Patient outlook affects diabetes treatment benefits
medwireNews: The attitudes of patients with diabetes towards treatment burden may affect the overall benefits of tight glycaemic control, say researchers.
This was particularly the case for older patients, report Sandeep Vijan (Ann Arbor Veterans Affairs Hospital, Michigan, USA) and co-workers in JAMA Internal Medicine.
“We found that once moderate control of HbA1c level (9%) is achieved, patient views of the burdens of treatment are the most important factor in the net benefit of glucose-lowering treatments”, they write.
Therefore, high-quality treatment decisions are better achieved by looking at the overall balance of treatment benefit and perceived burden than purely by individualising HbA1c targets, says the team.
Vijan et al used a Markov simulation model to estimate the quality-adjusted life–years (QALYs) associated with diabetes treatment, balancing utility (reduction in diabetic complications and disease burden) against disutility (dislike of insulin treatment, adverse effects of oral therapies).
“Because we are challenging existing paradigms of treatment, we chose somewhat optimistic assumptions of the benefits of glycemic control”, the researchers note.
They found that, where disutility is very low (equivalent to 0.3 days of high-quality life lost per year), all age groups of patients made substantial gains from a reduction of HbA1c from 8.5% to 7.5%, ranging from 0.906 QALYs in a 45-year-old to 0.104 QALYs in a 75-year-old.
However, patient perception of treatment burden had a “profound” effect on the benefits of glycaemic control, reports the team. A high level of disutility, equivalent to 18.2 days of high-quality life lost per year, cancelled the QALY gains, even in the youngest age group.
The point at which perceived treatment burden began to outweigh treatment gains ranged from 3.65 to 18.2 days of high-quality life lost per year, with older age and lower starting HbA1c level reducing the amount of perceived treatment burden needed to counteract treatment gains.
Overall, however, perceived treatment burden had the largest effect on QALYs gained.
“Our findings provide further reason to favor evaluating diabetes medications with clinically relevant end points rather than HbA1c level alone”, comment Vijan and team.
Their study also generated estimated absolute risk reductions for a range of diabetic complications associated with starting oral antidiabetic treatment at diagnosis and switching to insulin after 10 years.
“These estimates of the potential benefits of HbA1c level reduction can provide clinicians a means of considering and balancing treatment benefits with the burdens of glucose-lowering treatments”, says the team.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014
By Eleanor McDermid, Senior medwireNews Reporter