Tag Archives: Endocrinology

Age 40+ With Diabetes Should Be a Priority for the COVID-19 Vaccine | Instant News


People with type 2 diabetes as young as 40 face a disproportionately increased risk of dying from COVID-19 infection, suggesting a British analysis of three large-scale data sets highlighting the need to prioritize vaccination in younger groups of vulnerable patients.

Research it published February 8 in the journal Diabetology.

Most European countries have prioritized COVID-19 vaccination for people with type 2 diabetes, but usually only age 50 and over. However, data from the current study suggest that this age limit should be lowered.

“It is important to remember that the risk of dying from COVID-19 in middle-aged people with diabetes is very low in absolute terms compared to the elderly,” said lead researcher Andrew P. McGovern, MD, of Royal Devon & Exeter Hospital, Exeter. , United Kingdom, in a press release from its agency.

However, he said that “strategies for determining priority groups for vaccination must take into account the disproportionate relative risk of COVID-19 death in middle-aged people with type 2 diabetes whose risk of COVID-19 has already increased with their age.”

McGovern informed Medscape Medical News that the magnitude of the effect of type 2 diabetes on deaths from COVID-19 is “absolutely shocking” about the new findings, and “not what you expected.”

Therefore, he said it was imperative that diabetics be put “in line” to get the vaccine “in the right place, and clearly in countries where vaccine rollout will be slower, it is more important.”

Bridget Turner, director of policy and improvement campaigns at Diabetes UK, which funded the study, said the results provide “important new insights into how much type 2 diabetes adds to the overall risk of dying from coronavirus at different ages, particularly the additional risk of that condition. increases in middle age. “

“The UK has made good progress in prioritizing those most vulnerable for vaccination, which includes all adults with diabetes,” he added in a press release, “but we need to continue to work with pace to identify and protect those people at a greater level. high risk. “

The Relationship Between COVID-19 Death and Diabetes Is Complex

The authors note that the association between COVID-19-related death and type 2 diabetes is not only a “co-effect of diabetes and age-related risk” but appears to be a “more complex” relationship, with “a disproportionately higher relative risk of excess relative risk.” death in young people with diabetes. “

To investigate this, they examined data from two UK population-based studies that previously reported age-specific hazard ratios for diabetes-related COVID-19 deaths:

  • Open safely, which includes 17.2 million people, 8.8% of whom have diabetes, and has an overall 90-day mortality rate of 0.06%.

  • QCOVID, comprising 6 million people, of whom 7% had diabetes, and had an overall 97-day mortality rate of 0.07%.

The team also looked at data from type 2 diabetes patients with severe COVID-19 from the COVID-19 Hospitalization in England Surveillance System (CHESS), which contained 19,256 patients were admitted to critical care in the UK, 18.3% of whom had diabetes.

The 30-day hospital mortality rate in this study was 26.4%.

They translated the death hazard ratio associated with COVID-19 infection in diabetics to “COVID-19 age,” which equates to additional years of “risk of death” added to the individual’s chronological age if diabetes is present.

Taking the QCOVID dataset as an example, the results showed that the diabetes-related “COVID age” for someone aged 40 was 20.4 years; which would indicate that “the risk of death [for COVID-19] similar to a 60 year old without diabetes. “

The impact of diabetes on the risk of death from COVID-19 decreases with age, so that diabetic patients aged 50 have COVID-19 aged 16.4 years. This drops to 12.1 years in someone who is 60, and 8.1 years in someone who is 70, meaning the latter has the same risk of dying from COVID-19 as someone without diabetes who is 78 years old.

Similar results were obtained when the team looked at data from the OpenSAFELY study.

But when they looked at the effect of diabetes on the risk of dying from COVID-19 in the CHESS data set, it was less visible..

Just Looking At Diabetes Is Too Simple, But It’s An Easy Marker For Vaccination

The investigators acknowledge that “only considering age and diabetes status when assessing COVID-19-related risk … is an oversimplification,” because factors such as body mass index (BMI), diabetes duration, and glycemic control are also known to play an important role. authority.

However, they said consideration of these factors was “impractical for vaccine rollout at the population level.”

“The time-critical nature of the COVID-19 vaccination population requires pragmatic group level priority, which is the approach initiated by the government so far,” the team concluded.

This study was supported by Diabetes UK. Study author John M. Dennis was supported by an Independent Fellowship funded by the Research England’s Expanding Excellence in England (E3) fund and by the NIHR Exeter Clinical Research Facility. McGovern is supported by the NIHR Exeter Clinical Research Facility.

Diabetology. Published online February 8, 2021. Full text

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Dexcom G6 Glucose Monitor for Diabetes Cost-Effective in UK | Instant News


Wider use of the UK’s real-time Dexcom G6 continuous glucose monitoring system (RT-CGM) would be cost-effective in the long term, new research suggests.

The analysis is published in the October issue Diabetes Care. The lead author of this article is Stéphane Roze, chief executive of the Vyoo Agency (formerly HEVA HEOR), which conducts a medical cost-effectiveness analysis.

