[Medication use in diabetes mellitus (VI). Economics and effectiveness of insulin and sulfonyl-urea combination therapy compared with conventional two daily doses].
BACKGROUND
To compare the cost and effectiveness of bedtime intermediate-acting insulin and daytime-sulfonylurea (SU) combination therapy versus the conventional two-daily-dose insulin treatment.


METHODS
A pharmacoeconomical analysis of cost minimization. To prove a similar effectiveness a transversal prospective study was carried out. Patients recently converted to insulin due to oral hypoglycaemic agents failure were recruited. Entry criteria were: age > 40 years-old, more than 3 and 1 years of diagnosed diabetes and follow-up, respectively, current BMI between 20-40 kg/m2, baseline HbA1c > 8.5% and fasting C-peptide > 0.3 nmol/l. BMI, HbA1c, hypoglycaemic crisis, insulin and SU (glicazide and glibenclamide) daily dose were recorded, estimating the cost of both therapies.


RESULTS
Sixty-five patients (23 male), 32 in combined therapy (mean daily dose of insulin 19.5 U and 2.4 SU tb t.i.d.) and 33 patients with a two-insulin-injection regimen (38.4 U) were treated during a follow-up period of 2.4 years. The two groups exhibited similar mean age (67.8/67.7y), known diabetes duration (15.9/15.1y), BMI (28.9/28.8/kg/m2), previous HbA1c (8.9/9.1%) and fasting C-peptide (1.6/1.2 nmol/l). No statistical differences in BMI increase (1/1.4 kg/m2), neither in mean HbA1c (7.8/7.9%) nor severe hypoglycaemic crisis (0.03/0.17 episodes/year) were evidenced. Patients in combined therapy reported a lower number of mild hypoglycaemic crisis (0.7/1.9 episodes/month; p < 0.01) and the daily cost was significantly lower (94.5/134.3 ptas./day; p < 0.0001).


CONCLUSIONS
Both therapies, two-insulin-injection regimen and insulin and sulfonylurea combination therapy were similarly effective in having an acceptable glycaemic control with similar risk for weight gain or severe hypoglycaemia. Combined therapy was more cost-effective and well-tolerated, thus, comfort and a lower risk of mild hypoglycaemic episodes were evidenced.
Costa
B
B
Unitat de Diabetis, Hospital de Móra d'Ebre, Tarragona. bcosta@tinet.fut.es
Estopá
A
A
Borrás
J
J
Sabaté
A
A
D015992:Body Mass Index; D017281:Cost of Illness; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D013453:Sulfonylurea Compounds / Q000627:therapeutic use*
D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds
Consumo de medicación en la diabetes mellitus (VI). Economía y efectividad de la terapia combinada con insulina y sulfonilureas sobre la administración convencional con dos dosis.