N. Kleefstra

Intraperitoneal insulin infusion: treatment option for type 1 diabetes resulting in beneficial endocrine effects beyond glycaemia.

Continuous intraperitoneal insulin infusion (CIPII) is a treatment option for patients with type 1 diabetes mellitus who fail to reach adequate glycaemic control despite intensive subcutaneous (SC) insulin therapy. CIPII has clear advantages over SC insulin administration in terms of pharmacokinetic and pharmacodynamic properties and has been shown to improve glycaemic regulation. Due to the delivery of insulin predominantly in the portal vein, as opposed to systemically, CIPII offers a unique research model to investigate the effects of insulin on endocrine and metabolic parameters in vivo. The aim of the present article is to provide an overview of the literature with respect to the effects of CIPII on glucose management, quality of life, complications and costs, with additional focus on metabolic and endocrine aspects. Finally, future use and research objectives are discussed.

Management of Hyperglycemia in Type 2 Diabetes, 2015

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a joint task force that examined the evidence on blood glucose–lowering therapy in adults with type 2 diabetes and published a position statement (1). Recently, these recommendations were updated and published in the January 2015 issue of the journal (2).nnThe ADA/EASD recommendations are postulated as being …

Healthcare reimbursement costs of children with type 1 diabetes in the Netherlands, a observational nationwide study (Young Dudes-4)

BackgroundType 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in children. Studies on costs related to T1DM are scarce and focused primarily on the costs directly related to diabetes. We aimed to investigate both the overall healthcare costs and the more specific costs related to the management of diabetes.MethodsThis is a retrospective and observational, nationwide cohort study of all Dutch children (aged 0–18xa0years) with T1DM. Data were collected from the national registry for healthcare reimbursement, in which all Dutch insurance companies combine their reimbursement data. In the Netherlands for all Dutch citizens health care is covered by law and all children are treated by hospital-based paediatricians.ResultsWe analysed 6710 children distributed over 81 hospitals: 475 children in 6 university hospitals and 6235 children in 75 general hospitals. Total reimbursement for all children with T1DM over the period 2009 to 2011 was € 167,494,732 corresponding to an annual mean of € 55,831,577 of total costs and € 8326 euros per child. When comparing small (between 26 and 54 patients), medium (57–84 patients) and large (88–248 patients) general hospitals, costs per patient were highest in the hospitals with the highest number of T1DM patients. The costs for devices, secondary care and pharmaceutics had most impact on total expenditures. Over the study period, there was a slight decrease in per person costs.ConclusionThe overall health expenditure of a child with T1DM is more than € 8000 per patient per annum. Given the move towards more device-intensive multidisciplinary care for these patients, the costs of treating T1DM in children are likely to increase further in the coming years.

De nieuwe NHG-standaard en het behalen van HbA1cstreefwaarden bij insulinegebruikers (ZODIAC-51)

SamenvattingDoelHet inzichtelijk maken van de effecten van de nieuwe NHG-standaard op het behalen van de HbA1c-streefwaarden bij patiënten met type 2-diabetes die worden behandeld met insuline.OpzetCross-sectionele cohortstudie.MethodeVoor de huidige studie werden alle patiënten geïncludeerd die in 2010 deelnamen aan de ZODIAC-studie − een prospectieve observationele cohortstudie van eerstelijnspatiënten met type 2-diabetes − en ten minste één jaar werden vervolgd (n = 55724). Er werd alleen gebruikgemaakt van beschrijvende statistiek.ResultatenVan de gehele studiepopulatie (n = 55.724) werden in 2010 2.140 (3,8%) patiënten behandeld met een eenmaal daags insulineregime, en 3.957 patiënten (7,1%) met een twee- tot viermaal daags insulineregime. Het toepassen van het nieuwe algoritme betekende voor de patiënten met een eenmaal daags insulineregime een toename van het percentage dat de streefwaarde haalde van 37,3% naar 70,8%. Voor de patiënten met een intensiever regime steeg dit percentage van 40,3% naar 71,6%.ConclusieWij concluderen dat het toepassen van het nieuwe algoritme, op basis van een meer evidence-based benadering van het vaststellen van streefwaarden, tot gevolg heeft gehad dat het percentage insulinegebruikers die de streefwaarde behaalde bijna is verdubbeld.