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Evaluation of the Potential Clinical and Economic Effects of Bodyweight Stabilisation with Acarbose in Patients with Type 2 Diabetes Mellitus

A Decision—Analytical Approach

  • Original Research Article
  • Acarbose in Type 2 Diabetes Mellitus
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Summary

Bodyweight is an acknowledged independent risk factor for coronary heart disease (CHD). The present model analysis was undertaken to investigate the clinical and economic impact of bodyweight gain in patients with type 2 (non— insulin—dependent) diabetes mellitus and its effects on the development of CHD. Based on a retrospective re—evaluation of data from the Diabetes Intervention Study (DIS), patients with type 2 diabetes mellitus and stable body—weight (group A) had a significantly lower rate of combined CHD events (30.3%) than patients showing a bodyweight gain (group B; 38.2%) over 10 years. Prevention of bodyweight gain, therefore, appears to be a meaningful strategy in the management of diabetes mellitus. In addition to this clinical advantage, prevention of CHD will also result in economic savings associated with avoided treatment of coronary events. Based on the clinical outcomes from the DIS, the calculated per—patient net savings for a patient with type 2 diabetes mellitus and stable bodyweight amounted to 1085 deutschmarks (DM) when compared with a patient experiencing a bodyweight increase.

In a further step, the above situation was projected to current type 2 diabetes mellitus practice. Oral first—line treatment of type 2 diabetes mellitus is usually initiated with glibenclamide (glyburide), which is known to increase bodyweight (reflecting group B). The novel α—glucosidase inhibitor acarbose, in contrast, appears to be as effective as glibenclamide, but has the advantage of being body—weight— neutral (reflecting group A). From the clinical viewpoint, acarbose can thus be considered an alternative to glibenclamide. From the viewpoint of drug costs, monotherapy with acarbose is 4 times as expensive as glibenclamide in Germany, resulting in per-patient incremental costs of DM3527 for acarbose over 10 years. Balanced against the potential 10−year cost saving of DM1085 resulting from the potential of acarbose to prevent CHD, around one—third of the incremental cost of acarbose may be recouped by this single effect. However, further possible benefits of acarbose, including the avoidance of hypoglycaemia and the deferral of costly insulin therapy, may improve the economic value of this novel antidiabetic agent. Given the indirect approach of this evaluation and its many limitations, the above findings need critical appraisal, and comparative trials are urgently required to substantiate our preliminary results.

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References

  1. Dornan T. Diabetes in the elderly: epidemiology. J R Soc Med 1994; 87: 609–12

    PubMed  CAS  Google Scholar 

  2. Garcia MJ, Mc Namara PM, Gordon T, et al. Morbidity and mortality in diabetics in the Framingham population: sixteen year follow—up study. Diabetes 1974; 23: 105–11

    PubMed  CAS  Google Scholar 

  3. Morrish NJ, Stevens LK, Head J, et al. A prospective study of mortality among middle—aged diabetic patients (the London Cohort of the WHO Multinational Study of Vascular Disease in Diabetics) II: associated risk factors. Diabetologia 1990; 33: 542–8

    Article  PubMed  CAS  Google Scholar 

  4. Songer TJ. The economic costs of NIDDM. Diabetes Metab Rev 1992; 8 (4): 389–404

    Article  PubMed  CAS  Google Scholar 

  5. Dinkel R, Banz K. Management of diabetes: socioeconomic aspects. Medicographia 1995; 17 (2): 35–8

    Google Scholar 

  6. Huse DM, Oster G, Killen AR, et al. The economic costs of non—insulin—dependent diabetes mellitus. JAMA 1989; 19: 2708–13

    Article  Google Scholar 

  7. Fölsch UR, Lembcke B. Inhibition of intestinal alphaglucosidases in the treatment of diabetes mellitus. Internist 1991; 32: 699–707

    PubMed  Google Scholar 

  8. Hanefeld M, Fischer S, Schulze J, et al. Therapeutic potentials of acarbose as first—line drug in NIDDM insufficiently treated with diet alone. Diabetes Care 1991; 14: 732–7

