Authors' objectives:

This assessment determines the effectiveness, safety and cost implications of management of diabetes mellitus; and cost implications of screening for microalbuminuria in diabetics.

Authors' results and conclusions: Oral drug: The results from the assessment showed that among the oral drugs, there is good evidence of safety and effectiveness of Glimepiride, Metformin, Acarbose, Repaglinide, Rosiglitazone in NIDDM patients. In adequately controlled NIDDM patients, there is sufficient evidence that combination therapy is safe and effective. Insulin: There is sufficient evidence of safety and effectiveness of insulin aspart, insulin detemir, insulin glargine, and insulin lispro. With respect to inhaled and oral insulin, there is inconclusive evidence of safety and effectiveness. Diet and exercise: There is sufficient evidence that diet control and exercise are important in both the prevention and treatment of type 2 diabetes. Monitoring: There is inconclusive evidence that self-monitoring of diabetes mellitus improves glucose control in type 1 and type 2 diabetes. There is sufficient evidence that Glycated serum haemoglobin (HbA1c) is effective for monitoring blood glucose control in diabetes, while there is some evidence that near patient HbA1c is effective in inpatient care. There is inconclusive evidence on the benefits of fructosamine testing, and insufficient evidence on the benefits of fasting plasma glucose testing. Cost: With respect to costs, there is evidence that intensive glucose control is cost effective. Microalbuminuria: There is good evidence that all diabetics need to be screened for microalbuminuria. While a timed urinary albumin excretion rate overnight or over a 24 hour period is most sensitive, random sample testing using a dipstick (spot urinary albumin concentration) or albumin: creatinine ratio are found to be more convenient. There is some evidence that the newer screening test kits are effective.

Authors' recommendations: The recommendation from the assessment is that for treatment of NIDDM patients oral drugs like Glimepiride, Metformin, Acarbose, Repaglinide, Rosoglitazone are recommended either singly or in combination. For IDDM, insulin aspart, insulin detemir, insulin glargine, and insulin lispro are recommended. Diet control and exercise of recommended for all diabetics. Self monitoring of diabetes using HbA1c is recommended for all patients despite the lack of evidence on improvement in glucose control due to other benefits of monitoring. Screening for microalbuminuria is recommended for all diabetics either by spot albumin concentration or by albumin: creatinine ratio testing.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.moh.gov.my/

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Malaysia

Organisation Name: Malaysian Health Technology Assessment Unit

Contact Address: Health Technology Assessment Unit, Medical Development Division, Ministry of Health Malaysia, Level 21, PERKIM Building, Jalan Ipoh, 51200 Kuala Lumpur, Malaysia. Tel: 603 4045 7781, Fax: 603 4045 77 40

Copyright: Malaysian Health Technology Assessment Unit (MHTAU)