Suchergebnisse

Diabetes mellitus, better known simply as "diabetes", is a chronic disease that occurs when elevated blood glucose levels occur because the body stops producing or does not produce enough of the hormone called insulin, or fails use said hormone effectively. Currently 6.4 million Mexicans have a medical diagnosis of DM II, that is, 9.4% of the adult population (20 years and older). However, this figure does not include those who have not been diagnosed or are at high risk of developing the disease. DM II is the second cause of death in Mexico and is among the five leading causes of years of life lived with disabilities. Objective: Evaluate the Cost Effectiveness of Diabetes treatment in Mexico. Material and Method: A systematic review was carried out on the Internet based on articles published in Crossref, PUBMED, JCR, NCBI, SCOPUS, information from government institutions; the search is performed using keywords such as; Cost-Effectiveness and Diabetes. Results: Of a total of 22 references reviewed, 5. (23%) were detected in CROSSREF, 12 (54%) in PUBMED, 5 (23%) were detected from information from government institutions. Conclusion: According to the revised literature, the expense that is made in Mexico for diabetes care is high, but most of that investment is going to treat complications and not prevention. ; La diabetes mellitus II (DM II), más conocida simplemente como "diabetes", es una enfermedad crónica que se produce cuando se dan niveles elevados de glucosa en sangre debido a que el organismo deja de producir o no produce suficiente cantidad de la hormona denominada insulina, o no logra utilizar dicha hormona de modo eficaz. Actualmente 6.4 millones de mexicanos tienen un diagnóstico médico de DM II, es decir, el 9.4% de la población adulta (20 años y más). Sin embargo, esta cifra no incluye a quienes no han sido diagnosticados o están en alto riesgo de desarrollar la enfermedad. La DM II es la segunda causa de muerte en México y está entre las cinco principales causas de años de vida vividos con discapacidad. Objetivo: Describir el costo del tratamiento de Diabetes en México. Material y Método: Se realizó una revisión sistemática en la red de internet en base a artículos publicados en CROSSREF, PUBMED, JCR, NCBI, SCOPUS, información de instituciones gubernamentales; se realizó la búsqueda mediante palabras clave como; Costo-Efectividad y Diabetes. De un total de 32 referencias revisadas, 5 (15.5%) se detectaron en CROSSREF; 22 (54%) en PUBMED; 5 (15.5%) se detectaron de información de instituciones gubernamentales. Resultados: En el 2013 en México los costos del tratamiento para DM II, fueron los siguientes: a) Directos. $179,495.3 millones de pesos (1.11% del PIB) y b) Indirectos. $183,364.49 millones de pesos (1.14% del PIB). Conclusión: De acuerdo a la bibliografía revisada el gasto que se hace en México para la atención de Diabetes es alto, pero la mayor parte de esa inversión se va a tratar las complicaciones y no a la prevención.

AIMS: The aim of this study was to evaluate the association of diabetes and diabetes treatment with risk of postmenopausal breast cancer. METHODS: Histologically confirmed incident cases of postmenopausal breast (N = 916) cancer were recruited from 23 Spanish public hospitals. Population-based controls (N = 1094) were randomly selected from primary care center lists within the catchment areas of the participant hospitals. ORs (95 % CI) were estimated using mixed-effects logistic regression models, using the recruitment center as a random effect term. Breast tumors were classified into hormone receptor positive (ER+ or PR+), HER2+ and triple negative (TN). RESULTS: Diabetes was not associated with the overall risk of breast cancer (OR 1.09; 95 % CI 0.82-1.45), and it was only linked to the risk of developing TN tumors: Among 91 women with TN tumors, 18.7 % were diabetic, while the corresponding figure among controls was 9.9 % (OR 2.25; 95 % CI 1.22-4.15). Regarding treatment, results showed that insulin use was more prevalent among diabetic cases (2.5 %) as compared to diabetic controls (0.7 %); OR 2.98; 95 % CI 1.26-7.01. They also showed that, among diabetics, the risk of developing HR+/HER2- tumors decreased with longer metformin use (ORper year 0.89; 95 % CI 0.81-0.99; based on 24 cases and 43 controls). CONCLUSION: This study reinforces the need to correctly classify breast cancers when studying their association with diabetes. Given the low survival rates in women diagnosed with TN breast tumors and the potential impact of diabetes control on breast cancer prevention, more studies are needed to better characterize this association. ; This work was supported by research Grants from Spain´s Health Research Fund Fondo de Investigación Sanitaria (PI12/00488, PI08/1770, PI08/0533, PI08/1359, PS09/00773, PS09/01286, PS09/01903, PS09/02078, PS09/01662, PI11/01403, PI11/01889, PI11/00226, PI11/01810, PI11/02213, PI12/00265, PI12/01270, PI12/00715, PI12/00150), Fundación Marqués de Valdecilla (API 10/09), ICGC International Cancer Genome Consortium CLL, Junta de Castilla y León (LE22A10-2), Consejería de Salud of the Junta de Andalucía (PI-0571), Conselleria de Sanitat of the Generalitat Valenciana (AP_061/10), Recercaixa (2010ACUP 00310), Regional Government of the Basque Country by European Commission GrantsFOOD-CT-2006-036224-HIWATE, Spanish Association Against Cancer (AECC) Scientific Foundation and the Catalan Government DURSI Grant 2014SGR647 ; Sí

