Impact of Type 2 Diabetes and its Prevention

 Section: Human and Financial Impacts of Type 2 Diabetes 

 Foos, et al., (2015) explains that Type 2 diabetes is quite a prevalent is a prevalent illness that is affecting almost 8.3 percent of individuals in the United States of America. Out of these people, 18.8 million people have been healed or diagnosed while 7 million people have yet to be diagnosed. The CDC or Centers for Disease Control in the Fact Sheet reported that cases up to almost 1.9 million were healed in 2010 and 1.3 percent of the individuals are over 25 years and twenty-six percent have age over 65 seem to have diabetes. Even though gender doesn’t impact the presence of diabetes, ethnicity does play a significant role in its prevalence. Seven percent of white nonHispanic are affected, ten percent of Hispanic, and almost twelve percent of black non-Hispanic individuals are affected by it.

Type 2 diabetes is actually an international epidemic which is not restricted by boundaries and its incidence has only increased in the recent years. It is evaluated that individuals up to 285 million are affected by it and have diabetes and this figure will only rise up to 438 million by the end of 2030. Increments in the prevalence of diabetes seem to correlate with an improvement in the status of national socioeconomic, as indicated by the sharp and drastic increment in the diabetes and obesity in China and India.At present, India is ranking the highest in the prevalence of this epidemic and is closely followed by China and then there is the United States of America following the lead(Foos, et al., 2015).

Furthermore, it has been projected that by the end of 2030, the presence and prevalence of diabetes will be doubled. In 2004, it has been estimated that 3.4 million individuals have passed away due to the hyperglycemic issues and complications. It is projected by WHO that this mortality will be doubled among 2005-30. Most of the direct fatalities from the epidemic of diabetes take place in middle and low-income nations. This epidemic was actually ranked as the 8^th leading reason of death internationally but now, it is ranked fifth since it follows trauma, cancer, cardiovascular disease, and infections. Even though the mortality which diabetes cause is lower in America, it still accounts for seventy-one thousand deaths and played a role in 160,022 deaths in 2007. That is why, in accordance with CDC, diabetes has contributed in almost 231, 404 deaths out of approximately 2.5 million deaths. It is predicted that these figures will only increase and they will reach one in every three children being born in the 21^st century. Together with important consequences of health, an immense economic load is imposed by diabetes. The cost of diabetes has been examined by various studies over the globe and have evaluated that the developed nations tend to have larger burdens of finance through the costs of direct treatment and indirect costs from the loss which occurs in productivity. The USA in 2010 was measured to have invested almost 198 billion dollars or almost fifty-two percent of the global expenditure on the treatment of diabetes(Roze, et al., 2019) 

This seems to correspond with the average yearly cost of 9967 dollar per individual who is not diagnosed for treating diabetes along with its related comorbidities.It can also be said that indirect costs from decreased productivity and lost earnings reached almost 58 billion dollars in 2007 in the US. In China and India, these costs were higher due to the early mortality which is associated with diabetes. Almost twelve percent of the international expenditure of health care in the US. Meanwhile, myocardial infraction, stroke, and hypertension seemed to represent only ten percent of the international expenditure of healthcare. It is predicted by WHO that China and India will be inventing forty percent of their expenditure of healthcare on the management of diabetes when they will be expected to have at least 130 million cases. Therefore, the international expenditure for treatment and prevention of diabetes is predicted to get over 490 billion dollars by 2030(Morello & Hirsch, 2017).

 According to CDC (2019), diabetes at present is one of the most common diseases which is non-communicable internationally. It is fifth or fourth leading cause of death in developed nations and there is also a substantial evidence that it is an epidemic in many nations which are developing at the moment along with new industrial countries. Complications associated with diabetes like blindness, renal failure, amputations, neuropathy, stroke, vascular disease, and coronary artery are resulting in decreased expectancy of life, increased disability, and high costs for health for almost every society.

 Diabetes is actually certain to be one of the most challenging issues of health at present. The number of researches over the past two decades has been commendable. However, many public health and government planners still seem to be unaware of the present magnitude or the future increments in the cases of diabetes in their nations. Besides diabetes, the condition of IGT or impaired glucose tolerance also constitutes to an important problem of public health, both due to its relation with the incidence of diabetes and relation with a strong threat of the growth of cardiovascular disease(CDC, 2019).

