Evidence map›Paper›PMID 27717768›Full record

ArticleThe lancet. Diabetes & endocrinology2016

Comparative effectiveness and cost-effectiveness of treat-to-target versus benefit-based tailored treatment of type 2 diabetes in low-income and middle-income countries: a modelling analysis.

Sanjay Basu, Vishnu Shankar, John S Yudkin

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The lancet. Diabetes & endocrinology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  11. Integrating hypertension and diabetes management in primary health care settings: HEARTS as a tool.Revista panamericana de salud publica = Pan American journal of public health · 2022
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  16. Matching Microsimulation Risk Factor Correlations to Cross-sectional Data: The Shortest Distance Method.Medical decision making : an international journal of the Society for Medical Decision Making · 2018
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors.

Sanjay BasuDepartment of Medicine, Stanford University, Palo Alto, CA, USA; Center for Primary Care, Harvard Medical School, Boston, MA, USA. Electronic address: basus@stanford.edu.
Vishnu ShankarDepartment of Medicine, Stanford University, Palo Alto, CA, USA.
John S YudkinDivision of Medicine, University College London, London, UK.

Funding

Trial of strategies to communicate genetic information to different ethnic and racial subpopulationsU54MD010724 · NIMHD · STANFORD UNIVERSITY · PI CULLEN, MARK RICHARD · 2016 to 2021
$16.3M
CORE--PROGRAM DEVELOPMENTP30AG017253 · NIA · STANFORD UNIVERSITY · PI BHATTACHARYA, JAY · 1999 to 2019
$5.8M
Towards improving the measurement of health and disability trends, the compressioR01AG034479 · NIA · WORLD HEALTH ORGANIZATION · PI CHATTERJI, SOMNATH · 2010 to 2014
$5.3M
Cohort filtering models to identify social program effects on health disparitiesDP2MD010478 · NIMHD · STANFORD UNIVERSITY · PI BASU, SANJAY · 2015 to 2015
$2.4M
NIA NIH HHS P30 AG017253NIA NIH HHS R01 AG034479NIMHD NIH HHS DP2 MD010478NIMHD NIH HHS U54 MD010724
6 · The paper itself

Abstract

backgroundOptimal prescription of blood pressure, lipid, and glycaemic control treatments for adults with type 2 diabetes remains unclear. We aimed to compare the effectiveness and cost-effectiveness of two treatment approaches for diabetes management in five low-income and middle-income countries.

methodsWe developed a microsimulation model to compare a treat-to-target (TTT) strategy, aiming to achieve target levels of biomarkers (blood pressure <130/80 mm Hg, LDL <2·59 mmol/L, and HbA

findingsThe TTT strategy recommended treatment to a larger number of people-who were generally at lower risk of diabetes complications-than the BTT. The BTT strategy recommended treatment to fewer people at higher risk. Compared with the TTT strategy, the BTT strategy would be expected to avert 24·4-30·5% more complications and be more cost-effective from a societal perspective (saving US$4·0-300·0 per disability-adjusted life-year averted in the countries simulated). Alternative treatment thresholds, matched by total cost or population size treated, did not change the comparative superiority of the BTT strategy, nor did titrating treatment using fasting plasma glucose (for areas without HbA

interpretationA BTT strategy is more effective and cost-effective than a TTT strategy in low-income and middle-income countries for prevention of both cardiovascular and microvascular complications of type 2 diabetes. However, the superiority of the BTT strategy for averting microvascular complications is contingent on insulin availability.

fundingRosenkranz Prize for Healthcare Research in Developing Countries and US National Institutes of Health (U54 MD010724, DP2 MD010478).

Indexed as

Developing CountriesModels, TheoreticalAdultAgedCost-Benefit AnalysisDiabetes Mellitus, Type 2Drug Therapy, CombinationFemaleHumansMaleMiddle AgedYoung Adult

Identifiers

PMID27717768
PMCPMC5315061

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.