    Article  PubMed  CAS  Google Scholar 

  9. Hoffmann J. Acarbose und glibenclamid bei typ—II—diabetes. Münch Med Wochenschr 1990; 31/32: 487–90

    Google Scholar 

  10. Spengler M, Hänsel G, Boehme K. Acarbose und glibenclamid bei typ—II—diabetes. Z Allgemeinmed 1990; 66: 606–10

    Google Scholar 

  11. Chiasson J-L, Josse RG, Hunt JA, et al. The efficacy of acarbose in the treatment of patients with non—insulin—dependent diabetes mellitus. Ann Intern Med 1994; 121: 928–35

    PubMed  CAS  Google Scholar 

  12. Alberti KGMM. NIDDM: the forgotten millions. IDF Bull 1995; 40 (2): 8–9

    Google Scholar 

  13. Donahue RP, Abbott RD, Bloom E, et al. Central obesity and coronary heart disease in men. Lancet 1987 April 11; I: 821–4

    Google Scholar 

  14. Hanefeld M, Schmechel H, Julius U, et al. Five—year incidence of coronary heart disease related to major risk factors and metabolic control in newly diagnosed non—insulin—dependent diabetes. Nutr Metab Cardiovasc Dis 1991; 1: 135–40

    Google Scholar 

  15. Manson J, Colditz GA, Stampfer MJ, et al. A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med 1990; 322: 882–92

    Article  PubMed  CAS  Google Scholar 

  16. Obesity. London: Office of Health Economics, 1994

  17. Pekkanen J, Tervahauta M, Nissinen A, et al. Does the predictive value of baseline coronary risk factors change over a 30−year follow—up? Cardiology 1993; 82: 181–90

    Article  PubMed  CAS  Google Scholar 

  18. Ravussin E, Swinburn BA. Pathophysiology of obesity. Lancet 1992; 340: 404–8

    Article  PubMed  CAS  Google Scholar 

  19. Ashley FW, Kannel WB. Relation of weight change to changes in atherogenic traits: the Framingham study. J Chronic Dis 1974; 27: 103–14

    Article  PubMed  Google Scholar 

  20. Hanefeld M. Principles of treatment in NIDDM. In: Lefèbvre PJ, Standl E, editors. New aspects in diabetes. New York: Walter de Gruyter Berlin, 1992: 150–61

    Google Scholar 

  21. Tattersall RB. Combined insulin and tablet treatment in sulphonylurea failures. Diabetes Nutr Metab 1990; 3 Suppl. 1: 35–45

    Google Scholar 

  22. United Kingdom Prospective Diabetes Study Group. United Kingdom Prospective Diabetes Study (UKPDS) 13: relative efficacy of randomly allocated diet, sulphonylurea, insulin or metformin in patients with newly diagnosed non—insulin dependent diabetes followed for three years. BMJ 1995; 310: 83–8

    Article  Google Scholar 

  23. Wolffenbuttel BH, Weber RF, van Koetsveld PM, et al. A randomised crossover study of sulphonylurea and insulin treatment in patients with type 2 diabetes poorly controlled on dietary therapy. Diabet Med 1989; 6 (6): 520–5

    Article  PubMed  CAS  Google Scholar 

  24. Hanefeld M, Fischer S, Schmechel H, et al. The Diabetes Intervention Study: multi—interventional trial in newly diagnosed type 2 diabetes. Diabetes Care 1991; 14 (4): 308–17

    Article  PubMed  CAS  Google Scholar 

  25. Rose GA, Blackburn H, Gillum RF, et al. Cardivascular survey methods. 2nd ed. Geneva: World Health Organization (WHO), 1982. WHO monograph series no.: 56

  26. Wezel H, Liebhold R, editors. Handkommentar: bewertungsmaβst’ab für kassenärztliche Leistungen (BMÄ’ 87), Ersatzkassen—Gebührenordnung (E-GO’ 87), Amtliche Gebührenordnung für Ärzte (GOÄ). St. Augustin: Asgard Verlag, 1995