Type 2 diabetes is actually classified by the deficiency of relative insulin and insulin resistance, either of which might be prevalent at the time when diabetes is manifesting clinically. The certain reasons for the growth of these abnormalities actually are not known at the moment. Type 2 diabetes’ diagnosis normally takes place after 40 years of age even though onset age is normally ten years earlier in the populations with a high prevalence of diabetes. This epidemic can actually be asymptomatic for numerous years and the diagnosis is made from the related complications through a urine glucose test or abnormal blood. This disease is common but is not always, related to obesity which can easily cause insulin resistance while leading to elevated levels of blood sugar. It is familiar but important susceptibility genes have yet to be identified. Compared to the Type 1, people with Type 2 diabetes are independent on the exogenous insulin and are seemingly not ketosiprone. However, it might need insulin for controlling hyperglycaemia it this hasn’t been achieved with only diet(Waller, et al., 2019).

Haghparast-Bidgoli, et al., (2018) explain thatType 2 diabetes seem to constitute for eight-five to ninety-five percent of all diabetes prevalent in the developed nations and seems to account for a further higher percent in the countries which are developed. This disease is now a serious and common health problem at an international level and for many countries, it has evolved in relation with the rapid social and cultural changes, unhealthy lifestyle, decreased physical activity, dietary changes, and rising urbanization. The large range of prevalent diabetes even in the similar or same ethnic groups when surviving under different conditions are highlighted in the Figure 1(Haghparast-Bidgoli, et al., 2018).

Figure 1 of Impact of Type 1 Diabetes and its Prevention

 It can be seen clearly that many of the differences among the rates seem to reflect underlying social and environmental risk factors like level of physical activity and obesity. The high rates of Type 2 diabetes in ethnic groups are normally identified in urbanized or migrant populations that might have suffered or experienced a greater degree of the change in lifestyle. The lowest rates are normally determined in communities which are rural where individuals are living lifestyles integrating very high levels of physical work. The prevalence and incidence of Type 2 diabetes is also identified to be rising in children. Studies from Japan and America have demonstrated a rising rate of incidence and other ethnic groups with a high prevalence of adult diabetes like Pima Indians are also reporting a rising number of adolescent prevalence. This problem’s significance and the need for more study are emphasized by the authors. It is recognized well that the international burden of Type 2 diabetes is both rising and significant with most the cases registered in the recent twenty years(Breeze, et al., 2017).

The international prevalence to 2025 from 2003 in adults is actually expected to increase from five percent in terms of the adult population to 6.3 percent. The absolute and proportional increase will take place in developing nations where the prevalence will seemingly increase to 5.6 percent from 4.2 percent. In China and India, the diabetic population is predicted to be double by the ending of 2025(Waller, et al., 2019).

The prevalence of Type 2 diabetes is actually expected to get to 2.8 percent in Africa and it will reach 7.2 percent in Central and South America. It was estimated that only 0.2 percent of the diabetic population was under the age of 15 years in 1990. It actually seems to increase with age and some are affected due to it, particularly those who are quite old in the United States and the proportion is almost the same in many other nations. However, this is more likely to be underestimated since eight to forty-five percent of the diagnosed patients in the young population are in the United States and is because of Type 2 diabetes. Information and data from the third Survey of National Health and Nutrition Examination or NHANES III indicates that almost 16 million citizens of America have Type 2 diabetes in the US (Healthypeople, 2019).

Section 2: Interventions of Impact of Type 1 Diabetes and its Prevention

Hippisley-Cox, Coupland, Vinogradova, Robson, and Brindle(2008) explain that in the UK, there are actually 3.5 million individuals suffering from diabetes. With the increasing levels of aging population and obesity, the growth of diabetes is also increasing. Lifestyle interventions have been targeted at the individuals with severe risk of Type 2 diabetes and it has been determined to be effective in decreasing its occurrence. The threat of Type 2 diabetes is affected by many factors which include family history, physical activity, age, and obesity. Individuals from some specific population groups and communities are seemingly at a higher risk. The algorithm of QRISK2 was utilized for estimating the likelihood of the CVD or cardiovascular disease even conditional on the diabetes, deprivation, ethnicity, and smoking data was included in the equation. The events of CVD were actually allocated for either vascular disease, stroke, transient ischaemic attack, unstable angina, and stable angina in accordance with the distributions of probability utilized in the previous of Assessment of Health Technology. It is believed by the authors that various factors detail the differences which are present in the incremental costs. First of all, the model of SPHR involved a very wide range of outcomes related to health like colorectal cancer, osteoarthritis, and depression which weren’t included in the previous calculations.

