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bookDiabetes articles about daily topics that affect those living with diabetes. There is a lot of information about diabetes and hopefully you find this information useful in your everyday life. Here we have compiled a list of older articles from our previous "The Diabetes Network" along with links to blogs and articles, an extended reading archive. You can use the search in the top-right menu to search for specific articles.

 

4 Years In

  • 14,600 finger pokes
  • 910 shots of insulin

  • 426 site changes

  • 3 blood draws
  • 1 very happy, healthy little boy who I love more than life itself



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Islet cell transplants can be cost effective as well as increase the quality of life- a study

I recently found this abstract and thought it was very interesting and exciting. I was able to get a copy of the entire article from a friend, thanks Jason, but can't print all of it due to copyright laws. I am going to attempt to write about the highlights of what this shows. A health economic analysis of clinical islet transplantation

Keywords:

  • cost;
  • cost-effectiveness analysis;
  • economic model;
  • health economics;
  • islet cell transplantation

Beckwith J, Nyman JA, Flanagan B, Schrover R, Schuurman H-J. A health economic analysis of clinical islet transplantation. Clin Transplant 2011 DOI: 10.1111/j.1399-0012.2011.01411.x. © 2011 John Wiley & Sons A/S.

Abstract: Islet cell transplantation is in clinical development for type 1 diabetes. There are no data on the cost in relationship to its benefits. We performed a cost-effectiveness analysis and made a comparison with standard insulin therapy, using Markov modeling and Monte Carlo simulations. The patient population was adults aged 20yr suffering from hypoglycemia unawareness. Data were estimates from literature and clinical trials: costs were based on the situation in the United States. For insulin therapy, cumulative cost per patient during a 20-yr follow-up was $663000, and cumulative effectiveness was 9.3 quality-adjusted life years (QALY), the average cost-effectiveness ratio being $71000 per QALY. Islet transplantation had a cumulative cost of $519000, a cumulative effectiveness of 10.9 QALY, and an average cost-effectiveness ratio of $47800. During the first 10yr, costs for transplantation were higher, but cumulative effectiveness was higher from the start onwards. In sensitivity analyses, the need for one instead of two transplants during the first year did not affect the conclusions, and islet transplantation remained cost-saving up to an initial cost of the procedure of $240000. This exploratory evaluation shows that islet cell transplantation is more effective than standard insulin treatment, and becomes cost-saving at about 9–10yr after transplantation.

This study has attempted to compare the cost of managing Type 1 diabetes by intense insulin therapy to the cost of intervention with an islet cell transplant. Also woven into the design is how both affect the quality of life.

It begins with data on islet cell graft survival. I converted their graph into a chart.

one year results: full function= 93% partial function= 8% no function= 0%

five year results: full function= 47% partial function= 37% no function= 17%

ten year results: full function= 27% partial function= 49% no function= 24%

This shows that most recipients make it to one year, and half make it to five years with no insulin.

And that half make it to ten years with at least partial function.

This is very positive. Its personally disappointing to me because I am behind the curve. I only made it 2 years with no insulin, but it gives me hope that I will remain where I am for awhile which is still at a very good place. This data reflects what I notice from the cast of characters on the islet cell recipient facebook page as well.

The Quality of life variable was very complicated and I am going to simplify it greatly. It was comparing how the hardships of each treatment affected the quality of the patient's life. The values ranged from 0 which is worst to 1 which is best. The values that I thought the most interesting were:

A healthy person aged 25-34 had a quality of life valued at 0.91

A diabetic aged 25-34 had a quality of life valued at 0.81 If this person had hypoglycemic unawareness, which all recipients do, a reduction of 0.06 put this pt at a 0.75 quality of life.

From here, adjustments were made base on diabetes causing complications that the insulin group would face, and side effects and graft failure issues that the transplant group would face. A graph shows a mostly parallel line with the transplant group slightly ahead of the insulin group.

Then came the cost analysis. The numbers themselves were stunning.

Cost of the organ procurement was $25,000.

Cost of harvesting the islets was $20,000. with a 50% success rate means $40,000.

