Markosyan, R.

Perikhanyan, A.

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A336  VA L U E  I N  H E A LT H  1 7  ( 2 0 1 4 )  A 3 2 3 – A 6 8 6  
PDB27
Uses of electronic Patient information systems anD national 
registers – imPlementation of the clinical Practice gUiDeline anD 
evalUation of costs anD Use of resoUrces in Patients with inciDent 
tyPe 2 DiaBetes in finlanD
Prami T.1, Sulamaa A.2, Sipilä R.3, Linna M.4, Hahl J.5, Miettinen T.5, Leppä E.6, Haukka J.1, 
Tuomilehto J.7, Enlund H.8, Niskanen L.8, Korhonen P.1
1EPID Research, Espoo, Finland, 2Pharma Industry Finland, Helsinki, Finland, 3Finnish Medical 
Society Duodecim, Helsinki, Finland, 4Aalto University, HEMA Institute, Espoo, Finland, 5AT 
Medical Affairs Consulting, Espoo, Finland, 6Pharmaceutical Information Centre, Helsinki, Finland, 
7University of Helsinki, Helsinki, Finland, 8Finnish Medicines Agency Fimea, Helsinki, Finland
Objectives: Effective management of diabetes is the cornerstone for prevention 
of diabetic complications. However, how well the Finnish Current Care guideline 
for diabetes is implemented in practice is unknown. Combining local and nation-
wide patient registers provide a valuable resource for evaluating risks, benefits 
and costs. The purpose of this study was to identify how the Finnish electronic 
patient information systems and national registers can be used to explore the treat-
ment for patients with incident type 2 diabetes. MethOds: Selected primary and 
specialty care organizations representing different geographical areas and patient 
information system providers were invited to participate in the study. Study per-
mits were obtained from several local and nationwide register holders. The study 
protocol was reviewed by the Ethical Review Board of Hospital District of Helsinki 
and Uusimaa. Results: Register linkage is accomplished using unique personal 
identification numbers. We collect nationwide data on prescriptions, hospital and 
primary care, reimbursed dental care, and the causes of death. Cost data are based 
on hospital benchmarking database, sickness allowances and rehabilitations. We 
use local registers as a source of information on diagnoses, medical procedures, 
prescriptions and contact types. High quality laboratory data are also included from 
several local providers. cOnclusiOns: Register linkages enable longitudinal fol-
low-up of patients for research purposes in Finland. In our study a unique combined 
register database of diabetic patient cohort is created that improves the evaluation 
of prognosis and care of diabetic patients. This is a promising and versatile source 
for research in pharmacoepidemiology.
PDB28
ePiDemiology anD Unmet meDical neeD in DiaBetes mellitUs tyPe 2 in 
germany –resUlts of a literatUre search
Greiner R.A.1, Paulus G.1, Driedger J.1, Schröder C.1, Timtschenko V.1, Batscheider A.1,  
Eheberg D.2, Vosgerau S.1
1IMS Health, Munich, Germany, 2IMS HEALTH, Munich, Germany
Objectives: Diabetes mellitus Typ2 (T2DM) is a metabolic disease characterized 
by hyperglycemia with a high risk-potential of microvascular and macrovascular 
complications. In addition to glycemic control important therapy targets are the 
prevention of hypoglycemia and weight gain as well as blood pressure control due 
to national guidelines (German Medical Association 2013). To describe the current 
state of T2DM epidemiology and therapeutic needs in Germany which is mandatory 
when submitting AMNOG dossiers. MethOds: To describe epidemiology of diabetes 
a targeted literature research was conducted in PubMed in 2014 using the search 
terms (epidemiology OR incidence OR prevalence). To identify relevant comorbidity 
information the following terms were used (metabolic syndrome OR glycemic con-
trol OR hypoglycemia OR obesity OR blood pressure) and combined with AND dia-
betes AND Germany. PubMed research was supplemented by additional searches in 
guidelines in German/English. Results: The screening of the epidemiologic results 
identified nine relevant publications: two specified a T2DM-prevalence of 15.3% and 
14.7% (Wittchen et al 2007, Huppertz et al 2009) and two studies estimated a T2DM 
incidence of 15.8 per 1000 patient years (KORA, MONICA). Treatment prevalence 
increased from 5.9% in 1998 to 8.9% in 2007 related to the total population (Hauner 
