Resource use and outcomes associated with initiation of injectable therapies for patients with type 2 diabetes mellitus

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Abstract

Introduction: Management of type 2 diabetes mellitus (T2DM) often requires intervention with oral and injectable therapies. Across National Health Service (NHS) England, injectable therapies may be initiated in secondary, intermediate or primary care. We wished to understand resource utilization, pathways of care, clinical outcomes, and experience of patients with T2DM initiated on injectable therapies.

Method: We conducted three service evaluations of initiation of injectable therapies (glucagon-like peptide1 receptor agonists (GLP-1 RAs) or basal insulin) for T2DM in primary, secondary and intermediate care. Evaluations included retrospective review of medical records and service administration; prospective evaluation of NHS staff time on each episode of patient contact during a 3-month initiation period; patient-experience survey for those attending for initiation. Data from each evaluation were analysed separately and results stratified by therapy type.

Results: A total of 133 patients were included across all settings; 54 were basal-insulin initiations. After initiation, the mean HbA1c level fell for both types of therapies, and weight increased for patients on basal insulin yet fell for patients on GLP-1 RA. The mean cost of staff time per patient per initiation was: £43.81 for GLP-1 RA in primary care; £243.49 for GLP-1 RA and £473.63 for basal insulin in intermediate care; £518.99 for GLP-1 RA and £571.11 for basal insulin in secondary care. Patient-reported questionnaires were completed by 20 patients, suggesting that patients found it easy to speak to the diabetes team, had opportunities to discuss concerns, and felt that these concerns were addressed adequately.

Keywords: diabetes, injectable therapies, outcomes,pPatient pathway, resource use, primary care, intermediate care, secondary care, service evaluation.

Abbreviations: AACE, American Association of Clinical Endocrinologists; ADA, American Diabetes Association; AfC, Agenda for Change; BMI, body mass index; DM, diabetes mellitus; GLP-1 RAs, glucagon-like peptide-1 receptor agonists; HbA1c, haemoglobin type A1c; HCPs, healthcare professionals; LVF, left ventricular failure; NHS, National Health Service; NICE, National Institute for Health and Care Excellence; T2DM, type 2 diabetes mellitus

Citation
Brice R, Shelley S, Chaturvedi P, Glah D, Ashley D, Hadi M. Resource use and outcomes associated with initiation of injectable therapies for patients with type 2 diabetes mellitus. Drugs in Context 2015; 4: 212269. doi: 10.7573/ dic.212269

Copyright
© 2015 Brice R, Shelley S, Chaturvedi P, Glah D, Ashley D, Hadi M. Distributed under the terms of the Creative Commons License Deed CC BY NC ND 3.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No other uses without permission.

Correct attribution
Copyright © 2015 Brice R, Shelley S, Chaturvedi P, Glah D, Ashley D, Hadi M. http://dx.doi.org/10.7573/dic.212269. Published by Drugs in Context under Creative Commons Attributions License Deed CC BY NC ND 3.0.

Article URL
https://www.drugsincontext.com/resource-use-outcomes-associated-initiation-injectable-therapies-patients-type 2-diabetes-mellitus

Correspondence
Dr Monica Hadi, pH Associates, Derwent House, Dedmere Road, Marlow SL71PG, UK.
monicahadi@phassociates.com

Provenance
Submitted, externally peer reviewed

Dates
Submitted: 26 November 2014
Accepted for publication, subject to peer review: 28 November 2014
Revised manuscript submitted: 19 December 2014
Accepted for publication: 5 January 2015
Publication date: 23 January 2015

Publisher & contact information
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