This work was supported by research Grants from Spain´s Health Research Fund Fondo de Investigación Sanitaria (PI12/00488, PI08/1770, PI08/0533, PI08/1359,PS09/00773, PS09/01286, PS09/01903, PS09/02078, PS09/01662,PI11/01403, PI11/01889, PI11/00226, PI11/01810, PI11/02213, PI12/00265, PI12/01270, PI12/00715, PI12/00150), Fundació Marqué de Valdecilla (API 10/09), ICGC International Cancer Genome Consortium CLL, Junta de Castilla y Leon (LE22A10-2), Consejería de Salud of the Junta de Andalucía (PI-0571), Conselleria de Sanitat of the Generalitat Valenciana (AP_061/10), Recercaixa (2010ACUP 00310), Regional Government of the Basque Country by European Commission Grants FOOD-CT-2006-036224-HIWATE, Spanish Association Against Cancer (AECC) Scientific Foundation and the Catalan Government DURSI Grant 2014SGR647 ; García-Esquinas, E., Guinó, E., Castaño-Vinyals, G., Pérez-Gómez, B., Llorca, J., Altzibar, J.M., Peiró-Pérez, R., Martín, V., Moreno-Iribas, C., Tardón, A., Caballero, F.J., Puig-Vives, M., Guevara, M., Villa, T.F., Salas, D., Amiano, P., Dierssen-Sotos, T., Pastor-Barriuso, R., Sala, M., Kogevinas, M., Aragonés, N., Moreno, V., Pollán, M.

Although US health care expenditures reached 17.6 percent of GDP in 2009, quality measurement in this important service sector remains limited. Studying quality changes associated with 11 years of health care for patients with diabetes, we find that the value of reduced mortality and avoided treatment spending, net of the increase in annual spending, was $9,094 for the average patient. These results suggest that the unit cost of diabetes treatment, adjusting for the value of health outcomes, has been roughly constant. Since input prices have not been declining, our results are consistent with productivity improvement in health care.

It has been estimated that 24 million Americans have diabetes, many of whom are Medicare beneficiaries. These individuals carefully monitor their blood glucose levels primarily through the use of in-home blood glucose testing kits. Although the test is relatively simple, the cumulative expense of providing glucose test strips and lancets to patients is ever increasing, both to the Medicare program and to uninsured individuals who must pay out-of-pocket for these testing supplies. This article discusses the diabetes durable medical equipment (DME) coverage under Part B Medicare, the establishment and role of DME Medicare administrative contractors, and national and local coverage requirements for diabetes DME suppliers. This article also discusses the federal government's ongoing concerns regarding the improper billing of diabetes testing supplies. To protect the Medicare Trust Fund, the federal government has contracted with multiple private entities to conduct reviews and audits of questionable Medicare claims. These private sector contractors have conducted unannounced site visits of DME supplier offices, interviewed patients and their families, placed suppliers on prepayment review, and conducted extensive postpayment audits of prior paid Medicare claims. In more egregious administrative cases, Medicare contractors have recommended that problematic providers and/or DME suppliers have their Medicare numbers suspended or, in some instances, revoked. More serious infractions can lead to civil or criminal liability. In the final part of this article, we will examine the future of enforcement efforts by law enforcement and Medicare contractors and the importance of understanding and complying with federal laws when ordering and supplying diabetes testing strips and lancets.

Abstract Background To compare the first-in-class sodium glucose co-transporter 2 (SGLT2) inhibitor, dapagliflozin, with existing type 2 diabetes mellitus (T2DM) treatment options available within the European Union (EU) for add-on therapy to sulfonylureas (SUs). Methods A systematic review was conducted to identify randomised controlled trials (RCTs) in T2DM patients inadequately controlled by SU monotherapy. Direct meta-analysis, Bucher indirect comparisons and Bayesian network meta-analysis (NMA) were conducted on studies meeting predefined inclusion criteria. Sufficient data were available to assess three clinical endpoints at 24 (+/- 6) weeks follow-up: mean change in HbA1c from baseline, mean change in weight from baseline, and the proportion of patients experiencing at least one episode of hypoglycaemia. The effect of confounding baseline factors was explored through covariate analyses. Results The search identified 1,901 unique citations, with 1,870 excluded based on title/abstract. From reviewing full-texts of the remaining 31 articles, 5 studies were considered eligible for analysis. All studies were comparable in terms of baseline characteristics, including: HbA1c, age and body mass index (BMI). In addition to dapagliflozin, sufficient data for meta-analysis was available for three dipeptidyl peptidase-4 (DPP-4) inhibitors and one glucagon-like peptide-1 (GLP-1) analogue. Based on fixed-effect NMA, all treatment classes resulted in statistically significant decreases in HbA1c at follow-up compared to placebo. Dapagliflozin treatment resulted in significantly decreased weight at follow-up compared to placebo (-1.54 kg; 95% CrI -2.16, -0.92), in contrast to treatment with GLP-1 analogues (-0.65 kg; 95% CrI -1.37, 0.07) and DPP-4 inhibitors (0.57 kg; 95% CrI 0.09, 1.06). The odds of hypoglycaemia were similar to placebo for dapagliflozin and DPP-4 inhibitor add-on treatment, but significantly greater than placebo for GLP-1 analogue add-on treatment (10.89; 95% CrI 4.24, 38.28). Assessment of NMA model heterogeneity was hindered by the small size of the network. Conclusions Dapagliflozin, DPP-4 inhibitors and GLP-1 analogues, in combination with SU, all provided better short-term glycaemic control compared to SU monotherapy. Dapagliflozin was the only add-on therapy that had both a favourable weight and hypoglycaemia profile compared to the other classes of treatment evaluated.

