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Article ; Online: The cost-effectiveness of metformin in the US diabetes prevention program trial: Simple interpretations need not apply.

Rittenhouse, Brian E / Alolayan, Sultan / Eguale, Tewodros / Segal, Alissa R / Doucette, Joanne

2023 Volume 178, Page(s) 107819

Abstract: Based on previously published US Diabetes Prevention Program (DPP) cost-effectiveness analyses (CEAs) metformin continues to be promoted as "cost-effective." We review the DPP within-trial CEA to assess this claim. Treatment alternatives included placebo ...

Abstract	Based on previously published US Diabetes Prevention Program (DPP) cost-effectiveness analyses (CEAs) metformin continues to be promoted as "cost-effective." We review the DPP within-trial CEA to assess this claim. Treatment alternatives included placebo (plus standard lifestyle advice), branded metformin and individual lifestyle modification. We added generic metformin as an alternative. Original published CEA data were taken as given and re-analyzed according to accepted principles for calculating incremental cost-effectiveness ratios (ICERs) in the economic evaluation field. With more than two treatments as in the DPP, these require attention to the rankings of interventions according to cost or effect prior to stipulating appropriate ICERs to calculate. With proper ICERs neither branded nor generic metformin was cost-effective, regardless of the value assumed for the willingness to pay for the quality-adjusted life year outcome assessed. Metformin alternatives were technically inefficient compared to placebo or the lifestyle modification alternative. Net loss calculations indicated substantial costs/health losses to using metformin instead of the optimal lifestyle alternative in response to metformin having been inaccurately labelled "cost-effective" in the original CEA. That CEA and subsequent analyses and citations of such analyses continue to claim that both metformin and lifestyle modification are cost-effective in diabetes prevention based on DPP data. Using metformin implies substantial costs and health losses compared to the cost-effective lifestyle modification. It may be that metformin has a role in cost-effective diabetes prevention, but this has yet to be shown based on DPP data.
MeSH term(s)	Humans ; Metformin/therapeutic use ; Hypoglycemic Agents/therapeutic use ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/prevention & control ; Cost-Benefit Analysis ; Life Style
Chemical Substances	Metformin (9100L32L2N) ; Hypoglycemic Agents
Language	English
Publishing date	2023-12-11
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	184600-0
ISSN	1096-0260 ; 0091-7435
ISSN (online)	1096-0260
ISSN	0091-7435
DOI	10.1016/j.ypmed.2023.107819
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Zs.A 878: Show issues

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Article ; Online: Prolonged glucosuria and relapse of diabetic ketoacidosis related to SGLT2-inhibitor therapy.

Westcott, Gregory P / Segal, Alissa R / Mitri, Joanna / Brown, Florence M

Endocrinology, diabetes & metabolism

2020 Volume 3, Issue 2, Page(s) e00117

Abstract: SGLT2 inhibitors (SGLT2i) are glucose-lowering medications which increase the renal threshold for glucose reabsorption and promote glucosuria. Treatment with these agents raises serum ketone levels, and cases of diabetic ketoacidosis (DKA) during therapy ...

Abstract	SGLT2 inhibitors (SGLT2i) are glucose-lowering medications which increase the renal threshold for glucose reabsorption and promote glucosuria. Treatment with these agents raises serum ketone levels, and cases of diabetic ketoacidosis (DKA) during therapy have been reported. The duration of glucosuria and inpatient course of SGLT2i-related DKA, however, is not well-characterized. We report 11 inpatient cases of SGLT2i-related DKA, including a subset of patients who experienced prolonged glucosuria and relapse of DKA during their hospitalization.
Language	English
Publishing date	2020-02-29
Publishing country	England
Document type	Case Reports
ISSN	2398-9238
ISSN (online)	2398-9238
DOI	10.1002/edm2.117
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Article ; Online: SGLT-2 inhibitors may be targeting higher risk patients with diabetes possibly justifying higher cost: Single center repeated cross-sectional analysis.

Weinrauch, Larry A / Liu, Jiankang / Segal, Alissa R / Woodward, Jason / D'Elia, John A

Journal of diabetes and its complications

2020 Volume 35, Issue 2, Page(s) 107761

Abstract: Introduction: We studied the use of all hypoglycemic agents in periods before and after introduction of SGLT-2 inhibitors in the USA by repeated cross sectional analysis to initially assess improvement in HbA1c control among patients with type 2 ... ...