The cost of individual screening for Type 2 diabetes at a very high risk because of the hyperglycaemia wasn’t included in the SPHR model’s version. The model’s main drivers are the effect of the intervention in decreasing CVD and diabetes. A sufficient portion of the incremental costs can be attributed to the cost-saving which is related with CVD and diabetes. The analysis of deterministic sensitivity actually highlights that the results of the model are most sensitive to the changes in the incidence of baseline of these conditions. In the analysis of authors, six high-risk groups were investigated separately. However, it is highly probable that combining the overall criteria would increase the allocation of resource to a subpopulation with even higher gain in cost-savings and gains. The model of SPHR actually can changed for evaluating the combined criteria of treatment, in addition to various other policies for the prevention of Type 2 diabetes. The policymakers of the UK can utilized this model for deciding just which populations they want to target with the interventions of lifestyle in accordance with overall objectives whether they are short or long-term gains, preventing diabetes or CVD, or equity(Hippisley-Cox, Coupland, Vinogradova, Robson, & Brindle, 2008).

According to Kalyani, Saudek, Brancati, and Selvin, (2010), evidence is rising that the disease of diabetes is related to some other comorbidities which include prognosis, cancer risk, fracture risk, incontinence, and cognitive impairment, the significance of both comorbidities diabetes will continue to increase with the increasing age of populations. Therapies which have seemingly proven to decrease the macrovascular and microvascular complications will require to be assessed under the consideration of comorbidities which are identified newly.

The change in lifestyle has proven to be successful in delaying or preventing the Type 2 diabetes’ onset in individuals who are at a high-risk. On the basis of this, new approaches of public health are emerging that might have competent monitoring a national level. For instance, the research trial of Diabetes Prevention Program demonstrated that the intervention of lifestyle had its effect in the adults who were older and it was successful all ethnic and racial groups. The usual studies regarding this work have demonstrated that lifestyle intervention’s delivery the settings of group at a level of community are also successful in reducing the risk of Type 2 diabetes. The program of National Diabetes Prevention has been established now for implementing this intervention of lifestyle in the whole nation.

It can be said that another merging issue is the impact of new criteria which is based on laboratory on public health like introducing the utilization of A1c for the diagnosis of this disease of Type 2 diabetes. These changes might affect the number of people who are undiagnosed while facilitating Type 2 diabetes introduction. It has been suggested by several studies that process indicators like eye exams and foot exams might not be sufficiently sensitive for capturing every aspect of quality of care that results ultimately in lower morbidity. New quality of care indicators of diabetes are actually under development and might assist in determining whether evidence-based, timely, and appropriate care is connected to the reduction of risk factor. Additionally, the scientific evidence that the Type 2 diabetes can be somehow delayed or prevented has seemingly stimulated a new study into the best approaches and markers for referring and identifying individuals at a high-risk to prevention programs in diabetes or its complications by affecting several factors of behavioral risk like certain dietary choices, which haven’t been experimented in trials which are controlled and randomized(Kalyani, Saudek, Brancati, & Selvin, 2010).

According to Zhuo, Zhang, and Hoerger(2013), diabetes’ progressive nature and the resulting reliance on medicines seem to pose very significant challenges for many healthcare systems and patients. In spite of the improvements in safety and efficacy of the prevalent medications, the issue with adherence still is there. Recognizing the determinants of sticking and adherence might have the system, provider, and patient-focused strategies for ensuring and encouraging optimized adherence and ultimately medical or clinical results. Recent developments and advances in the technology might have also helped in lifting the weight which is related to nonadherence and methods for the adjustments in doses. Medication adherence of patient is a very significant component to successful treatment, and adherence to the therapies which are prescribed can delay or prevent the complications’ onset, decrease the hospitalization risk, and reduce the direct costs of healthcare. This adherence seems to go beyond the passive act of simply following a recommendation of a prescriber. It also includes an agreement by patients for purchasing medications and taking them in accordance with the schedule and does which is prescribed by the healthcare expert. But lack of adherence to medication is not always the mistake or fault of the patient. The adherence barriers can simply be classified into 3 categories including external factors, provider factors, and patient factors.

