Diabetes Articles
  • Sign Up
FacebookTwitterDiggStumbleuponGoogle BookmarksRedditLinkedinPinterest

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.

 

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............

Read Full Article

Dream a little

The challenge;

Sunday 5/16 - Dream a little dream - life after a cure. To wrap up Diabetes Blog Week, let’s pretend a cure has been found. We are all given a tiny little pill to swallow and *poof* our pancreases are back in working order. No side effects. No more insulin resistance. No more diabetes. Tell us what your life is now like. Or take us through your first day celebrating life without the Big D. Blog about how you imagine you would feel if you no longer were a Person With Diabetes.

For a while I would feel as if a part of me was missing. That would be my insulin pump. It's been attached to me for more than a decade now, 24 hours a day, 7 days a week. To not have it with me, clipped on my belt, would be... lonely.

I'd also miss carrying my man-purse everywhere since I wouldn't need my meter. Where would I carry my iPod?

But at the same time, I'd certainly LOVE not having to do all the fingersticks, infusion set insertions, math games, paying lots of $$$ each month for the medical supplies... I'd also enjoy the chance to be free to do anything, anywhere, anytime without having to worry about everything.

Read Full Article

Insulin Gone Bad?

Just when I think Gee, C's numbers have been really great lately...boom!  Relentless highs.  I mean blood glucose readings in the 200s, 300s, and yes, even 400s. Gobs of insulin corrections weren't making them even budge at times.

These highs began happening as soon as the kids were out of school last month.  But I couldn't figure it out.  It didn't make sense.  We were even more busy, with lots of activities...swimming included.  And swimming always makes C go low.  It was so frustrating.

What was totally insane was that it wasn't just at one or two different times during the day.  It was round-the-clock.  I'd get her down to the mid 100s with jumbo corrections, only to have her test in the 200s or 300s before her next meal.  This continued throughout the nighttime.  I did a couple of our famous middle-of-the-night-site-changes to no avail.

I began changing the site daily...opening another insulin vial, and then another.  Maybe it's gone bad, I thought.  Maybe it's a bad lot.  I just kept pushing forward, checking and correcting overnight, feeling overly exhausted.  You know this kind of tired...when the first thing you think of upon wakening is the bottle of Advil.

And then one day, I B-lined it for the pharmacy.  The insulin must have gone bad, I kept thinking.  Maybe they'll replace these vials that are barely used...I know, wishful thinking.  But, I was tired.  So off I went with C to the pharmacy.  I asked to speak with the guy who's been there the longest, as long as we've been getting insulin for C.  There are really only 2 employees left at our particular pharmacy who  remember me from the beginning...the haggard, emotional mom who needed, yes, 300 test strips a month for her baby.  He's one of them, so I thought for sure he'd see things my way!

"My daughter," I said, "her numbers have been crazy high.  I've opened like 3 new vials of insulin in the last week.  Could the insulin have gone bad?"  I asked.

"Uh, no," Mr. Pharmacist said.  "Let me see the cartons...Hmmm...no, they should be good.  Our shipments go directly in refrigeration.  She's possibly having a growth spurt."

A growth spurt?  That really didn't cross my mind.  Why hadn't it?  I thought for sure the insulin had gone bad.  Her numbers were high across the board.  Usually when we make adjustments and tweek basals in the pump, it's because numbers are creeping up, sneekily...not all at once.

So, with blurry, sleep-deprived eyes, I nodded, "Hmmm," I said.  "thanks."  We headed back home...determined to make adjustments and figure this out.  Over the course of the next few days, with some nurse help over the phone and internet, we adjusted every single basal setting and even added 2 more.  We changed so many things!  It made me nervous.  I'm very much a fan of the scientific method of changing one variable at a time.  But I knew we had to wrangle these numbers in a bigger way.  So, that's what we did.

It seems to always take several days for any type of setting change to really work itself out and show results.  We dug in for the long haul.  I knew this meant lots more testing and lots less sleeping but...oh well.  That's life with diabetes.

And, did the basal changes help?  Boy, did they?! But that's to be continued in another post...
Insulin gone bad?  Well, I know it can.  But not this time.  Now we have 3 newly-opened vials...ug. 
 

Sometimes insulin can go bad.

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.

