Insulin glargine in a Brazilian State : an assessment of drug utilization, effectiveness and value to provide future direction

The cost and utilisation of the insulin analogue (Insulin glargine) has grown appreciably in the State of Minas Gerais in Brazil in recent years, with costs growing on average by 291% per year. This growth has been driven by an increasing number of successful law suits and a 536% price differential between insulin glargine and neutral protamine Hagedorn (NPH) insulin. One way forward to address concerns with its growing utilisation is to undertake a systematic review assessing the efficacy and safety of insulin glargine compared with NPH insulin in patients with Type I diabetes. As a result, provide published data to support future recommended activities by the State to limit its use

Crude corn oil with high acidity in broiler feed

This study aimed to evaluate crude corn oil with high acidity (CCOHA) as a surrogate for degummed soybean oil (DSO) in broiler diets. The design was completely randomized, with four treatments and ten replicates. Each box contained 40 birds (male), totaling 1600 Cobb Slow birds. Treatments consisted of two sorghum-based diets, one with DSO (SSO) another with CCOHA (SCO), and two corn-based diets, one with DSO (CSO) another with CCOHA (CCO). At 30 days of age, a digestibility test was performed using total excreta collection to determine apparent metabolizable energy (AME) and nitrogen-corrected AME (AMEn) from test rations. At 42 days of age, we evaluated live weight (LW), feed intake (FI), feed conversion (FC), carcass yield (CY), and the yields of breast with bone and skin (BWBS), skinless boneless breast (SBB), thigh (T), drumstick (D), and wing (W), as well as breast centesimal composition. Neither corn nor sorghum-based diets with CCOHA showed differences between AME and AMEn. Both DSO and CCOHA diets showed no differences in LW, FI, FC, carcass and cuts yields when using CCOHA. Regarding breast composition, no differences in dry matter and in the levels of crude protein, fat, and mineral matter were observed. We may conclude that CCOHA had no effect on the performance variables, carcass and cuts yields, and broiler meat quality

Authors’ reply to Dr. Malerbi: "Insulin glargine in a Brazilian state: should the government disinvest?"

Dear Editor, We thank Dr. Malerbi for his comments regarding the systematic review [1]: “Insulin Glargine in the Brazilian State: Should the Government Disinvest? An Assessment Based on a Systematic Review” [2]. In particular, we thank Dr. Malerbi for pointing out the recently published ORIGIN study [3] clarifying the situation regarding insulin glargine and its neutral effects on the development of cancer following the previous observations of Hemkens et al. and Jonasson et al. [4, 5]. This will be welcomed by patients. However, we were concerned by his comments that we “seem to have prepared their review with the primary motivation of justifying—both on administrative and juridical grounds—the denial from the government to dispense insulin analogues to those diabetic patients who need them”

Insulin glargine in a Brazilian state : should the government disinvest? an assessment based on a systematic review

Introduction and Objective: The costs of the insulin analogue (insulin glargine) have been growing appreciably in the State of Minas Gerais in Brazil, averaging 291 % per year in recent years. This growth has been driven by an increasing number of successful law suits and a 536 % price difference between insulin glargine and neutral protamine Hagedorn (NPH) insulin. One potential way to address this is to undertake a systematic review assessing the efficacy and safety of insulin glargine analogue compared with NPH insulin in patients with type 1 diabetes mellitus (T1DM), and, as a result, provide published data to support future recommended activities by the State of Minas Gerais. These could include maintaining it on the list of the Public Health System (SUS) provided there is a price reduction. Alternatively, the review could provide potential arguments to defend against future law suits should the authorities decide to delist insulin glargine. Methods: A systematic review of published studies researching the effectiveness of insulin glargine in patients with T1DM between January 1970 and July 2009 in MEDLINE (PubMed), the Latin American and Caribbean Centre on Health Sciences Information, the Cochrane Controlled Trials Databases and the National Health Service Centre for Reviews and Dissemination. Inclusion criteria included insulin glargine on its own or combined with other insulin formulations. Only randomised controlled clinical trials were included. Initially, the titles of all studies were assessed by two independent reviewers before being potentially discarded, with the quality of papers assessed using a modified Jadad scale. The outcome measures included blood levels of glycated haemoglobin, episodes of hypoglycaemia, adverse effects and the reduction of microvascular and macrovascular end-organ complications of T1DM. Results: Out of 803 studies found in the selected databases, only eight trials met the inclusion criteria. Most of the studies were of poor methodological quality or had a high risk of bias, with a mean score of 2.125 on the Jadad scale. No study could be classified as double-blind, and only one study documented the increased efficacy of insulin glargine in relation to both glycaemic control and hypoglycaemic episodes. Typically, there was no significant difference between insulin glargine and NPH insulins. Conclusions: This systematic review showed no therapeutic benefit of insulin glargine over other insulin formulations studied when analysing together glycaemic control and the frequency and severity of hypoglycaemia. We therefore recommend to the State Authority to delist insulin glargine or renegotiate a price reduction with the manufacturer. This systematic review provides support for this decision as well as documentation to combat potential law suits if discussions are unsatisfactory

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora