National Clinical Guideline on Adult type 1 diabetes mellitus
The National Clinical Effectiveness Committee (NCEC) requires inclusion of evidence on both the clinical- and cost-effectiveness of health technologies in the development of all National Clinical Guidelines in Ireland. Additionally, the completion of a budget impact analysis (BIA) is a required step in the development of National Clinical Guidelines in Ireland. The role of HRB-CICER is to independently review evidence and provide scientific support for the development, by guideline development groups, of these evidence-based National Clinical Guidelines.
The Adult type 1 diabetes mellitus guideline has been developed through contextualisation of the NG17 Type 1 diabetes in adults: diagnosis and management, published by the National Institute for Health and Care Excellence (NICE) in the United Kingdom in 2015. As part of the contextualisation process, HRB-CICER reviewed the economic literature underpinning the 2015 NICE guideline to ensure that the economic evidence was relevant to the Irish healthcare setting.
A BIA was conducted to quantify the resource implications to the Health Service Executive (HSE) following implementation of the guideline. There are three key changes to service delivery that will occur as a result of implementation of the guideline recommendations. These are:
- the national provision of a high-quality structured patient education programme to empower people with Type 1 diabetes to effectively manage their diabetes and the external factors that can influence their blood glucose levels such as exercise and stress
- the standardisation of patient follow-up in diabetes clinics where patients are recalled at least every six months
- short courses for all staff who deliver care to people with Type 1 diabetes in Ireland.
Type 1 diabetes is a chronic autoimmune disease that arises following the destruction of insulin-producing beta cells in the pancreas. As a result, people with Type 1 diabetes require insulin therapy to adequately regulate blood glucose levels. In the short term, people with Type 1 diabetes may face significant challenges to daily living such as hyperglycaemia, hypoglycaemia and ketoacidosis, while long-term complications can occur in the form of both microvascular complications, such as diabetic retinopathy and neuropathy, and macrovascular complications such as stroke and coronary artery disease.
The additional strain placed on healthcare resources when diabetes patients are hospitalised illustrates that diabetes-related complications impose not only a significant burden on patients and the healthcare system, but can also have a substantial societal impact due to productivity losses (such as days off work because of illness).
The review, in line with NICE contextualisation methodology, was constrained to literature identified in the systematic review that informed the 2015 NICE guideline and economic evidence available from within the Irish healthcare context. The review followed HIQA guidelines for the retrieval and interpretation of economic literature.
The BIA was conducted in accordance with the HIQA guidelines for budget impact analysis and economic evaluation in Ireland.