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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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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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Invisible Illness Week - Sept. 13-19

Via Karen at Bitter-Sweet Diabetes, I am posting this to raise awareness of Invisible Illness Week. Despite 20 years with the ups and downs of living with bigD, I don't think I've ever considered myself ill - I guess that goes to show just how invisible it is; even to me! But, I have been struggling with my feelings about living with an invisible disease and whether I can come to peace with adding someone to my team who would make type 1 diabetes much more visible, but no better understood, to the rest of the world. I'll post more about that later. In the meantime, it's Meme time:

30 Things About My Invisible Illness You May Not Know...

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Dream a little dream- Life after a cure... Diabetes Blog Week- Day 7 (Ha! I did it!)

Lightyears ago, when I was working in a little used bookstore on Queen Street, my boss told me this story about his brother... He said that his brother had a form of epilepsy. I don't remember the name of it exactly, but he had frequent and severe seizures. He was on a fair amount of medication to curb them, but at some point brain surgery became an option. So, he went through with the surgery and the doctors were fairly certain they'd removed the part of the brain that was responsible for the seizures. He was so terrified of them returning though, he refused to stop taking the medication they'd first prescribed him.

I tell you this, because it was one of the first things that came to my mind when I read this final topic for the Diabetes Blog Week was this story. And, honestly, if suddenly the perpetual five-year-plan until the cure for diabetes was up and sitting there was a cure... I think I'd still be testing my blood sugars for a good long while after: Every time I got thirsty. Every time I felt tired. Every time I got shaky. And, yeah, it would probably subside a bit over time, but I'd always wonder if and when it were coming back.

Another story that came to mind: when I started using an insulin pump it totally a positive change for me... physically. For the first time that I can remember I wasn't tired all the time. I think I mentioned somewhere here before, but when I told one of the nurses/diabetes educators helping make the transition to the pump she told me that this was fairly common. Apparently long acting insulins are pretty hard on your body. NPH, the crap stuff that I was on for a large part of my MDI routine, is notoriously nasty... which why it is affectionately referred to as "Not Particularly Helpful" amongst some medical professionals. That plus the fact that I spent years with impossible to avert daily lows, some of which were so low I felt like they were digging my grave for me, I got kind of pissed off that it took sooooo long for me get on the pump.

Actually, I don't even think I realized until I just wrote those words, that a lot of my anger when I got my pump was probably related to me being resentful for all those years of crappy insulins (remember the infernal Regular and Lente???) and multiple daily injections. I know it works great for a lot of people. But, really, that stuff was my own private hell, which is something I couln't realize until a better way of being came along... kind of what I think the shift from insulin pump to cure would be like...

Finally, my very first knee-jerk reaction when I read the topic for today's post: I've met so many awesome people because of my diabetes, I have to admit that I had a moment of sadness thinking that our relationship might go away without the common link of illness. Which I know isn't true- I think the relationship would just change. We might not have the same day to day struggles with the "D-beast", but I think we'd always have the lingering link of being ex-D-beast peoples. At least, I hope we would all stay in touch. I would miss you guys if you all went away. I guess the second thing I realize as I write this- my online D-friends aren't just diabetes support; sometimes you guys are life support. Which is great, so I wouldn't want that side-effect to be cured along with the broken pancreas.

Anyway, I don't mean to end the week on a bummer note. Nor do I don't mean to suggest that I wouldn't jump at a cure in a nano-second or that I wouldn't be happy (extremely happy!) or grateful. I think, though, that having recently just made the shift from needles to insulin pump, the reality of good things sometimes being a mixed bag is still very much a reality for me. And, maybe like most things in life, it's just complicated.

Here, though, I'll end with some happier thoughts:
- Having said all that, I'd totally test the limits of my new found food freedom by a one-time gorge on deep-fried ice cream. I don't know why, but I really get a hankering for that stuff every now and then... and cherries. I really like cherries... and pie. Cherry pie, of course. Stawberry-rhubarb too. Pie is one of the worst things to carb count.
- I think I'd also keep my pump by my pillow as a nightlight, 'cause I've gotten kind of attached to the little guy. I might even wear it around in public occassionally and tell everyone it's my new super gigantic pager...
- And my last, somewhat perverse thought? I'd tell everyone my diabetes was coming back in five years... just so that if it really were creeping back, it would take it's dear sweet time about it.

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Why I will never get an A in Diabetes Math

Why I will never get an A in Diabetes Math

Simplify.  Solve.  Repeat.


127bg + 20g carbs - 4 units insulin + 3 hours housework = 232bg


232bg + 40g carbs - 3 units insulin + 30 minutes sitting in car = 180bg


180bg + 10g carbs + 5 min waiting to get trail pass = 70bg


70bg + 30g carbs + 15 min cross country skiing = 42bg


42bg + 15g carbs + 60 min skiiing = 82bg


82bg + 30 g carbs + 90 min skiing = 559bg (recheck: 508bg, which is really the same number given meter accuracy)


559bg - 3.2 units insulin + 90 min waiting = 395bg


395bg - 1 unit insulin + 2 hour nap = 120bg


120bg + 10 g carbs + 2 hours loafing and feeling like crap = 187bg


187bg + 3hours sleeping = 51bg


51bg + 15 g carbs + 3 hours sleeping = 237bg

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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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