE databases with several combinations of agreed terms involving randomized controlled trials (RCTs) and cohorts, as well as manual searches and gray literature was undertaken. The primary outcome measure was a change in QoL. The quality of the studies and the risk of bias was also assessed. RESULTS: Eight studies were eventually included in the systematic review out of 634 publications. Eight different QoL instruments were used (2 generic, 2 mixed and 4 specific), in which the Diabetes Treatment Satisfaction Questionnaire (DTSQs) was the most used. The systematic review did not consistently show any significant difference overall in QoL scores whether as part of subsets or combined into a single score with the use of GLA versus NPH insulin. Only in patients’ satisfaction measured by DTSQ was a better result consistently seen with GLA versus NPH insulin but not using the WED scale. However, none of the cohort studies scored a maximum on the Newcastle-Ottawa scale for quality and they generally were of moderate quality with bias in the studies. CONCLUSION: There was no consistent difference in QoL or patient reported outcomes when the findings from the eight studies were collated. In view of this, we believe the current price differential between GLA and NPH insulin in Brazil cannot be justified by these findings.",
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Quality of life of patients with type 1 diabetes using insulin analoge glargine compared to NPH insulin : a systematic review and policy implications. / Almeida, Paulo HRF; Silva, Thales BC; de Assis Acurcio, Francisco; Guerra Júnior, Augusto A; Araújo, Vania E; Diniz, Leonardo M; Godman, Brian; Almeida, Alessandra M; Alvares, Juliana.

In: The Patient - Patient-Centered Outcomes Research, Vol. 11, No. 4, 31.08.2018, p. 377-389.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Quality of life of patients with type 1 diabetes using insulin analoge glargine compared to NPH insulin

T2 - The Patient - Patient-Centered Outcomes Research

AU - Almeida, Paulo HRF

AU - Silva, Thales BC

AU - de Assis Acurcio, Francisco

AU - Guerra Júnior, Augusto A

AU - Araújo, Vania E

AU - Diniz, Leonardo M

AU - Godman, Brian

AU - Almeida, Alessandra M

AU - Alvares, Juliana

PY - 2018/8/31

Y1 - 2018/8/31

N2 - INTRODUCTION: Insulin analogue glargine (GLA) has been available as one of the therapeutic options for patients with type 1 diabetes mellitus to enhance glycemic control. Studies have shown that a decrease in the frequency of hypoglycemia episodes improves the Quality of Life (QoL) of diabetic patients. However, there are appreciable acquisition cost differences between different insulins. Consequently, a need to assess their impact on QoL to provide future guidance to health authorities. METHOD: A Systematic review (SR) of multiple databases including Medline, LILACS, Cochrane and EMBASE databases with several combinations of agreed terms involving randomized controlled trials (RCTs) and cohorts, as well as manual searches and gray literature was undertaken. The primary outcome measure was a change in QoL. The quality of the studies and the risk of bias was also assessed. RESULTS: Eight studies were eventually included in the systematic review out of 634 publications. Eight different QoL instruments were used (2 generic, 2 mixed and 4 specific), in which the Diabetes Treatment Satisfaction Questionnaire (DTSQs) was the most used. The systematic review did not consistently show any significant difference overall in QoL scores whether as part of subsets or combined into a single score with the use of GLA versus NPH insulin. Only in patients’ satisfaction measured by DTSQ was a better result consistently seen with GLA versus NPH insulin but not using the WED scale. However, none of the cohort studies scored a maximum on the Newcastle-Ottawa scale for quality and they generally were of moderate quality with bias in the studies. CONCLUSION: There was no consistent difference in QoL or patient reported outcomes when the findings from the eight studies were collated. In view of this, we believe the current price differential between GLA and NPH insulin in Brazil cannot be justified by these findings.

AB - INTRODUCTION: Insulin analogue glargine (GLA) has been available as one of the therapeutic options for patients with type 1 diabetes mellitus to enhance glycemic control. Studies have shown that a decrease in the frequency of hypoglycemia episodes improves the Quality of Life (QoL) of diabetic patients. However, there are appreciable acquisition cost differences between different insulins. Consequently, a need to assess their impact on QoL to provide future guidance to health authorities. METHOD: A Systematic review (SR) of multiple databases including Medline, LILACS, Cochrane and EMBASE databases with several combinations of agreed terms involving randomized controlled trials (RCTs) and cohorts, as well as manual searches and gray literature was undertaken. The primary outcome measure was a change in QoL. The quality of the studies and the risk of bias was also assessed. RESULTS: Eight studies were eventually included in the systematic review out of 634 publications. Eight different QoL instruments were used (2 generic, 2 mixed and 4 specific), in which the Diabetes Treatment Satisfaction Questionnaire (DTSQs) was the most used. The systematic review did not consistently show any significant difference overall in QoL scores whether as part of subsets or combined into a single score with the use of GLA versus NPH insulin. Only in patients’ satisfaction measured by DTSQ was a better result consistently seen with GLA versus NPH insulin but not using the WED scale. However, none of the cohort studies scored a maximum on the Newcastle-Ottawa scale for quality and they generally were of moderate quality with bias in the studies. CONCLUSION: There was no consistent difference in QoL or patient reported outcomes when the findings from the eight studies were collated. In view of this, we believe the current price differential between GLA and NPH insulin in Brazil cannot be justified by these findings.

KW - insulin glargine

KW - Brazil

KW - diabetes mellitus

UR - https://link.springer.com/journal/40271

U2 - 10.1007/s40271-017-0291-3

DO - 10.1007/s40271-017-0291-3

M3 - Article

VL - 11

SP - 377

EP - 389

JO - The Patient - Patient-Centered Outcomes Research

JF - The Patient - Patient-Centered Outcomes Research

SN - 1178-1653

IS - 4

ER -