The UK’s National Institute for Health and Care Excellence (NICE) allows real-time use of CGM for people who have it type 1 diabetes who experience it is often severe hypoglycemiahypoglycemia, extreme fear of hypoglycemia, or A1c levels> 9.0% (75 mmol / mol) despite frequent self-monitoring of blood glucose (SMBG).

Up to 25% of people with type 1 diabetes in the United Kingdom meet at least one of these criteria. However, funding is limited, and paying for it yourself is common.

“For type 1 diabetes patients based in the UK, the G6 RT-CGM device was associated with a significant improvement in clinical outcomes and, over the patient’s lifetime, is a cost-effective disease management option relative to SMBG on the basis of a willingness to pay threshold of GBP 20,000 [USD 26,032] per QALY [quality-adjusted life year] obtained, “wrote Roze and colleagues.

Asked for comment, Partha Kar, MD, national special adviser, diabetes, at the UK’s National Health Service (NHS), called the new data “welcome news, and will hopefully help as NICE is currently reviewing evidence surrounding Dexcom.”

Today, says Kar, more people in the UK are using the cheaper 14-day Abbott Libre FreeStyle “flash” glucose monitoring system. The first version of the system, approved in Europe in 2014, did not include alarms for high and low glucose levels. A newer version with an optional alarm, Libre 2, Approved in 2018 but not yet available in the UK. A newer version, Libre 3, recently cleaned for use in Europe.

According to Kar, Libre 2 will arrive in the UK in early 2021. “The NHS is happy to welcome it, when it arrives. We hope Libre 3 will follow soon after,” he said.

New data suggest that Libre may have competition in the UK.

CGM Dexcom Meets the Desire-to-Pay Threshold

The analysis by Roze and colleagues was performed using validated computer simulations that project long-term outcomes for patients with type 1 or type 2 diabetes, including cardiovascular, ophthalmic, and renal complications, as well as peripheral neuropathy, leg ulcers, amputations, and hypoglycemic events.

Patient data used in the model comes from previous data DIAMOND trial, which includes 158 people with type 1 diabetes who received it several times a day insulin injection. The patients were randomly assigned to RT-CGM or SMBG (mean 4.6 tests / day) for 24 weeks. The mean age of the patients was 48 years, the mean duration of diabetes was 20 years, and the mean A1c level was 8.6% (70 mmol / L).

Based on the DIAMOND results, the cost-effectiveness analysis assumes an average A1c reduction of 1.0 percentage points with RT-CGM, vs 0.4 with SMBG. The rate of severe hypoglycemia was 4.2, vs 12.2 per 100 patient years.

This result translates to a 1.49 increase in mean increase in QALYs for RT-CGM compared to SMBG (11.47 vs 9.99).

Over lifetime, this means total average cost was £ 14,234 higher with RT-CGM (£ 102,468 vs £ 88,234), resulting in an additional cost-effectiveness ratio (ICER) of £ 9,558 per QALY earned for RT-CGM vs SMBG.

Most of the higher costs were attributable to the RT-CGM system itself, but savings resulted from improvements in the long-term reduction in complications and hypoglycemic events. At the willingness to pay threshold of £ 20,000, the likelihood that RT-CGM would be considered cost-effective was around 99%.

In a secondary analysis of patients with baseline A1c ≥8.5% (69 mmol / L; mean, 9.1% per 76 mmol / L), use of RT-CGM was associated with an increase of 1.39 QALYs compared to SMBG, and the total lifetime cost on average is £ 13,176 higher than that of SMBG, resulting in an ICER of £ 9,478 / QALY and a 98% probability of being considered cost effective.

“The findings presented here indicate that RT-CGM improves long-term yield relative to SMGD and that initial acquisition costs are at least partially offset by savings due to a reduction in the incidence of long-term complications,” Roze and colleagues wrote.

The sensitivity analysis, they said, “revealed that RT-CGM was most cost-effective in the group of patients who met the NICE eligibility criteria for RT-CGM, in particular, those with high A1c at baseline, FoH. [fear of hypoglycemia], often SHE [severe hypoglycemia episodes], and the use of high-level SMGD. “

The G6 May Be More Cost Effective Than the G4 Used in Diamond Testing

The authors also suggest that the findings may be conservative, as the RT-CGM used in the DIAMOND trial was the older Dexcom G4.

That system has been replaced by the G6, which incorporates an “as soon as possible” warning that allows the user to take action to prevent hypoglycemia.

“It is therefore plausible that the effect of treatment in this analysis in terms of the incidence rate of hypoglycemic, and potentially also FoH. [fear of hypoglycemia], in patients using RT-CGM may have been underestimated, “write the authors.

“The findings presented here provide valuable information to UK-based payers and policymakers regarding the cost-effectiveness of RT-CGM in T1D. [type 1 diabetes], “they concluded.

The study was funded by Dexcom, which paid Roze’s company for the analysis. Kar did not disclose the relevant financial relationships.

Diabetes Care. October 2020; 43: 2411-2417. Abstract

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