Cost of immunosuppression was about $1400/month

Cost of transplant was $93,500. Each successive year was $19,000.

Cost of insulin therapy/year was $6,600. The cost of having complications varied from $106,000 for renal failure to $1,400 for neuropathy.

Combining these two variables shows that initially the transplant is more costly. But, over time, as the cost of the transplant stabilizes, the cost of insulin therapy and its long term complications increases. This study covered a span of 20 years. At about 9 years, the costs intersect and the islet cell transplant remains the lower cost option.

Interesting numbers here were:

20 year cost of insulin therapy was $663,000. Quality of life years gained was 9.1.

20 year cost of islet cell transplant was $519,000. Quality of life years gained was 10.9

The article goes into much more detail, but these are the highlights. It also includes a discussion about how the transplant procedure is expected to improve. This has already proven to be true in that due to a change in an enzyme used in the harvesting procedure, more islets are now obtained per pancreas than when I had my transplant in 2008. And there is much more on the horizon............

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Diabetes Awareness Month - ways to help

There are several ways you can get involved in the fight against the bigD this month.

First on my list is watch the video above. If they get 100,000 views (you can watch more than once - I'm at four and counting), Roche will be making a donation to Diabetes Hands Foundation that will be used to support two humanitarian diabetes programs: Life for a Child (run by the International Diabetes Federation) and Insulin For Life. These programs provide people in need (children in the case of the donation that will be given to them this time) with diabetes supplies and insulin that they otherwise cannot afford. Seriously, all you have to do is watch the video.

Team Type 1 is sending six Type 1 professional cyclists to the Tour of Rwanda November 15. In conjunction with the race, TT1 is doing a "Strip-A-Thon." You can donate unused test strips or make a financial donation to help Type 1 kids in Rwanda.

Diabetes Research Institute is a leader in cure-focused research. You can be part of the cure by uploading a photo and making a donation. The first $25,000 raised will be matched by Animas and Lifescan (both Johnson + Johnson companies and the makers of my pump and meter dynamic duo, Gromit and Wallace).

You can join the Pancremaniacs and ride with us in the Twin Cities ADA Tour de Cure June 4.

You can wear blue and/or orange this month. I know, not as clear as pink in October, but we're just getting ourselves pulled together on this aspect of marketing and we're missing the one focused fundraising machine; it's a little more grassroots in the DOC.* Wait 'til next year: you'll be so sick of blue by the end of November, you'll be begging for Christmas red and green.

And, last (for tonight), but not least, send me your questions. I'm thinking this is the perfect time for another bigD Q&A.


*DOC = Diabetes Online Community

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Show-and-tell...

I have rectified the aforementioned problem by introducing my pump to the entire office at this morning's all-staff meeting. I just said that I know people have had questions and, so, rather than repeat myself to each concern (which was getting quite stressful) I thought it best to just present it to the group.

I introduced several issues I knew to be of concern: I went through how the pump works, the various types of diabetes, the misconception that people have, like: somehow people with diabetes cause their own illness and that treatment starts with diet, then if it's really bad you go on needles and then if it's really really bad you end up on a pump. I relayed that the truth is there are various regimes for various types of diabetes and that everyone is different. I told them that I do not manage by diet, but rather I have an insulin to carb ration that tells me for every gram of carbohydrate I eat I know I take X amount of insulin to keep my blood sugar under control. I said that managing this way meant I could eat whatever I wanted, included candy and treats.

Finally, I told people I realized that their concerns come from a good place and I wasn't blaming people, because I realize there is a big public information gap regarding diabetes.

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Study uncovers new diabetes genes

27 June 2010 (BBC)

Twelve new genes linked with type 2 diabetes have been found in a study into the differences in people's DNA and their risk of having the condition.

A consortium including Edinburgh University scientists have identified "important clues to the biological basis of type 2 diabetes". It is hoped the findings will lead to better ways of treating the condition.

The genes tend to be involved in working cells producing insulin, which controls levels of glucose in blood. The 12 new genes brings the total number linked with type 2 diabetes to 38.

