Pazienti diabetici di tipo 2, non in terapia insulinica e albumina glicata: una valutazione multidimensionale

AUTORI

Lucrezia Ferrario¹, Fabrizio Schettini¹, Emanuela Foglia¹, Angelo Avogaro², Chiara Bellia³, Federico Bertuzzi⁴, Graziella Bonetti⁵, Antonio Ceriello⁶, Marcello Ciaccio^3,7, Massimiliano Corsi Romanelli^8,9, Elena Dozio⁹, Luca Falqui¹⁰, Angela Girelli¹¹, Antonio Nicolucci¹², Gianluca Perseghin^13,14, Mario Plebani¹⁵, Umberto Valentini¹¹, Martina Zaninotto¹⁵, Davide Croce^1,16
¹Centro sull’Economia e il Management nella Sanità e nel Sociale, Università Carlo Cattaneo - LIUC, Castellanza, Varese
²Dipartimento di Medicina, Azienda Ospedaliera di Padova, Università degli Studi di Padova
³Sezione di Biochimica Clinica e Medicina Molecolare Clinica, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Universitá degli Studi di Palermo
⁴Unità di Diabetologia, ASST Grande Ospedale Metropolitano Niguarda, Milano
⁵Laboratorio Centrale Analisi Chimico Cliniche, ASST Spedali Civili, Brescia
⁶Dipartimento di Malattie Cardiovascolari e Metaboliche, IRCCS MultiMedica, Sesto San Giovanni, Milano
⁷Dipartimento di Medicina di Laboratorio, Azienda Ospedaliera Universitaria, Palermo
⁸Struttura Complessa Laboratorio di Patologia Clinica, I.R.C.C.S. Policlinico San Donato, Milano
⁹Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano
¹⁰Dipartimento di Medicina, Diabete ed Endocrinologia, IRCCS Multimedica, Sesto San Giovanni, Milano
¹¹Medicina ad indirizzo Metabolico e Diabetologico, Dipartimento della Cronicità, A.S.S.T. Spedali Civili di Brescia
¹²Center for Outcomes Research and Clinical Epidemiology (CORERESEARCH), Pescara
¹³Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano Bicocca, Milano
¹⁴Dipartimento di Medicina e Riabilitazione, Unità di Medicina Metabolica, Policlinico di Monza
¹⁵Dipartimento Strutturale Medicina di Laboratorio, Azienda Ospedaliera- Università degli Studi Padova
¹⁶Scuola di Public Health, Facoltà di Scienze della Salute, Università di Witwatersrand, Johannesburg, Sudafrica

ABSTRACT

Insuline-Naive type 2 diabetic patients: a multidimensional evaluation on the role of glycated albumin

Insuline-Naaïve type 2 diabetic patients: a multidimensional evaluation on the role of glycated albumin Introduction: glycated Albumin (GA) is an innovative glycemic marker, that could be used in the clinical practice, as an add-on strategy, to the traditional glycemic monitoring systems, such as glycated haemoglobin (Hb1Ac) and fasting plasma glucose (FPG). The study aims at presenting the results of a multidimensional analysis conducted in Italy, exploring the main clinical, economic, ethical, social and organizational implications, related to the introduction of GA. Methods: an Health Technology Assessment (HTA) approach was implemented. The analysis considered the Italian National Healthcare Service (NHS) perspective, and assumed a 12-month time horizon, focusing on type 2 diabetes patients insulin-naïve, assuming oral therapy. The 9 HTA dimensions (derived from the Core Model developed by the European Network of HTA – EUnetHTA) were deployed, considering scientific evidence, health economics tools and qualitative approaches, through the administration of specific questionnaires to 15 diabetes experts. Results: literature reported better GA safety and efficacy profiles, thus being a predictor of the relative risk for diabetes complications development, and increasing the therapeutic success after 3 months of therapy (97.0% versus71.6%). From an economic point of view, GA introduction resulted in an economic advantage of 1.06% and in a better trade-off between costs sustained and efficacy gained. Considering a 7-item Likert Scale (ranging from -3 to +3), negative perceptions emerged with regard to equity aspects (0.13 versus0.72) due to GA limited accessibility, whereas it would improve both patients (2.17 versus1.33) and care givers (1.50 versus0.83) quality of life. In the short term, GA required training courses and equipment update, whereas, in the long term, it could be considered the preferable solution from an organizational perspective (0.30 versus0.01). Conclusions: the results of this study demonstrated GA strategic relevance, its economic sustainability and feasibility, as well as the potential clinical pathway improvement.

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