Read Full Article

Islet Cell Transplant - Chapter 2

After worrying over my increasing blood sugars for some time now, it has finally become apparent that the time has come to supplement my cells with some insulin.  Its mostly heartbreaking, but a little relieving.  It has become more and more stressful to see those higher numbers appearing on my glucose monitor.  I will enjoy seeing a higher percentage of good numbers.  Also, this will lead to a better next A1c.

I did my best to postpone or prevent this.  I've been exercising and cutting carbs as much as possible.  I'm now on my third painful stressed or pulled muscle.  It started with my back, then my foot and now my back/neck again.  With hindsight, I know they were all due to being overworked.  Exercise does really help, but there are limits.

So, I am now on day 4 of insulin.  I started with 3 units of Lantus per day.  Yesterday, I had some high postprandials (220s) so increased to 4 units.  It seems to be helping.  I really don't mind the injections and this is probably not enough to cause any serious low blood sugars, I just hate to give up being insulin free and having the ability to say so. There is hope that this could be temporary.  If the islets get some rest, maybe they will become stronger.  Time will tell.  In the mean time, I am still exercising and watching what I eat.  Partly in hope to need less insulin, and partly to be able to judge how the insulin is affecting my numbers.  I was able to gain a few pounds throughout all of this.  I was concerned that it might have gone the other way.  Its easy to keep blood sugars lower by not eating as much and that is so tempting to do.  And its still feels like such a privilege to have the ability to do so.  But, I was really pushing the meat, cheeses, and nuts and I guess that worked.

This is a painful post to have to write, but also an important one.  The whole idea of this blog was to chronicle my experience, the good and the bad.  Good news is just so much more fun to share.

Of course, I'm not going through this alone.  Janet and Dr. Bellin are as disappointed as I am.  We all understand each other well enough to know that we aren't disappointed in each other, or even with the transplant, just disappointed.  I get just the right mix of sympathy, encouragement, and optimism from them.  Its also so nice to be able to share this with Dave, another transplant patient from SDI.


Yesterday was my JDRF walk, number two.  I didn't have walkers for this one.  I was handing out information at the Government Advocacy booth.  I displayed my poster again and enjoyed meeting people and sharing my experience with them.  Again, it was the mothers of diabetic children who were the most excited to hear about it.  It turned out to be a cold, rainy day, but there were still a lot of people who came for the walk.  Its very heartwarming to see such dedication and support.

Here are my current fall flowers.  A new season and a new chapter.

Read Full Article

Racing to Cure Diabetes...

I found this article on Team Type 1's website. Inspiring...

Team Type 1 is made up of champions – winners at endurance cycling who conquer life with Type 1 diabetes at the same time. In just its second showing in the annual Race Across America (RAAM), the team took home the victory – beating every other team by more than three hours.

"Team Type 1’s goal is to prove that by using the tools provided to manage diabetes, exercise and healthy living, a person with diabetes can do the same as a normal person – only better,” said Phil Southerland, team founder.

The Team Type 1 Race Across America team is comprised of ten persons with Type 1. These international cyclists, who must all monitor their blood sugar with testing, insulin through their pumps, diet, and exercise, are inspiring others with their triumphant journey. The team will cross the United States in 2008, challenging others to find a cure for Type 1 diabetes and encouraging healthy living.

Pressing ahead, Team Type 1 has initiated a pro cycling team of which 4 of the 15 team members will race while managing their diabetes in the pro peleton. Follow Team Type 1 and learn how they make minimal adjustments to lead a maximum life.

Maybe I will get a bycicle...

Read Full Article

Subcategories

Find out if you qualify for discount Diabetic testing supplies, free offers or other running discounts at this time.


  1. First Name*
    Enter first name
  2. Last Name*
    Enter last name
  3. Phone*
    Enter valid US phone number
  4. E-mail*
    Enter email address



By submitting this form I authorize to be contacted by telephone. Please be assured that we value and protect your privacy. Co-Pays and Deductibles may apply.

About The Diabetes Network

The Diabetes Network was developed with the idea that people living with diabetes needed a central place to go for resources as well as get ideas, suggestions and encouragement. We have put a lot of effort into this website to make it easy and fun to navigate as well as informative so that you can have a voice when it comes to managing your diabetes. Please let us know how we can improve this website to better suit your needs.

More about our Mission

We're on a mission to make the healthcare community more technologically advanced than ever before. This website adapts to fit your tablet, iPad®, iPhone®, Android® or other smartphone. Just one of the ways we are working to make life easier for those living with Diabetes. Learn More...