Diabetes research and clinical practice
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Diabetes Res. Clin. Pract. · Nov 2001
ReviewThe role of cost-effectiveness analysis and health insurance in diabetes care.
The theme of World Diabetes Day for 1999 is 'The Costs of Diabetes'. This theme was chosen quite purposely to reflect the broad nature in which diabetes affects individuals, families, and society. For the theme can highlight the importance of diabetes from a medical, social, or economic perspective. ⋯ They also include costs to society, such as the impact of using existing resources in diabetes care unwisely, or having inappropriate priorities. Cost-effectiveness analyses in diabetes care address this last point. Health insurance issues highlight one aspect of opportunity costs in diabetes care.
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Diabetes Res. Clin. Pract. · Nov 2001
A computer simulation model for cost-effectiveness analysis of mass screening for Type 2 diabetes mellitus.
The cost-effectiveness analysis of mass screening for Type 2 diabetes mellitus (DM) was performed to elucidate whether, who and how often it should be conducted in Taiwan. A series of Markov process was developed to model the disease natural history of Type 2 DM. A hypothetical cohort with 30,000 residents aged over 30 years in Taiwan was randomly assigned to three arms of screening regimes, biennial, five-yearly and the control group. ⋯ The corresponding figures for five-yearly screening regime were $10,531 per life-year gained and $17,113 per QALY. The incremental costs per life-year gained and per QALY increase with age, ranging from $17,238 for aged 30-39 years to $54,700 for aged over 70 years and from $9193 to 36,467, respectively. In conclusion, mass screening for Type 2 DM, especially in younger subjects, with 5-year inter-screening interval is cost-effective in Taiwan.
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Diabetes Res. Clin. Pract. · Nov 2001
Evaluation of three screening tests and a risk assessment model for diagnosing peripheral neuropathy in the diabetes clinic.
with the aim of evaluating predictive power, three simple screening tests as alternates to nerve conduction tests for diagnosing diabetic peripheral neuropathy (DPN) were investigated. Results of the screening tests, along with the subjects' demographic and clinical characteristics, were planned as the variables for the development of a risk assessment tool for predicting DPN. ⋯ this data, through the development of a model involving training and validation sets, demonstrates that the knowledge of clinical risk factors alters the interpretation of sensory tests for DPN. This finding lends further support to the validity of simple sensory testing maneuvers in the conditional diagnosis of DPN. We recommend annual screening with either the SWME or vibration by the on-off method in the primary care and diabetes clinics.
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Diabetes Res. Clin. Pract. · Dec 2000
Multicenter Study Comparative StudyCognitive dysfunction in older subjects with diabetes mellitus: impact on diabetes self-management and use of care services. All Wales Research into Elderly (AWARE) Study.
To determine whether cognitive impairment is associated with changes in self-care behaviour and use of health and social services in older subjects with diabetes mellitus. ⋯ Elderly subjects with predominantly Type 2 diabetes mellitus display significant excess of cognitive dysfunction, associated with poorer ability in diabetes self-care and greater dependency. Routine screening of cognition in older subjects with diabetes is recommended.
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Diabetes Res. Clin. Pract. · Oct 2000
Multicenter StudyReduced pulmonary function and its associations in type 2 diabetes: the Fremantle Diabetes Study.
To determine whether diabetes is associated with reduced lung function, we studied 421 Anglo-Celt/European subjects, representing 20.5% of all patients with type 2 diabetes identified in an urban Australian catchment area of 120097 people. In addition to collection of detailed demographic and diabetes-specific data, spirometry was performed and forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), vital capacity (VC) and peak expiratory flow (PEF) measured. When expressed as a percentage of those predicted (%pred) for age, sex and height, the means of all spirometric measures were reduced by > or =9.5%. ⋯ In sub-group analyses, these three spirometric measures were associated with BMI, CHD and diabetes duration in males, and age and BMI in females. Pulmonary function is reduced in type 2 diabetes. Diabetes duration seems a more important influence than glycaemic control, but obesity and vascular disease may also contribute.