Stephanie Anne Amiel, United Kingdom
Kings College London Diabetes Research GroupAuthor Of 2 Presentations
OP047 - ASSOCIATION BETWEEN PERSON-REPORTED HYPOGLYCAEMIA AND TIME BELOW RANGE: THE HYPO-METRICS STUDY. (ID 594)
Abstract
Background and Aims
Time below range from continuous glucose monitoring (CGM), is widely used to assess hypoglycaemia risk. However, its relationship with personal experience of hypoglycaemia is unclear. We investigated the association between time <3.9 mmol/l (TBR3.9) and person-reported hypoglycaemia; symptomatic episodes that resolved on carbohydrate ingestion and/or a measured glucose ≤3.9mmol/l.
Methods
This analysis included 401 adults with insulin-treated diabetes (n=204 with type 1 diabetes (T1D); n=197 with type 2 diabetes (T2D)), who reported ≥1 hypoglycaemic episode in the past 3 months. For 10 weeks, they wore blinded CGM and recorded person-reported hypoglycaemia in real time using the Hypo-METRICS app. Data were analysed using generalised linear regression.
Results
Participants had a median (IQR) age 58 (47-66) years and 45% were women. HbA1c was 7.4% (6.8-8.0%), 23% had impaired awareness of hypoglycaemia, and 43% used capillary glucose monitoring only. During 658,802 hours of CGM, TBR3.9 was 3.0% (1.1-5.9%) and 11,600 person-reported hypoglycaemia episodes were recorded. Using a generalised linear regression model, TBR3.9 explains 25% of the variation of person-reported hypoglycaemia (21% in T1D, 12% in T2D). With every 1% change in TBR3.9, the weekly rate of person-reported hypoglycaemia changes by 9.4% (p<0.0001), with a 6.2% change in T1D (p<0.0001) and 9.4% change in T2D (p<0.0001).
Conclusions
While TBR3.9 is a valuable tool to understand hypoglycaemia risk, it explains a relatively small proportion of the variation in person-reported hypoglycaemia rates and highlights the limitation of using this metric as a surrogate marker for the experience of hypoglycaemia by the person living with diabetes.
OP085 - AN INTERVENTION TO ADDRESS TREATMENT-RESISTANT HYPOGLYCAEMIA BECOMES COST-EFFECTIVE THROUGH IMPROVED QUALITY OF LIFE AND FEWER ADMISSIONS. THE HARPDOC RANDOMISED CONTROLLED TRIAL. (ID 603)
Abstract
Background and Aims
Aim: to assess cost effectiveness of HARPdoc (Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes (T1D) and problematic hypoglycaemia persisting despite optimised care), which addresses attitudinal barriers to hypoglycaemia avoidance, vs Blood Glucose Awareness Training (BGAT, psychoeducation not addressing cognitions) as adjunctive treatments for adults with T1D and treatment-resistant problematic hypoglycaemia in a randomised controlled trial.
Methods
Eligible adults were randomised to either intervention and followed for 24 months. Quality of life (QoL, EQ-5D-5L) was measured at baseline, 12 and 24 months; utilisation of health services (Client Services Receipt Inventory) at 12 and 24 months; time spent by educators by interview and costs from UK databases. Incremental net benefit (INB), HARPdoc over BGAT, at 12 and 24 months calculated as cost per QALY, differences adjusted for group clustering using a mixed-effects random intercepts model using Stata 17.
Results
Delivery costs for HARPdoc were higher (mean±SD £1697±290 vs £541±82) but EQ-5D-5L total scores were higher and service utilization lower with HARPdoc. Over 24 months, mean[95%CI] expected difference in QALYs +0.067 per participant [ -0.024 to 0.155], equivalent to a gain of 24 days in full health over 24 months; expected difference in mean [95%CI] total cost (adjusted) -£194/participant [-£2498 to £1942]; adjusted difference in QALYs =-0.067/participant [-0.024 to 0.155], giving INBs £1,057 - £2,184 with 80-85% probability of cost-effectiveness at 24 months.
Conclusions
Addressing unhelpful health cognitions around hypoglycaemia in people with treatment-resistant hypoglycaemia likely achieves cost-effectiveness at 2 years, through improved QoL and reduced need for medical services
Presenter of 1 Presentation
OP085 - AN INTERVENTION TO ADDRESS TREATMENT-RESISTANT HYPOGLYCAEMIA BECOMES COST-EFFECTIVE THROUGH IMPROVED QUALITY OF LIFE AND FEWER ADMISSIONS. THE HARPDOC RANDOMISED CONTROLLED TRIAL. (ID 603)
Abstract
Background and Aims
Aim: to assess cost effectiveness of HARPdoc (Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes (T1D) and problematic hypoglycaemia persisting despite optimised care), which addresses attitudinal barriers to hypoglycaemia avoidance, vs Blood Glucose Awareness Training (BGAT, psychoeducation not addressing cognitions) as adjunctive treatments for adults with T1D and treatment-resistant problematic hypoglycaemia in a randomised controlled trial.
Methods
Eligible adults were randomised to either intervention and followed for 24 months. Quality of life (QoL, EQ-5D-5L) was measured at baseline, 12 and 24 months; utilisation of health services (Client Services Receipt Inventory) at 12 and 24 months; time spent by educators by interview and costs from UK databases. Incremental net benefit (INB), HARPdoc over BGAT, at 12 and 24 months calculated as cost per QALY, differences adjusted for group clustering using a mixed-effects random intercepts model using Stata 17.
Results
Delivery costs for HARPdoc were higher (mean±SD £1697±290 vs £541±82) but EQ-5D-5L total scores were higher and service utilization lower with HARPdoc. Over 24 months, mean[95%CI] expected difference in QALYs +0.067 per participant [ -0.024 to 0.155], equivalent to a gain of 24 days in full health over 24 months; expected difference in mean [95%CI] total cost (adjusted) -£194/participant [-£2498 to £1942]; adjusted difference in QALYs =-0.067/participant [-0.024 to 0.155], giving INBs £1,057 - £2,184 with 80-85% probability of cost-effectiveness at 24 months.
Conclusions
Addressing unhelpful health cognitions around hypoglycaemia in people with treatment-resistant hypoglycaemia likely achieves cost-effectiveness at 2 years, through improved QoL and reduced need for medical services