Recent changes in diabetes treatment guidelines and the introduction of new, more expensive pharmaceuticals appear to increase the financial challenges for nonelderly adults with diabetes. The authors used Medical Expenditure Panel Survey data to examine changes in the prevalence of diabetes and comorbidities, diabetes treatment, financial burdens, and the relationship between high financial burdens and patient characteristics. From 1997-1998 to 2006-2007, the total number of nonelderly adults treated for diabetes nearly doubled, from 5.4 to 10.7 million, and the proportion of diabetes patients using multiple drugs to treat their condition increased significantly. About a fifth of diabetes patients spent 10% or more of their family income on health care, and about one in nine spent 20% or more of their family income on health care. In 2006-2007, diabetes patients who were older, female, in poor health, or lacked insurance were more likely than others to have high burdens.

Objectives: To estimate the prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolaemia in an Angolan population aged 15 to 64 years and to determine relationships with sociodemographic, behavioural and anthropometric characteristics. Methods: A total of 2 354 individuals were assessed for behavioural, sociodemographic and physical characteristics in a cross-sectional, community-based survey. Post-stratification survey weights were applied to obtain prevalence levels. Adjusted odds ratios for each variable related to the conditions were calculated using logistic regression models. Results: Overall, the prevalence of hypertension was 18.0%, diabetes 9.2% and hypercholesterolaemia 4.0%. Among hypertensive individuals, the awareness rate was 48.5%; 15.8% were on treatment and 9.1% had their blood pressure controlled. Only 10.8% were aware they had diabetes, 4.5% were on treatment and 2.7% were controlled. The awareness level for hypercholesterolaemia was 4.2%, with 1.4% individuals on treatment and 1.4% controlled. Conclusion: The prevalence levels of hypertension and diabetes, which were higher than previous findings for the region, together with the observed low rates of awareness, treatment and control of all conditions studied, constitute an additional challenge to the regional health structures, which must rapidly adapt to the epidemiological shift occurring in this population. ; This study was funded by the promoters of the CISA as follows: Camões, Institute of Cooperation and Language, Portugal; Calouste Gulbenkian Foundation, Portugal; Government of Bengo Province, Angola; and the Angolan Ministry of Health. Also, the Eduardo dos Santos Foundation, Angola and the Institute of Public Health of the University of Porto, Portugal (ref UID/DTP/04750/2013) funded this study. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Abstract Background The objective of this review was to describe and situate the burden and treatment of diabetes within the broader context of the French health care system. Methods Literature review on the burden, treatment and outcomes of diabetes in France, complemented by personal communication with with diabetes experts in the Paris public hospital system. Results Prevalence of diabetes in the French population is estimated at 6%. Diabetes has the highest prevalence among all chronic conditions covered 100% by France's statutory health insurance (SHI), and the number of covered patients has doubled in the past 10 years. In 2010, the SHI cost for pharmacologically-treated diabetes patients amounted to €17.7 billion, including an estimated €2.5 billion directly related to diabetes treatment and prevention and €4.2 billion for treatment of diabetes-related complications. In 2007, the average annual SHI cost was €6 930 for patients with type 1 diabetes and €4 890 for patients with type 2 diabetes. Complications are associated with significantly increased costs. Diabetes is a leading cause of adult blindness, amputation and dialysis in France, which also has one of the highest rates of end-stage renal disease in Europe. Cardiovascular disease is the leading cause of death among people with diabetes. Historically, the French health care system has been more oriented to curative acute care rather than preventive medicine and management of long-term chronic diseases. More recently, the government has focused on primary prevention as part of its national nutrition and health program, with the goal of reducing overweight and obesity in adults and children. It has also recognized the critical role of the patient in managing chronic diseases such as diabetes and has put into place a free patient support program called "sophia". Additional initiatives focus on therapeutic patient education (TPE) and the development of personalized patient pathways. Conclusions While France has been successful in protecting patients from the financial consequences of diabetes through its SHI coverage, improvements are necessary in the areas of prevention, monitoring and reducing the incidence of complications. Systemic changes must be made to improve the coordination and delivery of chronic care.