Barriers which related with patients include sociocultural factors, educational levels, ethnicity, gender, age, health beliefs, fear, comorbid condition, and marital status. It is highlighted by an interesting study just how a mix of demographics can impact the adherence differentially. A research on Hispanic women and men with the disease of diabetes highlighted that there were less probable in receiving the support of treatment and facing great obstacles to the treatment in comparison with the Hispanic men. Among the Hispanic women, the perceived support was associated importantly with self-efficacy which is better, which in turn was associated significantly with the adherence of better self-care. Medication beliefs and health literacy together with the knowledge of patients of the illness and its treatment also have a part in whether patients will be adhering to the regimen of treatment. The attitudes which are positive tend to be related to better outcomes of adherence. A survey focusing on patients with the T2D demonstrated that beliefs about the benefit of treatment were associated significantly with the adhering intent to the treatment while beliefs which are negative were related to the reduced adherence to medication. The education about disease plays a significant role in just how the patient seems to perceive the disease and its threat. However, the information on diabetes along can be referred to as not sufficient or enough for self-management which is effective. Research on patients with the diabetes consistently demonstrates that the information on diabetes is not an individual factor which is associated with adherence to medication, exercise, diet, and self-care. Access, motivation, and confidence towards care also play significant and critical roles. 

The providers of healthcare play a significant part in the adherence to treatment through their association with the patient. Creating a successful environment that centers the patient, provides patient education, and ensures open communication can assist the patients effectively in overcoming the barriers.Making sure that patients meet their appointments of follow-up and have a sufficient support along with monitoring of patient are significant elements in delivering successful healthcare while encouraging the patients for adhering to the treatment. Systematic methods of patient assessment like the MTM or medication therapy management, Spider WEB, can assist the training clinicians in integrating adherence considerations consistently into care plans which are patient-centers that promote and don’t hinder the adherence of patient. 

External factors can actually be associated with the treatment or disease itself. The potency of the disease, its response, and duration in terms of treatment all seem to play a significant role in influencing the perception of patients regarding the diseases and their adherence. Factors which are associated with the medication are some of the most common factors for non-adherence to the treatment of insulin. Such factors include adverse effects, access to care, and cost. A research regarding 507 students with the disease of diabetes highlighted that only twenty-two percent of the patients with diabetes of 1 type and twenty-four percent of the patients with T2D had a high adherence to the treatment. Adverse eveents which are associated with the treatment including weight gain, feeling bad after the injection of insulin, and reactions of injection-site were associated significantly with low adherence. Difficulties, cost, and insulin shortage in preparing the injection also were importantly related with low adherence.

The cost of treatment, specifically with a low status of socioeconomic might be a factor which is limiting to the medication adherence. Researches have actually shown that costs which are related to the treatment of diabetes might seemingly result in patients that are diagnosed newly not seeking care after diagnosis, or inappropriate, or inconsistent usage of medication. A regression and bivariate analysis of the 2011-13 Survey of Medical Expenditure Panel highlighted that among the adults who are privately insured with diabetes that compared low deductible with no-deductible group. The group which is low-deductible has twenty-seven percent of the primary visits of care. Thirty-nine percent of checkups and seventy-seven percent fewer visits of specialty care(Zhuo, Zhang, & Hoerger, 2013).

According to Ikonen, Sund, Venermo, and Winell(2010), in Finland, the presence of Type 2 diabetes have actually been raised quite considerably recently and the figures from the Association from Finnish Diabetes estimates that there three-hundred and thousand individuals diagnosed with Type 2 diabetes and there are countless others with diabetes which are undiagnosed. The increasing and high availability with the Type 2 diabetes management in both growing and substantial.

In Finland, the healthcare systems offers universal coverage, even though this is organized largely on a municipal level instead of national level, resulting is some type of variation in the allocation of resource among different municipalities. Diabetes treatment is normally reimbursed fully in Finland and it is actually estimated that the management of related complications and diabetes now accounts for almost twelve to fifteen percent of the total healthcare investment.

Additionally, almost ninety percent of the medical costs which are direct are related to diabetes can be attributed to the management of complications which are related to diabetes with an annual direct costs for the patients with Type 2 diabetes with complications which are related to diabetes and is being almost twenty times higher than for the patients without any type of complications. Complications which are macrovascular in particular are the complications which are the leading cause of mortality and morbidity in patients who are suffering from diabetes, and these complications seem to account for a sufficient proportion for the complete utilization of healthcare resource. For instance, in 2002, in Finland, it was measured that twenty-five percent of all the myocardial infractions and additional fifty-four to sixty percent of the amputations of lower limb occurred in individuals suffering from diabetes.

The analysis was carried out utilizing the Diabetes Model of IQVIA CORE ICDM which is actually a validated long-term model of cost-effectiveness that can be used for analyzing either Type 2 diabetes or Type 1 diabetes. It is simply based on a series of sub-models which are inter-dependent in a structural way including renal, ophthalmic, and cardio-vascular complications; diabetic food, neuropathy, and peripheral vascular illness complications; along with acute events which include hypoglycemic events.