Abstract	Introduction: We studied the use of all hypoglycemic agents in periods before and after introduction of SGLT-2 inhibitors in the USA by repeated cross sectional analysis to initially assess improvement in HbA1c control among patients with type 2 diabetes and hypertension. We sought to identify changes in glucose management related to the availability of the SGLT-2 inhibiting agents. We hypothesized that patients transitioned to SGLT-2 inhibitor-based therapy represented a higher risk group that derived benefits in terms of Hba1c control. Methods: Deidentified records of patients seen at least twice during the relevant time periods at Joslin Clinic between January 1, 2010 and December 31, 2012 and/or between January 1, 2014 and December 31, 2016 were examined. Records required all of the following: demographic information of gender, age, height, weight, BMI, HbA1c, eGFR, blood pressure, smoking status and completed medication lists. Results: 10,191 patients met criteria for analysis, 7769 seen in period 1 and 6576 in period 2. 4625 patients were seen in both periods. The group of patients defined by SGLT-2 use had significantly higher BMI and HbA1c. Notable shifts in medication use were observed as SGLT-2 use increased from none to 14%. Increased use (all p < 0.001) of GLP-1 agents (16.0 to 23.8%), insulin (56.1 to 60.5%) and statins (78.4 to 81.5%) and statistically significant decreases (all p < 0.001) in use of biguanides (69.5 to 66.3%) and sulfonylurea compounds (44.7 to 39.4%), thiazolidinediones (13.6 to 3.4%) and diuretics (32.4 to 28.9%) were observed. Statistically significant decreases (all p < 0.001) of HbA1c (7.9 to 7.8%), BMI (32.5 to 32.1), eGFR (80.6 to 77.5 ml/min) and increased systolic blood pressure (130 to 132 mm Hg) were documented. Conclusions: In the absence of glycemia treatment resistance or clinical heart failure SGLT-2 inhibitor use may not be cost effective. Enthusiasm for use of SGLT-2 inhibition should be based upon long-term cardiorenal protection rather than short-term glycemia control given limited impact upon HbA1c levels in our tertiary care type 2 diabetes population.
MeSH term(s)	Blood Glucose ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/epidemiology ; ErbB Receptors ; Glycated Hemoglobin A/analysis ; Humans ; Hypoglycemic Agents/therapeutic use ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
Chemical Substances	Blood Glucose ; Glycated Hemoglobin A ; Hypoglycemic Agents ; Sodium-Glucose Transporter 2 Inhibitors ; ErbB Receptors (EC 2.7.10.1)
Language	English
Publishing date	2020-10-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	1105840-7
ISSN	1873-460X ; 1056-8727
ISSN (online)	1873-460X
ISSN	1056-8727
DOI	10.1016/j.jdiacomp.2020.107761
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Article ; Online: Insulin: Making Sense of Current Options.

Segal, Alissa R / Vootla, Tejaswi / Beaser, Richard S

Endocrinology and metabolism clinics of North America

2016 Volume 45, Issue 4, Page(s) 845–874

Abstract: Newer insulin products have advanced the evolution of insulin replacement options to more accurately mimic natural insulin action. There are new, modified, and concentrated insulins; administration devices calibrated for both increased concentrations and ...

Abstract	Newer insulin products have advanced the evolution of insulin replacement options to more accurately mimic natural insulin action. There are new, modified, and concentrated insulins; administration devices calibrated for both increased concentrations and administration accuracy to improve adherence and safety; and inhaled insulin. There are new combinations of longer-acting basal insulin and rapid-acting insulin or glucagon like protein-1 receptor agonists. Existing insulin replacement designs and methods can be updated using these tools to improve efficacy and safety. Individualized decisions to use them should be based on patient physiologic needs, self-care ability, comorbidities, and cost considerations.
Language	English
Publishing date	2016-12
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	92116-6
ISSN	1558-4410 ; 0889-8529
ISSN (online)	1558-4410
ISSN	0889-8529
DOI	10.1016/j.ecl.2016.06.009
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Se 148: Show issues

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Article ; Online: Cardiovascular Risk Reduction and the Community Pharmacist.

Weinrauch, Larry A / Segal, Alissa R / D'Elia, John A

Journal of the American College of Cardiology

2016 Volume 67, Issue 24, Page(s) 2855–2857

MeSH term(s)	Cardiovascular Diseases ; Humans ; Pharmacists ; Risk Factors ; Risk Reduction Behavior
Language	English
Publishing date	2016--21
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2016.04.018
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Zs.A 1846: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 196: Show issues

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Article ; Online: Metformin-SGLT2, Dehydration, and Acidosis Potential.

D'Elia, John A / Segal, Alissa R / Weinrauch, Larry A

Journal of the American Geriatrics Society

2017 Volume 65, Issue 5, Page(s) e101–e102

Abstract: Clinicians are aware of the risks and benefits of metformin in type 2 diabetes. In geriatric populations lactic acidosis due to diminishing kidney function is an issue. The recent addition of a group of agents to control diabetes through increased ... ...

Abstract	Clinicians are aware of the risks and benefits of metformin in type 2 diabetes. In geriatric populations lactic acidosis due to diminishing kidney function is an issue. The recent addition of a group of agents to control diabetes through increased glycosuria may increase the risk of dehydration and acidosis. This may happen due to gastrointestinal loss from metformin diarrhea or urine loss from diuretics. A typical example is presented.
MeSH term(s)	Acidosis, Lactic/etiology ; Aged, 80 and over ; Dehydration/etiology ; Diabetes Mellitus, Type 2/drug therapy ; Humans ; Hypoglycemic Agents/adverse effects ; Hypoglycemic Agents/therapeutic use ; Male ; Metformin/adverse effects ; Metformin/therapeutic use ; Risk Factors
Chemical Substances	Hypoglycemic Agents ; Metformin (9100L32L2N)
Language	English
Publishing date	2017-05
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.14724
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Ud II Zs.168: Show issues

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Article ; Online: Simplification of Insulin Regimen in Older Adults and Risk of Hypoglycemia.

