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Type 1 Diabetes in Adults: Diagnosis and Management

Type 1 diabetes affects over 370,000 adults in the UK, representing approximately 10% of adults diagnosed with diabetes. Given the complexity of its treatment regimens, successful outcomes depend, perhaps more than with any other long-term condition, on full engagement of the adult with type 1 diabetes in life-long day-by-day self-management. In order to support this, the health service needs to provide informed, expert support, education and training as well as a range of other more conventional biomedical services and interventionsfor the prevention and management of long term complications and disability.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: August 2015
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Insulin Pumps for Adults with Type 1 Diabetes: A Review of Clinical Effectiveness, Cost-effectiveness and Guidelines [Internet]

The aim of this report is to review the clinical and cost-effectiveness, and guidelines of insulin pumps for adults with type 1 diabetes. This report is an update to a previous Rapid Response report, “Continuous Subcutaneous Insulin Infusion for Type 1 Diabetes: Clinical Effectiveness, Cost-Effectiveness, and Guidelines”, published in April 2015. Available from: https://www.cadth.ca/sites/default/files/pdf/htis/apr-2015/RA0750%20Insulin%20Pumps%20for%20Type%201%20Diabetes%20Final.pdf

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: December 10, 2015
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Basal-Bolus Versus Sliding-Scale Insulin Therapy in the Acute Care Hospital Setting: A Review of Comparative Clinical Effectiveness and Cost-Effectiveness [Internet]

When patients with diabetes are hospitalized, their glucose control may be suboptimal because oral medications are often stopped on admission. In fact, high blood sugar levels, or hyperglycemia, are common among hospitalized patients and linked to complications, such as increased morbidity, mortality, and hospital stay. Although low blood sugar levels, or hypoglycemia are serious risks associated with insulin therapy, potentially leading to arrhythmias and other cardiac events,, better glucose control with insulin for both type 1 and type 2 diabetes may improve clinical outcomes and prevent complications in hospitals.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 12, 2017
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Diabetes (Type 1 and Type 2) in Children and Young People: Diagnosis and Management

Diabetes is a long-term condition that can have a major impact on the life of a child or young person, as well as their family or carers. In addition to insulin therapy, diabetes management should include education, support and access to psychological services, as detailed here and in this guideline. Preparations should also be made for the transition from paediatric to adult services, which have a somewhat different model of care and evidence base.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2015
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Indirect comparison of once daily insulin detemir and glargine in reducing weight gain and hypoglycaemic episodes when administered in addition to conventional oral anti-diabetic therapy in patients with type-2 diabetes

The review compared the effectiveness of insulin detemir and insulin glargine in maintaining glycaemic control, minimising weight gain and reducing hypoglycaemic episodes in diabetic patients by indirect comparison (no head-to-head trials were identified). The authors' conclusions reflected the evidence, but the reliability of the conclusions is unclear because of limited evidence and methodological shortcomings in the review process.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Safety and efficacy of glargine compared with NPH insulin for the treatment of type 2 diabetes: a meta-analysis of randomized controlled trials

This review compared the efficacy of glargine and neutral protamine Hagedorn (NPH) in adults with type 2 diabetes. The authors concluded that there was no statistical difference in terms of glycaemic control, but glargine was associated with lower rates of hypoglycaemia and NPH with slightly less weight gain. This conclusion reflects the evidence presented and is likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Drug Class Review: Newer Diabetes Medications, TZDs, and Combinations: Final Original Report [Internet]

To compare the effectiveness and adverse event profiles of amylin agonists, DPP-4 inhibitors, incretin mimetics, TZDs, and certain combination products for people with type 2 diabetes and for people with type 1 diabetes for pramlintide only.

Drug Class Reviews - Oregon Health & Science University.

Version: February 2011
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Third-Line Pharmacotherapy for Type 2 Diabetes — Update [Internet]

The objective of this review was to update the systematic review and network meta-analysis of third-line therapies for type 2 diabetes.

CADTH Optimal Use Report - Canadian Agency for Drugs and Technologies in Health.

Version: July 2013
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Integrated sensor-augmented pump therapy systems [the MiniMed® Paradigm™ Veo system and the Vibe™ and G4® PLATINUM CGM (continuous glucose monitoring) system] for managing blood glucose levels in type 1 diabetes: a systematic review and economic evaluation

The study found evidence to suggest that integrated continuous glucose monitoring insulin pump therapy systems are more clinically effective in patients with type 1 diabetes than stand-alone treatments. However, based on the evidence available, these integrated systems are unlikely to be cost-effective in comparison with stand-alone insulin delivery and monitoring. Further research on the clinical effectiveness and cost-effectiveness of these integrated systems in different populations is warranted.

