Vol 10, No 1 (2009): Practical Diabetology
Review article
Published online: 2009-03-18

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Improvement of the type 2 diabetes management - role of the innovative therapies taking DPP-4 inhibitors as an example

Władysław Grzeszczak, Jacek Sieradzki, Waldemar Karnafel, Janusz Gumprecht, Leszek Czupryniak, Małgorzata Szelachowska, Dorota Zozulińska
Diabetologia Praktyczna 2009;10(1):7-20.

Abstract

The prevalence of type 2 diabetes in Poland is estimated at 1.6-3.7%. Type 2 diabetes is diagnosed in about 90-95% of the cases worldwide. The prognosis alarms, that number of type 2 diabetes might reach even 300 million patients in the year 2025. Hospital admissions among diabetic patients exceed three folds admissions in non-diabetic patients. About 70-80% incidences of death in diabetic patients results from the cardio-vascular complications. These decrease life expectancy by 4-10 years. The total direct medical costs of type 2 diabetes in the year 2002 in Poland reached 2.6 billion PLN which constituted 8% of the total health care spending. The epidemic characteristic of the disease justify inclusion of the type 2 diabetes management in the health care policy priorities. The access of innovations in type 2 diabetes treatment in Poland is limited. The treatment goals determined by the Polish Society of Diabetology could only be executed with the use of all the available therapeutic options including also innovative drugs. The optimal glicemic control and maintenance of effectiveness in type 2 diabetes patients still constitutes the main therapeutic concern. Despite the currently used oral anti-diabetics and increasing administration of novel insulin therapies, there is plenty of scope for improvement with the use of innovative drugs acting through the mechanism close to the physiological reactions. The DPP-4 inhibitors constitute new therapeutic class of oral anti-diabetics effective in terms of gilcemic control and well tolerated. Moreover, DPP-4 have neutral influence on the body weight and their use is associated with very low risk of hypogycemy. Therefore DPP-4 give an opportunity to improve type 2 diabetes management, particularly in combination with metformine. As a result of their therapeutic added value, DPP-4 have been included into therapeutic guidelines of Polish Society of Diabetology issued in the year 2009. Results of the pharmacoeconomics evaluations, proved, that use of the DPP-4 (sitagliptine) as ad on therapy to metformine is cost-effective as compare to sulfonylourea addition. The calculated cost per QALY amounted to 6.7 thousand PLN in Polish setting. The increase of funds on innovative anti-diabetic drugs could constitute more profitable strategy than much more costly treatment of the future complications related to type 2 diabetes.

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