The sub-models actually have a structure of semi-Markov together with diabetes which depend on probabilities which are derived from the published literature for simulating the progression of disease. Simulation of Monte Carlo using the tracker variable for overcoming the properties which are memory-less of a standard model of Markovf and allows for interaction and interconnectivity among sub-models. For each simulation of model a cohort of almost thousand simulated patients was operated through the model which used the first-order simulation of Monte Carlo.

In Finland, it can be said that CSII is more likely to highlight a treatment alternative which is cost-effective for patients with the Type 2 diabetes and poor or inefficient glycemic control in spite of the MDI optimization. CSII is seemingly related to clinical outcomes which are associated with MDI with a high costs of acquisition partly offset by a decreased lifetime cost and incidence of complications which are related to diabetes(Ikonen, Sund, Venermo, & Winell, 2010).

Arora, Peters, Burner, Lam, and Menchine(2014) explains that interventions of text message have a potential for a very high population; need minimal resources and it can be translated into existing services and routine practice. Ninety-six percent of adults in Australia utilize phones and it has been determined that this utilization is quite high amongst individuals from remote, rural, and socioeconomic areas and those with a higher index of body mass, health comprises lower levels and behaviors of health which is self-rated.

Characteristics which are socio-demographic align quite closely with the ones having quite a high percent of diabetes which are Type 2, suggesting that the intervention of text message could be quite an authentic method for supporting the self0management of their conditions. It has been shown by research that interventions of text message can optimize cardiac patients’ short-term health, help in promoting the cessation of smoking, and help in the weight loss by offering prompts, support, reminders, and information. Researches have also determined that the text messaging can help in lowering the blood pressure while improving the adherence to medication, weight loss, physical activity, and glycaemic control. However, these researches have actually been limited because of the factors such as a short duration of study, lack of theories, and small size of sample(Arora, Peters, Burner, Lam, & Menchine, 2014).

The trial which is randomized controlled will seemingly include 2 parallel arms, a control arm, and an intervention. The six-month intervention of arm will be received in the arm. Both of the arms will obtain the usual care from their health professionals and treating doctor. The intervention of text message was actually developed by an expert panel of health promotion staff, academics, and clinicians using guidelines which are based on evidence along with recommendations. The content of the designed messages actually have a readability grade of 5-6. Each and every message was seemingly limited to one-hundred and sixty characters and no message was repeated during the process of intervention. Furthermore, the messages were tested with twenty individuals with Type 2 diabetes in a pilot program of 5 week pilot for determining the message acceptability and ensuring the content of message, structure, and tone was authentic. And adjustments to the messages simply were made on the basis of feedback of participant pilot. The text messages of DTEXT were just designed utilizing the system of COM-B from the Wheel of Behavior Change(Liang, et al., 2011).

This system actually raises the motivation, opportunity, and capability of an individual for enhancing their self-management of lifestyle and health associated with behaviors with the objective of optimizing the control of diabetes. Behavior change of an individual is actually a critical component for achieving the conditions’ self-management(Borus & Laffel, 2010).

Future Implications of Impact of Type 1 Diabetes and its Prevention

One of the most common issues that have been identified while reading the reviews and conducting a systematic literature review on finding the human and financial impact of Type 2 diabetes is that there weren’t suitable resources that allowed the authors to conduct their study on a better and larger scale. Diabetes is actually an epidemic that is increasing at a drastic pace and as the time is passing, patients with diabetes are increasing. Authors require enough resources for conducting their study and researching the issues. These resources include time, cost, and work. Considering the fact that the topic is all about massive international issue like diabetes, it is understandable that the authors have to not only conduct research but they also have to study the past works. Some of the theories and models in the studies are not accessible and they require the authors to invest their money in purchasing the sources from which they can gain information. Furthermore, finding the suitable resources for credible information also needs a lot of time because not all the sources are available on the internet. Therefore, authors also have to search manually by visiting libraries and other societies, where they can get the required information. This whole process is very time-costly and it is quite a long process because authors cannot access all the require data so quickly. Another important complication is that there is a lack of practicality in the models which have been designed and implemented. Models need to be implemented on patients suffering from Type 2 diabetes and it hasn’t been possible in most of the studies. This is a major limitation that has been observed in the articles utilized for finding the data. Studies that focus on such a big and international disease must have sufficient resources along with a large size of sample on which the proposed model can be applied and findings can be achieved for suggesting the results.

