RESUMO
INTRODUCTION: FreeStyle Libre® 2 system is a sensor-based flash-monitoring system that measures interstitial fluid glucose. The study aimed to compare cost of FreeStyle Libre 2 system and self-monitoring of blood glucose (SMBG) in the type 2 diabetes mellitus (T2DM) population from the Spanish Health System perspective. METHODS: On the basis of data collected from a literature review, the cost of glucose monitoring was modelled for patients with T2DM on a basal-bolus insulin regimen. The cost estimate included annual consumption for glucose monitoring (strips, lancets and sensors) and severe hypoglycaemic events (SHE) management. A published rate of SHE (2.5 episodes/patient-year) was considered. A reduction of SHE (- 48.8%) associated with FreeStyle Libre 2 system, derived from the REPLACE trial, was applied. Hospital attendance for 20.5% of SHEs (with subsequent hospitalization in 16.0%) was applied. Consumption of strips and lancets was set at 6/day for SMBG (derived from national monitoring recommendations), and 0.2/day for FreeStyle Libre 2 system users, with 26 FreeStyle Libre 2 sensors/year. Unitary costs (, year 2020 excluding VAT) were derived from literature (0.28/strip; 0.09/lancet; 3.09/daily FM sensor; 3804/hospitalized SHE; 1794/hospital-attended non-admitted SHE; 389/community-attended SHE). RESULTS: Costs were 2700 and 2120/year/patient using SMBG or FreeStyle Libre 2 system, respectively. For 1000 patients with T2DM using basal-bolus insulin, 1220 SHEs/year (with 48 hospitalizations) could be prevented and FreeSytle Libre 2 system could generate cost savings of up to 580,953/year versus SMBG (- 21.5%). CONCLUSION: FreeStyle Libre 2 system is a potential cost-saving strategy in patients with T2DM in Spain on a basal-bolus insulin regimen.
RESUMO
Objetivo: Pilotar una actividad profesional consistente en la detección de personas en riesgo de padecer diabetes o alteraciones del metabolismo de los hidratos de carbono y derivación para posible diagnóstico en los centros de salud. Comprobación del número de diagnósticos y evaluación del coste para la farmacia. Métodos: Estudio observacional transversal en farmacias comunitarias de Pontevedra en septiembre-octubre de 2014. Cuestionario Findrisc a usuarios de la farmacia con más de 18 años. Con Findrisc ≥ 15 determinación de la glucemia basal capilar y derivación al médico con ≥ 110mg/dL. Variables principales: puntos en cuestionario Findrisc, número de diagnósticos de diabetes, coste del servicio. Las diferencias entre grupos se calcularon con el test de chi-cuadrado, t de Student o test de Wilcoxon. Resultados: El estudio se realizó en 180 farmacias. La muestra incluyó a 4.222 usuarios. De ellos, 992 (23,5%) tenían alto o muy alto riesgo de diabetes (F≥15). Se realizaron 1.060 test de glucemia basal capilar, con un resultado medio de 110,2 (DE=20,4)mg/dL (56-254). De los 384 (9,1%) sujetos derivados al médico, el Servicio Gallego de Salud envió información de 83: 28 (33,7%) diagnosticados de diabetes (3,1% de la muestra) y 26 (31,3%) de prediabetes (2,8%). El coste por sujeto diagnosticado fue de 184,22 € y por sujeto con diabetes o prediabetes fue de 96,86 €. Conclusiones: El número de diagnósticos de nuevos pacientes diabéticos, 3,1% de la muestra total, muestra la alta eficiencia de un programa de cribado para diabéticos ocultos realizado en farmacias comunitarias como el que aquí se presenta
Objective: The aim of this study was to detect people at risk of suffering diabetes or changes in carbohydrate metabolism and to refer them for possible diagnosis to health care centres. The number of diagnoses and costs for the pharmacy were recorded. Methods: A cross-sectional, observational study was conducted in community pharmacies in Pontevedra in September-October of 2014. The Findrisc questionnaire was completed by pharmacy users over 18 years old. If Findrisc score was ≥ 15, capillary blood glucose was measured, and the participant was referred to a physician if the value was ≥ 110mg/dL. The main variables included score in the Findrisc questionnaire, number of diabetes diagnosed, and cost of the service. Differences between the groups were calculated using a Chi-squared test, a Student's t test, and/or a Wilcoxon test. Results: This study was conducted in 180 pharmacies on a sample of 4,222 users, including 992 (23.5%) with a high or very high risk of diabetes (F≥15). In the 1,060 basal capillary blood glucose tests performed, mean glucose level was 110.2 (SD=20.4) mg/dL (56-254). The Galician Health Service sent information about 83 of the 384 (9.1%) subjects referred to a physician: 28 (33.7%) of them were diagnosed with diabetes (3.1% of the sample), and 26 (31.3%) were diagnosed with prediabetes (2.8% of the sample). Cost per diagnosed subject was €184.22 per subject with diabetes and €96.86 per subject with prediabetes. Conclusions: The proportion of subjects with new diagnosis of diabetes (3.1%) shows the high efficiency of a screening program for hidden diabetics implemented at community pharmacies as the one presented here (AU)