2013). Arterial hypertension was the most frequent comorbity (83%) of T2DM (Hagen 
et al. 2010). In 2010, a disease management program in North Rhine showed that only 
15% of participants with T2DM achieved a BMI < 25 (Hagen et al. 2010). Long-term 
trials investigating the efficacy of antidiabetics on the prevention of macrovascular 
complications are limited (Drug Commission of German Medical Association 2009; 
Matthaei et al. 2009). cOnclusiOns: While treatment prevalence is increasing and 
glycemic control seems to be sufficiently achieved a substantial unmet medical need 
is identified for antidiabetics with a significant effect on weight reduction and blood 
pressure control in patients with T2DM in Germany.
PDB29
Progression of Physiological Parameters over time in tyPe 1 
DiaBetes mellitUs Patients in france
Beaudet A., Ong R.C.
IMS Health, Basel, Switzerland
Objectives: The objective of this study was to understand the progression over 
time of physiological parameters, including HbA1c, body mass index (BMI), sys-
tolic blood pressure (SBP), total cholesterol, LDL-cholesterol, HDL-cholesterol and 
triglycerides, in type 1 diabetes mellitus (T1DM) patients to inform disease mod-
eling. MethOds: This was a cross-sectional analysis of T1DM patients based on 
the IMS LifeLink Diabetes Cohort in France, which prospectively collects clinical, 
biological and treatment information from general practitioners. Patient age, gen-
der, year of diagnosis, BMI, HbA1c, cardiovascular risk factors, renal function and 
lab test results were collected at baseline and subsequent visits. Data were ana-
lyzed using R Studio. T1DM patients who visited their general physician between 
May 2011 and May 2014 and have received at least one insulin prescription were 
included in the analysis. Results: A cohort of 605 T1DM patients was included 
in this analysis. Forty-three percent of patients were male. Average patient age at 
first visit was 58 years of age. Mean HbA1c was 7.8%, mean SBP was 132 mmHg, 
and mean BMI was 27.6 kg/m2. Linear regression showed that BMI increased by 
0.092 kg/m2 (p< 0.001) for each additional year of age. SBP was projected to increase 
by 0.248 mmHg (p< 0.001) per additional year of age, LDL-cholesterol decreased by 
therapy, with a lower risk of hypoglycemia and without affecting weight versus 
sulfonilurea and metformin combination.
PDB24
recomBinant growth hormone theraPy in chilDren with gh 
Deficiency: first interventional stUDy in armenia
Markosyan R., Perikhanyan A.
Yerevan State Medical University, Yerevan, Armenia
Objectives: The purpose of this study was to evaluate the effectiveness and safety 
of treatment with recombinant growth hormone (RGH) in children with GH defi-
ciency. MethOds: This was an interventional study with 6 and 12 months follow-
up. Treatment was received by 15 children. The patients were receiving the RGH in 
0.033 mg/kg (0.1 Unit/kg) at the same time each day (9-10 pm) for period of 1 year. 
The effectiveness of treatment was evaluated based on change in growing speed, 
growth SDS and bone age maturation. Results: The mean age of children was 
9.5±3.6 years. In the given sample 6 children had MHPD, other 9 children had IGHD. 
There was a great improvement in absolute growth at 6 and 12 months period of 
treatment (p-0.001; p-0.001). The same was found for growth SDS (p-0.001; p-0.001). 
Effectiveness of RGH therapy on bone age maturation also showed great improve-
ment (p-0.001; p-0.001). The level of IGF-1 was increased (p-0.001; p-0.001); at 12 
months the level of IGF-1 reached to 248.72±70.7 ng/mL and remained consistently 
high. The same improvement was in IGF-pb3 levels (p-0.001; p-0.001). The lipidemic 
analysis showed that the blood cholesterol levels were from 3.21 to 12.39 mmol/L 
(norm 5.68±1.55 mmol/L) and the level of LDL - 1.3 to 10.86 mmol/L (norm 3.83±1.44 
mmol/L). During the treatment period we observed the significant improvement in 
cholesterol levels (p-0.001; p-0.001). High density lipoprotein and triglyceride levels 
did not change significantly (p. 0.05). cOnclusiOns: It can be concluded that the 
treatment with RGH in patient with GH deficiency is beneficial as it normalized the 
levels of cholesterol and LDL. During the treatment there were no any changes in 
indicators of kidney’s function, indicators of liver’s function as well as the indicators 
of carbohydrate metabolism.