    Google Scholar 

  27. Rote Liste 1995. Bundesverband der pharmazeutischen industrie. Frankfurt: Rote Liste GmbH, 1995

    Google Scholar 

  28. Statistisches Jahrbuch für die Bundesrepublik Deutschland 1995. Wiesbaden: Statistisches Bundesamt, 1995

  29. Kübler W, Niebauer J, Kreuzer J, et al. Stationäre und ambulante rehabilitation. Münch Med Wochenschr 1994; 136 (27): 418–23

    Google Scholar 

  30. Jennings AM, Wilson RM, Ward JD. Symptomatic hypoglycemia in NIDDM patients treated with oral hypoglycemic agents. Diabetes Care 1989; 12 (3): 203–8

    Article  PubMed  CAS  Google Scholar 

  31. Seltzer HS. Drug—induced hypoglycemia: a review based on 473 cases. Diabetes 1972; 21: 955–66

    PubMed  CAS  Google Scholar 

  32. Asplund K, Wilholm BE, Lithner F. Glibenclamide—associated hypoglycaemia: a report on 57 cases. Diabetologia 1983; 24: 412–7

    Article  PubMed  CAS  Google Scholar 

  33. Berger W, Caduff F, Pasquel M, et al. Die relative Häufigkeit der schweren Sulfonylharnstoff—Hypoglykämie in den letzten 25 Jahren in der Schweiz. Schweiz Med Wochenschr 1986; 116: 145–51

    PubMed  CAS  Google Scholar 

  34. Federlin F. Das Risiko therpiebedingter Hypoglykämien. In: Waldhäusl W, Gries FA, editors. Diabetes in der praxis. Berlin: Springer Verlag, 1993: 218–32

    Chapter  Google Scholar 

  35. Campbell IW. Metformin and the sulphonylureas: the comparative risks. Horm Metab Res Suppl 1985; 15: 105–11

    PubMed  CAS  Google Scholar 

  36. Lebovitz HE, Melander A. Sulfonylureas: basic aspects and clinical uses. In: Alberti KGMM, Defronzo RA, Keen H, et al. International textbook of diabetes mellitus. Chichester: John Wiley & Sons, 1992: 746–72

    Google Scholar 

  37. Gerich JE. Oral hypoglycemic agents. N Engl J Med 1989; 321 (18): 1231–45

    Article  PubMed  CAS  Google Scholar 

  38. Yee HS, Fong NT. A review of the safety and efficacy of acrbose in diabetes mellitus. Pharmacotherapy 1996; 16 (5): 792–805

    PubMed  CAS  Google Scholar 

  39. Campbell LK, White JR, Campbell RK. Acarbose: its role in the treatment of diabetes mellitus. Ann Pharmacother 1996; 30 (11): 1255–62

    Google Scholar 

  40. Spengler M, Cagatay M. The use of acarbose in the primarycare setting: evaluation of efficacy and tolerability of acrbose by postmarketing surveillance study. Clin Invest Med 1995; 18 (4): 325–31

    PubMed  CAS  Google Scholar 

  41. Niskanen L. Hyperinsulinemia at onset and during the early years of NIDDM. In: Standl E, editor. Perspectives of the hyperinsulinemia/insulin resistance syndrome in NIDDM. MMW Med Verlag Münch 1990; Special Edition: 49–58

    Google Scholar 

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Authors and Affiliations

  1. Healthcare Consultants, HealthEcon Ltd., P.O. Box 1510, CH-4001, Basle, Switzerland

    Kurt Banz & Rolf Dinkel

  2. Institute and Outpatient Department of Clinical Metabolic Research, Technical University Dresden, Dresden, Germany

    Markolf Hanefeld

  3. Institute of Biometrics, Medical Faculty, Technical University Dresden, Dresden, Germany

    Uta Schwanebeck

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  1. Kurt Banz
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  2. Rolf Dinkel
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  3. Markolf Hanefeld
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  4. Uta Schwanebeck
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Correspondence to Kurt Banz.

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Banz, K., Dinkel, R., Hanefeld, M. et al. Evaluation of the Potential Clinical and Economic Effects of Bodyweight Stabilisation with Acarbose in Patients with Type 2 Diabetes Mellitus. Pharmacoeconomics 13, 449–459 (1998). https://doi.org/10.2165/00019053-199813040-00007

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  • DOI: https://doi.org/10.2165/00019053-199813040-00007

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