The study was led by researchers at Oxford University and forms part of the Wellcome Trust case control consortium. The group of researchers, from across the UK, Europe, USA and Canada, compared the DNA of more than 8,000 people with type 2 diabetes with almost 40,000 people without the condition. They then checked the genetic variations they found in another group including over 34,000 people with diabetes and almost 60,000 controls.

Dr. Jim Wilson, of Edinburgh University, said: "One very interesting finding is that the diabetes susceptibility genes also contain variants that increase the risk of unrelated diseases, including skin and prostate cancer, coronary heart disease and high cholesterol. "This implies that different regulation of these genes can lead to many different diseases."

Professor Mark McCarthy of Oxford University's Centre for Diabetes, Endocrinology & Metabolism, said: "Gradually we are piecing together clues about why some people get diabetes and others don't, with the potential for developing better treatments and preventing onset of diabetes in the future. "The challenge will be to turn these genetic findings into better ways of treating and preventing the condition."

Sources include:

http://news.bbc.co.uk/2/hi/scotland/edinburgh_east_and_fife/10416128.stm
http://www.scotlandsfamily.com/dna-testing.htm
http://www.ocdem.ox.ac.uk/home
http://www.ndm.ox.ac.uk/principal-investigators/researcher/mark-mccarthy
http://www.diabetes.org.uk
http://www.wtccc.org.uk

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What your parents said

Last week I was invited to be a speaker at a local camp for families with diabetes.
There were four groups of children(as well as their parents), divided by ages . In preparing, I created a sheet that asked a series of questions.
Namely,
1. The easiest thing about dealing with diabetes is..
2. The hardest thing, etc....
3. The best thing, etc.....
4. The worst thing, etc.....
5. I wish my child knew....

The parents had the above questions, and the kids' sheets had the same questions, but the 'tense' was altered. For example, Q.1 read, "the easiest thing about having diabetes is..." and the last question was, "I wish my parents knew..."

Being that the responses were anonymous, I had hoped for honesty. What I got was beyond what I had hoped for. Here's a sampling of the parental responses...

The best thing about dealing with diabetes is...
-"There is treatment for the disease my son has."
-"Seeing the courage my daughter has.."
-"you can still do the same things that everyone else does"
And more than one parent said plainly,
-"nothing"

The worst thing about dealing with diabetes is...
-"dealing with potential restrictions on future activities."
-"missing activities with other children."
-"having it for the rest of your life??"
-"not knowing the future."
-"feeling like I am always bugging him about his sugar (level) or treating."

Now, let me address some of these answers: diabetes should not restrict or hinder you from anything. That's outdated info. Kids with diabetes do not need to miss anything. Further, we are on the cusp of the cure. As I said at camp, THERE HAS NEVER BEEN A BETTER TIME TO HAVE DIABETES!!

Not knowing the future can cause anxiety in anyone (with diabetes or not), but faith and a secure foundation can really counteract your fears.

And finally, "I wish my child knew..."

-"I would trade places with him if I could.."
-"How smart he is.."
-"how proud of her I am."
-"highs and lows will still happen even if you do everything 'by the book'"
-"there's nothing she can't do"
-"by not testing and taking care of himself how he is hurting his body."

These answers reveal much of what all parents feel for their kids. How many of us would do anything to take away our child's hurts, fears, or struggles?
Now compound that with a chronic disease that takes no prisoners, and the helpless feelings must multiply.

Yet there is another side to these answers that shows how diabetes affects more than just the diabetic. It affects the whole family, and includes friends, classmates, and more. Education is real power when it comes to effectively managing diabetes. There's no reason a child today should feel limited or inhibited in any way by diabetes.

All of this reinforces the conclusion I had previously reached, which is everyone with diabetes should be on the insulin pump.

It allows freedom and flexibility; but most importantly it is the best tool we have today to treat diabetes.

Stay tuned, because the next post will highlight what all the children with diabetes had to say, and you are NOT going to want to miss it!!

Until there's a cure, there's the pump.

That's why iPump.

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