Incretins and SGLT-2i Therapy of Type 2 Diabetes – Real Life Study of Their Therapeutic and Economic Effects

AimIncretins [dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide 1 RA (GLP-1 RA)] and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) groups are now routinely used for type 2 diabetes therapy and comprise a large number of medicinal products. The long term therapeutic and economic effect of the incretins’ and SGLT-2i in real life setting is not well documented. The goal of the current study is to analyze the cost and results of incretins and SGLT-2i based therapy for type 2 diabetes in Bulgaria.MethodsThe study uses information about the changes in glycated hemoglobin (HbA1c) level from the National diabetes register for 6122 patients and cost paid by the National Health Insurance Fund (NHIF) for diabetes complications, and medicine prices.ResultsThe results show that after the therapy patients achieved excellent diabetes control. There were no HbA1c values less than 6% before treatment. After the therapy, 3356 people showed values less than 7% HbA1c. It is considered very good diabetic control. The number of people with HbA1c above 8% is decreasing significantly. The number of people with values above 9% is decreasing by almost four times. HbA1c level decreases with the highest percentage for the patients treated with GLP-1 RA, followed by those treated with DPP-4i and SGLT-2i. For a year NHIF reimbursed 5.25 million BGN for incretins and SGLT-2i therapy. NHIF can save between 306 and 510 thousand BGN from incidents that have not occurred as a result of 5 years of therapy.ConclusionIncretins [dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA)] and sodium-glucose linked transporter-2 inhibitors (SGLT-2i) therapy steadily decreases the HbA1c level, and risk of developing diabetic incidents is reduced to between 333 and 465 cases among 6122 treated patients. Avoided cost for therapy of diabetes incidents account for between 305 and 510 thousand BGN

ROLE OF LYMPHOCYTIC IMMUNOHISTOCHEMICAL MARKERS IN EARLY DIAGNOSIS OF PERIPHERAL T-CELL LYMPHOMA OF THE SKIN – MYCOSIS FUNGOIDES

Background: Mycosis fungoides (MF) is the most common type of primary cutaneous peripheral T-cell lymphoma. The diagnosis of early-stage MF is challenging due to its clinical and histological resemblance to a number of benign inflammatory dermatoses. Often an immunohistochemical phenotyping is required for the diagnosis. Purpose: To assess the diagnostic value of a panel of seven lymphocytic immunohistochemical markers (CD3; CD20; CD4; CD8; CD45RO; CD30; Bcl2) in the early diagnosis of MF. Material/Methods: Biopsies from 30 patients with confirmed early-stage MF were stained with lymphocytic markers: CD3; CD20; CD4; CD8; CD45RO; CD30; Bcl2. The epidermal and dermal expression in this group was compared with a control group of 30 cases of benign inflammatory dermatoses, which clinically resemble MF. Results: A statistically significant difference was found in the expression of CD3, CD4, CD8, CD45RO and Bcl2 in the epidermis between the two groups and the expression of CD3, CD4, CD8, CD45RO and CD30 in the dermal infiltrate. There was no statistically significant difference in the expression of CD20 and Bcl2 in the dermal infiltrate between the two groups. Conclusions: There is no single marker that has enough sensitivity and specificity to be used independently for the diagnosis of MF. High epidermal expression of CD3, CD4, and CD45RO by infiltrating lymphocytes is diagnostic for MF. The most sensitive marker for MF is the CD4/CD8 ratio in the dermal infltrate; it takes into account the statistically different expression of CD4 and CD8 in both groups

Integrating Patient-Related Entities Using Hospital Information System Data and Automatic Analysis of Free Text

Part 1: ConferenceInternational audienceThe article presents research in secondary use of information about medical entities that are automatically extracted from the free text of hospital patient records. To capture patient diagnoses, drugs, lab data and status, four extractors that analyse Bulgarian medical texts have been developed. An integrated repository, which comprises the extracted entities and relevant records of the hospital information system, has been constructed. The repository is further applied in experiments for discovery of adverse drug events. This paper presents the extractors and the strategy of assigning time anchors to the entities that are identified in the patient record texts. Evaluation results are summarised as well as application scenarios which make use of the extracting tools and the acquired integrated repository

Cross-Border Exchange of Clinical Data Using Archetype Concepts Compatible with the International Patient Summary.

peer reviewedThis paper proposes an approach and demonstrates its application for cross-border exchange of clinical documents oriented towards the use of archetype concepts and international patient summary standards adopted in the European Union. A novelty in this approach is the management of native XML instances of an archetype concept in the CEN 13606 standard by means of a native XML database and XML technologies. The computer experiments demonstrate that it is suitable for representing relatively small clinical datasets such as those describing rare diseases like the Acromegaly illness, where the semantic context in the relatively small number of symptoms is practicable to tag in terms of SNOMED-CT terminology codes. Additionally, we demonstrate that the semantically enriched information model can facilitate secondary use of clinical data by visualizing the execution of queries based on standard terminologies. Finally, the compatibility of the information model with the IPS standard enables sharing of clinical data among different information models