Assuntos
Humanos , Diabetes Mellitus/epidemiologia , Índice Glicêmico , Glicemia/análise , Serviços Comunitários de Farmácia/estatística & dados numéricos , Diagnóstico Precoce , Suscetibilidade a Doenças/epidemiologia , Programas de Rastreamento/métodos , Fatores de RiscoRESUMO
OBJECTIVE: The aim of this study was to detect people at risk of suffering diabetes or changes in carbohydrate metabolism and to refer them for possible diagnosis to health care centres. The number of diagnoses and costs for the pharmacy were recorded. METHODS: A cross-sectional, observational study was conducted in community pharmacies in Pontevedra in September-October of 2014. The Findrisc questionnaire was completed by pharmacy users over 18 years old. If Findrisc score was ≥ 15, capillary blood glucose was measured, and the participant was referred to a physician if the value was ≥110mg/dL. The main variables included score in the Findrisc questionnaire, number of diabetes diagnosed, and cost of the service. Differences between the groups were calculated using a Chi-squared test, a Student's t test, and/or a Wilcoxon test. RESULTS: This study was conducted in 180 pharmacies on a sample of 4,222 users, including 992 (23.5%) with a high or very high risk of diabetes (F≥15). In the 1,060 basal capillary blood glucose tests performed, mean glucose level was 110.2 (SD=20.4)mg/dL (56-254). The Galician Health Service sent information about 83 of the 384 (9.1%) subjects referred to a physician: 28 (33.7%) of them were diagnosed with diabetes (3.1% of the sample), and 26 (31.3%) were diagnosed with prediabetes (2.8% of the sample). Cost per diagnosed subject was 184.22 per subject with diabetes and 96.86 per subject with prediabetes. CONCLUSIONS: The proportion of subjects with new diagnosis of diabetes (3.1%) shows the high efficiency of a screening program for hidden diabetics implemented at community pharmacies as the one presented here.
Assuntos
Serviços Comunitários de Farmácia/organização & administração , Diabetes Mellitus/diagnóstico , Estudos Transversais , Diabetes Mellitus/epidemiologia , Humanos , Espanha , Inquéritos e QuestionáriosRESUMO
Introducción: Una optimización de la atención a las personas con diabetes pasa por la incorporación de las tecnologías de la información y la comunicación a un modelo de cuidados crónicos. Objetivos: Determinar el desarrollo de la historia clínica electrónica relacionada con la diabetes en las distintas Comunidades Autónomas de España. Material y métodos: Estudio observacional, descriptivo y de naturaleza transversal, dirigido a analizar las características de los sistemas de registro utilizados en la atención a la población con diabetes en el ámbito de la atención primaria. Resultados: Se observa una gran variabilidad entre Comunidades Autónomas, tanto en el tipo de registros relacionados con la diabetes como en su explotación, destacando por su mayor implementación un grupo de Comunidades (Navarra, Aragón, Asturias, País Vasco, Comunidad Valenciana y Cataluña). Conclusiones: Existe una importante heterogeneidad en la calidad de los registros relacionados con la diabetes utilizados en atención primaria, en su distribución regional, con amplias posibilidades de mejora(AU)
Introduction: Optimising care for people with diabetes goes through the incorporation of information and communication technology to a chronic care model. Objectives: To determine the development of electronic medical records related to diabetes in different regions of Spain. Material and methods. Observational, descriptive and cross-sectional study, aimed at analysing the characteristics of the recording systems used in the care of people with diabetes in Primary Care settings. Results: There is a wide variability between regions, both in the type of records related to diabetes and in their operation, with its greater implementation in a group Communities (Navarra, Aragon, Asturias, Basque Country, Valencia and Catalonia) being noteworthy. Conclusions: There is significant heterogeneity in the quality of diabetes-related records used in Primary Care, their regional distribution, with ample room for improvement(AU)