Health Technology Assessment - NIHR Journals Library.

Version: February 2016
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Predictors and Consequences of Severe Hypoglycemia in Adults with Diabetes - A Systematic Review of the Evidence [Internet]

Prevalence of type 2 diabetes is increasing at an alarming pace, fueled by the rising rates of overweight and obesity in many populations. In the VA healthcare system, the prevalence of diabetes was 20% in fiscal year 2000 and is now estimated at nearly 25%.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: April 2012
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Use of insulin and insulin analogs and risk of cancer: systematic review and meta-analysis of observational studies

BACKGROUND: An association of insulin use and risk of cancer has been reported but evidence is conflicting and methodological issues have been identified.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

The beneficial effect of insulin degludec on nocturnal hypoglycaemia and insulin dose in type 1 diabetic patients: a systematic review and meta-analysis of randomised trials

AIMS: Insulin degludec is a new-generation ultra-long-acting basal insulin which offers a significantly more predictable glucose-lowering effect than other long-acting insulin analogues. The aim of this study was to compare the effect of treatment with insulin degludec and long-acting insulin analogues glargine and detemir in type 1 diabetic (T1D) patients by means of a systematic review and meta-analysis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

[Quality of life and treatment satisfaction in patients being treated with long-acting insulin analogues: systematic review]

BACKGROUND AND OBJECTIVES: The purpose of this study was to review studies reporting on quality of life and treatment satisfaction of patients with diabetes mellitus being treated with long-acting insulin analogues.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Insulin use and cancer risk in patients with type 2 diabetes: a systematic review and meta-analysis of observational studies

AIMS: To determine whether data from observational studies supports the hypothesis of an increased risk of overall and site-specific cancer among individuals with diabetes using exogenous insulin therapies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Insulin therapy and risk of prostate cancer: a systematic review and meta-analysis of observational studies

BACKGROUND: Previous observational studies have shown that insulin therapy may modify the risk of prostate cancer (PCa). However, these studies yielded controversial results. Thus, we performed this meta-analysis to determine whether insulin use was associated with PCa risk in patients with diabetes mellitus (DM).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Insulin versus an oral antidiabetic agent as add-on therapy in type 2 diabetes after failure of an oral antidiabetic regimen: a meta-analysis

BACKGROUND: Although evidence-based guidelines for the treatment of type 2 diabetes mellitus provide clear recommendations for initial therapy, evidence on an optimal treatment strategy after secondary failure is unclear.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Continuous subcutaneous insulin infusion (CSII) pumps for type 1 and type 2 adult diabetic populations: an evidence-based analysis

In June 2008, the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project, an evidence-based review of the literature surrounding strategies for successful management and treatment of diabetes. This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry's newly released Diabetes Strategy.After an initial review of the strategy and consultation with experts, the secretariat identified five key areas in which evidence was needed. Evidence-based analyses have been prepared for each of these five areas: insulin pumps, behavioural interventions, bariatric surgery, home telemonitoring, and community based care. For each area, an economic analysis was completed where appropriate and is described in a separate report.To review these titles within the Diabetes Strategy Evidence series, please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM: Summary of Evidence-Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics: An Evidence-Based AnalysisBehavioural Interventions for Type 2 Diabetes: An Evidence-Based AnalysisBARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY: An Evidence-Based SummaryCommunity-Based Care for the Management of Type 2 Diabetes: An Evidence-Based AnalysisHome Telemonitoring for Type 2 Diabetes: An Evidence-Based AnalysisApplication of the Ontario Diabetes Economic Model (ODEM) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes: systematic review and network meta-analysis

OBJECTIVE: To examine the safety, effectiveness, and cost effectiveness of long acting insulin for type 1 diabetes.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Comparing newer drugs for diabetes, including combination drugs

How do newer drugs for diabetes compare in lowering blood sugar levels?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: May 16, 2011

Long-acting insulin analogues NPH human insulin in type 1 diabetes: a meta-analysis

The authors concluded that long-acting insulin analogues had a small effect on glycated haemoglobin and reduced the risk of severe and nocturnal hypoglycaemia compared with neutral protamine Hagedorn human insulin. In view of the limited search and differences in results between trials evaluating glycated haemoglobin, the authors' conclusions may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

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