Munshi, Medha N / Slyne, Christine / Segal, Alissa R / Saul, Nora / Lyons, Courtney / Weinger, Katie

JAMA internal medicine

2016 Volume 176, Issue 7, Page(s) 1023–1025

Language	English
Publishing date	2016-07-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2016.2288
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Ua VI Zs.119: Show issues

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Article ; Online: Clinical pharmacy services provided to asthma patients in a school-based clinic.

Petrie, Jennifer L / Segal, Alissa R

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

2010 Volume 67, Issue 3, Page(s) 185, 188–9

MeSH term(s)	Adolescent ; Asthma/epidemiology ; Asthma/therapy ; Child ; Child Health Services/organization & administration ; Female ; Humans ; Male ; New Mexico/epidemiology ; Outcome Assessment (Health Care)/organization & administration ; Patient Education as Topic ; Pharmacy Service, Hospital/organization & administration ; School Health Services/organization & administration ; Self Care/methods ; Severity of Illness Index
Language	English
Publishing date	2010-01-20
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	1224627-x
ISSN	1535-2900 ; 1079-2082
ISSN (online)	1535-2900
ISSN	1079-2082
DOI	10.2146/ajhp080616
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Zs.A 419: Show issues

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Article ; Online: Are you ready for more insulin concentrations?

Segal, Alissa R / El Sayed, Nuha

Journal of diabetes science and technology

2014 Volume 9, Issue 2, Page(s) 331–338

Abstract: Practitioners need to prepare for a rapid expansion of new concentrated insulins. For many years, the treatment regimens for patients have been limited to 2 concentrations (100 units/mL and 500 units/mL), which pose challenges to both patients and ... ...

Abstract	Practitioners need to prepare for a rapid expansion of new concentrated insulins. For many years, the treatment regimens for patients have been limited to 2 concentrations (100 units/mL and 500 units/mL), which pose challenges to both patients and providers. As the new concentrated insulins are at various stages of development, this manuscript reviews the available information on the new concentrated products. This information was obtained from publications, poster presentations, abstracts, and the manufacturers for the products in earlier stages of development. To have a basis for comparison, it is important to understand the activity profile and the challenges with use of the currently available concentrated insulin, regular insulin 500 units/mL (U500R). We also examine how the newer products may assist clinicians and patients with the difficulties faced with the use of U500R.
MeSH term(s)	Diabetes Mellitus, Type 2/drug therapy ; Humans ; Hypoglycemic Agents/pharmacokinetics ; Hypoglycemic Agents/pharmacology ; Insulin/pharmacokinetics ; Insulin/pharmacology
Chemical Substances	Hypoglycemic Agents ; Insulin
Language	English
Publishing date	2014-11-10
Publishing country	United States
Document type	Journal Article ; Review
ISSN	1932-2968
ISSN (online)	1932-2968
DOI	10.1177/1932296814557860
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Article ; Online: Diabetes in long-term care facilities.

Singhal, Aaditya / Segal, Alissa R / Munshi, Medha N

Current diabetes reports

2014 Volume 14, Issue 3, Page(s) 464

Abstract: With the aging of the population and longer life expectancies, the prevalence of population with multiple chronic medical conditions has increased. Difficulty managing these conditions as people age (because of changes in physical, functional, or ... ...

Abstract	With the aging of the population and longer life expectancies, the prevalence of population with multiple chronic medical conditions has increased. Difficulty managing these conditions as people age (because of changes in physical, functional, or cognitive abilities and the complexity of many treatment regimens), has led to more individuals with multiple medical conditions admitted to the long-term care facilities. Older adults with diabetes residing in the long-term facilities represent the most vulnerable of this cohort. Studies that specifically target diabetes management in older population are lacking and those that target diabetes management in the long-term care facilities are even fewer. The lack of knowledge regarding the care of the elderly residing in long-term care with diabetes may lead to treatment failure and higher risk of hyperglycemia, as well as hypoglycemia. In aging populations, hypoglycemia has the potential for catastrophic consequences. To avoid this, the management of older population with diabetes and other medical comorbidities residing in long-term care facilities requires a more holistic approach compared with focusing on individual chronic disease goal achievement.
MeSH term(s)	Diabetes Mellitus/drug therapy ; Diabetes Mellitus/physiopathology ; Diabetes Mellitus/therapy ; Health Facilities ; Humans ; Hypoglycemic Agents/therapeutic use ; Life Style ; Long-Term Care ; Socioeconomic Factors
Chemical Substances	Hypoglycemic Agents
Language	English
Publishing date	2014-01-26
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2065167-3
ISSN	1539-0829 ; 1534-4827
ISSN (online)	1539-0829
ISSN	1534-4827
DOI	10.1007/s11892-013-0464-y
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