PDB25
effectiveness, safety anD Patients’ sUBjective feelings of insUlin 
Pen-neeDle: a systematic review
Sun L., Sun J., Chen B., Sun S., Wang R., Ren X.
Shenyang Pharmaceutical University, Shenyang, China
Objectives: To compare the differences of effectiveness, safety and patients’ 
subjective feelings for using different lengths of insulin pen-needle in diabetic 
patients. MethOds: A retrospective analysis of relevant publications that were 
identified via electronic searches of databases using multiple search terms related 
to insulin pen-needle. Results: Totally, 21 literatures were included. Firstly, 
for the effectiveness, 85.71% of the studies suggested that there was no differ-
ence between longer and shorter needle in controlling HbA1c, 14.29% thought 
the shorter needle was better than the longer. No changes were observed with 
respect to fructosamine, glycated albumin and body mass index. Secondly, about 
the safety, all of the studies proved that the shorter needle was better in intra-
muscular injections, adverse device effects, subcutaneous lipodystrophy and barb 
phenomenon. 33.33% reported less hypoglycemic events, bleeding, bruising and 
needle bending with the shorter needle, the others showed no difference. All of 
the studies considered the shorter needle was undifferentiated with the longer in 
the needle break, hyperglycemia and lipohypertrophy. 6.25% have pointed out that 
the shorter needle was better than the longer in leakage, while 81.25% showed no 
difference in the length. Thirdly, in terms of subjective feelings, for convenience 
and acceptance, all studies agreed that shorter needle was superior to the longer. 
For fear and pain, half of studies suggested that shorter needle was superior to the 
longer one; the other half thought that there was no difference. In all the studies, 
69.23% suggested patients prefer the shorter, 23.08% suggested the patients not 
prefer a particular needle length. cOnclusiOns: Overall, the effectiveness of 
insulin pens with longer and shorter needle are comparable in treating diabetes, 
but the shorter needle is little better in parts of the safety indexes. As for patients’ 
subjective feeling, our findings show that patients are generally willing to accept 
shorter needle.
PDB26
economic imPact of comBining metformin with DiPePtiDyl PePtiDase 
inhiBitors in DiaBetic Patients with renal failUre
Sicras-Mainar A.1, Navarro-Artieda R.2
1Badalona Serveis Assistencials, Badalona. Barcelona, Spain, 2Hospital Universitari Germans 
Trias i Pujol, Badalona, Spain
Objectives: To evaluate resource use and health costs due to the combination 
of metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with dia-
betes and renal failure (RF) in routine clinical practice. MethOds: An observa-
tional, retrospective study was performed. Patients aged ≥ 30 years treated with 
metformin who initiated a second oral antidiabetic treatment in 2008-2009 were 
included. Two groups of patients were analysed: a) metformin + DPP-4 inhibitors 
and b) other oral antidiabetics. The main measures were: compliance, persistence, 
metabolic control (glycosylated haemoglobin < 7%) and complications (hypogly-
cemia, cardiovascular events) and total costs. Patients were followed up for two 
years. Results: We included 395 patients, mean age 70.2 years, 56.5% male: 135 
patients received metformin + DPP-4 inhibitors and 260 patients received met-
formin + other oral diabetics. Patients receiving DPP-4 inhibitors showed better 
compliance (66.0% vs. 60.1%), persistence (57.6% vs. 50.0%) and metabolic control 
(63.9% vs. 57.3%), respectively, compared with those receiving other oral diabetics 
(p < 0.05), and also had a lower rate of hypoglycemia (20.0% vs. 47.7%) and lower 
total costs (€ 2,486 vs. € 3,002), p = 0.001. cOnclusiOns: Despite the limitations 
of the study, patients with renal failure treated with DPP-4 inhibitors had better 
metabolic control, lower rates of hypoglycaemia, and lower health costs for the 
Spanish national health system.


PDB24 Recombinant Growth Hormone Therapy in Children with GH Deficiency: First Interventional Study in Armenia 

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PDB24 Recombinant Growth Hormone Therapy in Children with GH Deficiency: First Interventional Study in Armenia

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