Irina Odnoletkova

Optimizing diabetes control in people with Type 2 diabetes through nurse-led telecoaching

To study the effect of a target‐driven telecoaching intervention on HbA1c and other modifiable risk factors in people with Type 2 diabetes.

Cost-Effectiveness of Therapeutic Education to Prevent the Development and Progression of Type 2 Diabetes: Systematic Review

Objective: To update current evidence on the cost-effectiveness (CE) of therapeutic education in prediabetes and type 2 diabetes. Research design and methods: A systematic review of economic evaluations of therapeutic education in prediabetes and type 2 diabetes, based on Randomized Controlled Trials (RCTs) and published in 2002 - 2014. The quality of the clinical evidence was appraised through the Cochrane Collaboration’s tool for assessing risk of bias. Economic studies were evaluated through the Consensus Health Economic Criteria List. The Incremental Cost- Effectiveness Ratios (ICERs) of patient education in prediabetes and type 2 diabetes were compared. Results: Out of 2031 identified publications, eight studies on prediabetes and nine on type 2 diabetes met the inclusion criteria. The level of the underlying clinical evidence was overall high in studies on prediabetes and varied in studies on type 2 diabetes. The mean ICER (95% CI) from the perspective of the healthcare system was €18,000 per QALY (range from dominance to €49,700) in prediabetes and €29,700 (range from €9,100 to €50,300) per QALY in type 2 diabetes. General flaws in the economic evaluations were short time horizons, limited uncertainty analysis and a lack of transparency in the modeling methods. Conclusions: The number of economic evaluations of patient education in prediabetes and type 2 diabetes has been growing in the past years. Our review compares the health economic evidence on therapeutic education for both conditions. The findings suggest that offering therapeutic education already in prediabetes stage may be a better value for money than postponing it till after the diagnosis. More robust methodologies in health economic evaluations are essential in further evidence generation.

Nurse-led telecoaching of people with type 2 diabetes in primary care: rationale, design and baseline data of a randomized controlled trial.

BackgroundDespite the efforts of the healthcare community to improve the quality of diabetes care, about 50% of people with type 2 diabetes do not reach their treatment targets, increasing the risk of future micro-and macro-vascular complications. Diabetes self-management education has been shown to contribute to better disease control. However, it is not known which strategies involving educational programs are cost-effective. Telehealth applications might support chronic disease management. Transferability of successful distant patient self-management support programs to the Belgian setting needs to be confirmed by studies of a high methodological quality. “The COACH Program” was developed in Australia as target driven educational telephone delivered intervention to support people with different chronic conditions. It proved to be effective in patients with coronary heart disease after hospitalization. Clinical and cost-effectiveness of The COACH Program in people with type 2 diabetes in Belgium needs to be assessed.Methods/DesignRandomized controlled trial in patients with type 2 diabetes. Patients were selected based on their medication consumption data and were recruited by their sickness fund. They were randomized to receive either usual care plus “The COACH Program” or usual care alone. The study will assess the difference in outcomes between groups. The primary outcome measure is the level of HbA1c. The secondary outcomes are: Total Cholesterol, LDL-Cholesterol, HDL-Cholesterol, Triglycerides, Blood Pressure, body mass index, smoking status; proportion of people at target for HbA1c, LDL-Cholesterol and Blood Pressure; self-perceived health status, diabetes-specific emotional distress and satisfaction with diabetes care. The follow-up period is 18 months. Within-trial and modeled cost-utility analyses, to project effects over life-time horizon beyond the trial duration, will be undertaken from the perspective of the health care system if the intervention is effective.DiscussionThe study will enhance our understanding of the potential of telehealth in diabetes management in Belgium. Research on the clinical effectiveness and the cost-effectiveness is essential to support policy makers in future reimbursement and implementation decisions.Trial registrationBelgian number: B322201213625. ClinicalTrials.gov Identifier: NCT01612520

Delivering Diabetes Education through Nurse-Led Telecoaching. Cost-Effectiveness Analysis.

Background People with diabetes have a high risk of developing micro- and macrovascular complications associated with diminished life expectancy and elevated treatment costs. Patient education programs can improve diabetes control in the short term, but their cost-effectiveness is uncertain. Our study aimed to analyze the lifelong cost-effectiveness of a nurse-led telecoaching program compared to usual care in people with type 2 diabetes from the perspective of the Belgian healthcare system. Methods The UKPDS Outcomes Model was populated with patient-level data from an 18-month randomized clinical trial in the Belgian primary care sector involving 574 participants; trial data were extrapolated to 40 years; Quality Adjusted Life Years (QALYs), treatment costs and Incremental Cost-Effectiveness Ratio (ICER) were calculated for the entire cohort and the subgroup with poor glycemic control at baseline (“elevated HbA1c subgroup”) and the associated uncertainty was explored. Results The cumulative mean QALY (95% CI) gain was 0.21 (0.13; 0.28) overall and 0.56 (0.43; 0.68) in elevated HbA1c subgroup; the respective incremental costs were €1,147 (188; 2,107) and €2,565 (654; 4,474) and the respective ICERs €5,569 (€677; €15,679) and €4,615 (1,207; 9,969) per QALY. In the scenario analysis, repeating the intervention for lifetime had the greatest impact on the cost-effectiveness and resulted in the mean ICERs of €13,034 in the entire cohort and €7,858 in the elevated HbA1c subgroup. Conclusion Taking into account reimbursement thresholds applied in West-European countries, nurse-led telecoaching of people with type 2 diabetes may be considered highly cost-effective within the Belgian healthcare system. Trial registration NCT01612520

A guide for the application of analytics on healthcare processes

OBJECTIVE The aim of this study is to guide healthcare instances in applying process analytics on healthcare processes. Process analytics techniques can offer new insights in patient pathways, workflow processes, adherence to medical guidelines and compliance with clinical pathways, but also bring along specific challenges which will be examined and addressed in this paper. METHODS The following methodology is proposed: log preparation, log inspection, abstraction and selection, clustering, process mining, and validation. It was applied on a case study in the type 2 diabetes mellitus domain. RESULTS Several data pre-processing steps are applied and clarify the usefulness of process analytics in a healthcare setting. Healthcare utilization, such as diabetes education, is analyzed and compared with diabetes guidelines. Furthermore, we take a look at the organizational perspective and the central role of the GP. This research addresses four challenges: healthcare processes are often patient and hospital specific which leads to unique traces and unstructured processes; data is not recorded in the right format, with the right level of abstraction and time granularity; an overflow of medical activities may cloud the analysis; and analysts need to deal with data not recorded for this purpose. These challenges complicate the application of process analytics. It is explained how our methodology takes them into account. CONCLUSION Process analytics offers new insights into the medical services patients follow, how medical resources relate to each other and whether patients and healthcare processes comply with guidelines and regulations.

Effectiveness of nurse-led telecoaching in optimising diabetes control: results of a randomised controlled trial in patients with type 2 diabetes

Abstracts of 51st EASD Annual Meetings of 51st EASD Annual Meeting OP 01 Insulin analogues: Is newer always better?