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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.

 

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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Eggs,bikes,and Tylenol PM

I have been struggling with some higher blood sugars lately. About 10 days ago, it got suddenly worse. My postprandials had been going higher for awhile, but then my fastings started to hover in the 130s. I became worried enough to contact Janet and then Dr. Bellin about the situation. After some discussion, it was decided to try a lower carb breakfast and to try not to worry about it too much. I know that stress can cause higher BGs, and seeing those high numbers was definitely causing some stress. This all occurred right before Labor Day weekend and it was decided to wait a few days and see if my numbers improved. If not, it might be time to try some insulin. It would break my heart a little to do this, but would bring down my numbers for sure.

When I told Gary about this, he asked if my sleeping problems might have something to do with the higher numbers? I realized that he might be right about that. So I started taking 2 Tylenol PMs at bedtime. I had been taking them before, but only if I really felt that I needed to. Its been almost a week now since I started all of this and my numbers are better. I know its not very scientific to try three things at once, but at that point, I was ready for any good idea.

So now, I'm having higher protein and fewer carb breakfasts, bike rides or long walks during the day, and Tylenol PM at night. My fastings are definitely better. I'm still having some higher postprandials, (200-250) but not as many. The exercise really helps. I'm planning on tapering off of the Tylenol PM and keeping up with the breakfasts and the exercising for awhile. I'm keeping a close watch on my weight during all of this.

The Labor Day weekend was wonderful. I was really hoping that I would be too busy to worry about my BGs too much, and it really worked out that way. We had a wedding on Saturday. We went to Kelly's Island with some friends on Sunday. We had fun playing some horseshoes there. And on Monday, we went kayaking on the Maumee River and then staffed a Donate Life Ohio booth at the Fulton county fair. Blake Shelton was playing in the background.

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School Supplies.

We, at my pump gear, strive to bring quality insulin pump accessories to kids & kids at heart. Our blog has several purposes:

1. To share information surrounding our #1 hope: a cure!
2. To share current & relevant information about insulin pumps and how to manage life with one.
3. To share anything having to do with diabetes awareness.
4. To share in the support system that is the diabetes online community, with empathy, compassion and humor!

Check out our website!

www.mypumpgear.com

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Phase 2 Mittens

Shucks, winter is here. We are getting some heavy snow right now - that's Minnesota for you.

I am thankful that I have a big supply of warm clothes and accessories. Inluding my walk to the bus stop and then the wait, I can be out in the elements anywhere from 10-30 minutes. It's best to be prepared.

These are my Phase 1 gloves, from the Dollar Store. I always lose them so will buy 4 pairs at a time. Phase 1 weather is between 20-40 degrees.

Then we come to Phase 2, about 0-20 degrees. These are mittens I knit and the pattern called them "Traditional Latvian Mittens", but we all know that things change over time and continents. There is another wool mitten inside, but, they are really not as warm as they look.

And finally, when it's below zero, we have to call on the big guys. The Phase 3's are lined with goosedown. I ordered them from Canada 10 years ago and guard them with my life. See that big diagonal ridge? That's where the down has lumped up, but if I put them in the dryer on low, the lump will disappear.

Today was a Phase 2 day. As I was getting ready to get off the bus, the woman next to me said, "oh, are those the mittens with that insulin from 3M"? Obviously she meant
Thinsulate, a synthetic product made to add warmth to outdoor clothing. I told her no, they weren't, but I had some insulin in my purse. She replied, "well, that's good - you can't go wrong with a nice warm handbag".

No, I guess you can't.

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THINGS ARE LOOKING UP

"Looks like things are really looking up".
A phrase often said when things go from bad to good (or at least, better).

For me this possitive phrase had quite a different meaning the other morning.

My normal routine is to wake up at 5:45am, stumble into the kitchen to grab a protein cookie, stumble into the front room to read my Bible (while eating my protein cookie), and stumble back into the bedroom by 6:20am to wake up Derek.


(+)

I've found that the protein cookie is the ONLY thing that I can eat for breakfast that doesn't make my blood sugars spike shortly after...which then comes plumeting down an hour later. I've tried EVERYTHING...eggs, fruit, yogurt, cereal.

Derek had the day off, so I decided to let myself sleep in a little bit longer, ignoring the 5:45am alarm, and slowly rolling out of bed shortly after 6:20am.

I definitely ran at a bit of a slower pace as the intense heat was making me so lethargic. AND I spent most of the morning wiping away the sweat that was literally dripping off of my face.

I only had time to grab a granola bar on my way out to the car.
Quaker Oats.
Chocolate Chip.
17 grams of carbs.
2.1 units of insulin
...and I was off to work.


(+)

Looked down at my pump (which communicates with my CGM...continuous glucose monitor) shortly after getting to work...and things surely seemed to be looking up...





Oh come on! 246??? Double arrow up? (which means my blood sugarwas increasing quickly, by at least 40 in the last 20 minutes)



But never fear...a little bit of insulin and shortly, things were looking up...well, actually (literally) down...which was a good thing... so I was looking Up.

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The Big Blue Test

The Big Blue Test is almost here!  On November 14th, at 2:00 pm (local time).Click here to find out more about the Big Blue Test and the Diabetes Hands Foundation.

Here's something you can do right now to, not only help spread awareness, but to give life-saving insulin to children in need.  Just watch the following video.  That's it.  Simple, right?!  It will take a mere minute and 49 seconds of your time but will give a child with diabetes a week supply of insulin!

Then, spread the word by telling your friends and family to do the same.  Post it on facebook.  Tweet about it on twitter.  Email the link to everyone you know.  Let's see how many views we can help make happen between now and November 14th...

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