The management of type 2 diabetes with fixed‐ratio combination insulin degludec/liraglutide (IDegLira) versus basal‐bolus therapy (insulin glargine U100 plus insulin aspart): a short‐term cost‐effectiveness analysis in the UK setting

Aim: To evaluate the cost‐effectiveness of IDegLira versus basal‐bolus therapy (BBT) with insulin glargine U100 plus up to 4 times daily insulin aspart for the management of type 2 diabetes in the UK. Methods: A Microsoft Excel model was used to evaluate the cost‐utility of IDegLira versus BBT over a 1‐year time horizon. Clinical input data were taken from the treat‐to‐target DUAL VII trial, conducted in patients unable to achieve adequate glycaemic control (HbA1c <7.0%) with basal insulin, with IDegLira associated with lower rates of hypoglycaemia and reduced body mass index (BMI) in comparison with BBT, with similar HbA1c reductions. Costs (expressed in GBP) and event‐related disutilities were taken from published sources. Extensive sensitivity analyses were performed. Results: IDegLira was associated with an improvement of 0.05 quality‐adjusted life years (QALYs) versus BBT, due to reductions in non‐severe hypoglycaemic episodes and BMI with IDegLira. Costs were higher with IDegLira by GBP 303 per patient, leading to an incremental cost‐effectiveness ratio (ICER) of GBP 5924 per QALY gained for IDegLira versus BBT. ICERs remained below GBP 20 000 per QALY gained across a range of sensitivity analyses. Conclusions: IDegLira is a cost‐effective alternative to BBT with insulin glargine U100 plus insulin aspart, providing equivalent glycaemic control with a simpler treatment regimen for patients with type 2 diabetes inadequately controlled on basal insulin in the UK

Empowerment-based education for established type 2 diabetes in rural England

People with newly-diagnosed type 2 diabetes are offered structured education, but there are few programmes for those with established diabetes. The empowerment-based education approach from the United States has been advocated as one approach that supports self-management, but is not used in England. The aim of this study was to assess the acceptability of empowerment-based diabetes education for patients with established type 2 diabetes. One 3.5-hour workshop was offered to participants joining a trial of peer support in rural Cambridgeshire, UK. Four main aspects of self-care (carbohydrates and portion size; truths and myths about diabetes; know your numbers and medications; keeping active and foot care) were addressed, followed by a question and answer session. Change in diabetes knowledge and participant perspectives were evaluated using questionnaires. Qualitative evaluation was by ethnographic observation of sessions. Patient expectations were met in 93.5% of participants. Aspects thought to be particularly useful related to diet and carbohydrates and also medications. Ethnography revealed five main themes: diet, group process, health service experience, within session peer support, and educator clinical grounding. Sixty percent of those participating increased their ability to answer diabetes knowledge-based questions. Adopting the ‘empowerment approach’ is a valid method of diabetes education for those with established type 2 diabetes in England. Delivery by experienced educators is important to address queries that arise during the sessions