For improving the potential of the studies, it is important to use more theories in the research and attempt to use the information which incorporates facts or data with the statements because it demonstrates that statements are not based on evidence. Furthermore, it is critical for the authors to utilize larger sample sizes for conducting their surveys and implementing their models to gain the information which can be relied upon for extending the studies. It can be said that this study will be used as a foundation for conduction further studies and conducting research on the Type 2 diabetes which has become one of the most common non-communicable diseases.

References of Impact of Type 1 Diabetes and its Prevention

Arora, S., Peters, A. L., Burner, E., Lam, C. N., & Menchine, M. (2014). Trial to examine text message–based mHealth in emergency department patients with diabetes (TExT-MED): A randomized controlled trial. Annals of emergency medicine, 63(6), 745-754.

Borus, J. S., & Laffel, L. (2010). Adherence challenges in the management of type 1 diabetes in adolescents: prevention and intervention. Current opinion in pediatrics, 22(4).

Breeze, P. R., Thomas, C., Squires, H., Brennan, A., Greaves, C., Diggle, P. J., . . . Chilcott, J. (2017). The impact of Type 2 diabetes prevention programmes based on risk‐identification and lifestyle intervention intensity strategies: a cost‐effectiveness analysis. Diabetic Medicine, 34(5), 632-640.

CDC. (2019). Diabetes—A Major Health Problem. Retrieved from CDC: https://www.cdc.gov/diabetes/ndep/pdfs/ppod-guide-diabetes-major-health-problem.pdf

Foos, V., Varol, N., Curtis, B. H., Boye, K. S., Grant, D., Palmer, J. L., & McEwan, P. (2015). Economic impact of severe and non-severe hypoglycemia in patients with Type 1 and Type 2 diabetes in the United States. Journal of Medical Economics, 18(6), 420-432.

Haghparast-Bidgoli, H., Shaha, S. K., Kuddus, A., Chowdhury, M. A., Jennings, H., Ahmed, N., . . . Batura, N. (2018). rotocol of economic evaluation and equity impact analysis of mHealth and community groups for prevention and control of diabetes in rural Bangladesh in a three-arm cluster randomised controlled trial. BMJ Open, 8(8).

Healthypeople. (2019). Diabetes. Retrieved from Healthypeople: https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes

Hippisley-Cox, J., Coupland, C., Vinogradova, Y., Robson, J., & Brindle, P. (2008). Performance of the QRISK cardiovascular risk prediction algorithm in an independent UK sample of patients from general practice: a validation study. Heart, 94(1), 34-39.

Ikonen, T. S., Sund, R., Venermo, M., & Winell, K. (2010). Fewer major amputations among individuals with diabetes in Finland in 1997–2007: a population-based study. Diabetes care, 33(12), 2598-2603.

Kalyani, R. R., Saudek, C. D., Brancati, F. L., & Selvin, E. (2010). Association of diabetes, comorbidities, and A1C with functional disability in older adults: results from the National Health and Nutrition Examination Survey (NHANES), 1999–2006. Diabetes care, 33(5), 1055-1060.

Liang, X., Wang, Q., Yang, X., Cao, J., Chen, J., Mo, X., . . . Gu, D. (2011). Effect of mobile phone intervention for diabetes on glycaemic control: a meta‐analysis. Diabetic medicine, 28(4), 455-463.

Morello, C. M., & Hirsch, J. D. (2017). Utilizing Advances in Diabetes and Targeting Medication Adherence to Enhance Clinical Outcomes and Manage Costs for Type 2 Diabetes Posttest.

Roze, S., Smith-Palmer, J., Delbaere, A., Bjornstrom, K., Portu, S. d., Valentine, W., & Honkasalo, M. (2019). Cost-Effectiveness of Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections in Patients with Poorly Controlled Type 2 Diabetes in Finland. Diabetes Therapy , 1-12.

Waller, K., Furber, S., Bauman, A., Allman-Farinelli, M., Dolder, P. v., Hayes, A., & al., F. F. (2019). DTEXT–text messaging intervention to improve outcomes of people with type 2 diabetes: protocol for randomised controlled trial and cost-effectiveness analysis. BMC public health, 19(1), 262.

Zhuo, X., Zhang, P., & Hoerger, T. J. (2013). Lifetime direct medical costs of treating type 2 diabetes and diabetic complications. American journal of preventive medicine, 45(3), 253-261.