Page 64 - Glucose Monitoring Devices

62 CHAPTER 4 Consequences of SMBG systems inaccuracy

FIGURE 4.5
Effect of HbA1c on the increased risk of complications.
Based on Fortwaengler K, Parkin CG, Neeser K, Neumann M, Mast O. Description of a new predictive modeling
approach that correlates the risk and associated cost of well-defined diabetes-related complications with
changes in glycated hemoglobin (HbA1c). Journal of Diabetes Science and Technology 2017;11(2):315e323.

Quality of Glycemic Control
(e.g., HbA1c)

Nonproliferative Proliferative
Normal Macular Edema Blindness
Retinopathy Retinopathy
FIGURE 4.6
Markov chain model of progression of retinopathy. Dotted lines represent how HbA1c
affects the likelihood of a patient transitioning to a more advanced stage of the disease.
Adapted from Zhou H, et al., A computer simulation model of diabetes progression, quality of life, and cost.
Diabetes Care 2005;28(12):2856e63.
From clinical performance to financial outcomes
Once the incidence of short- and long-term complications has been established,
attaching a financial cost is straightforward. In Refs. [86,87,92], the overall
economic value of a certain level of clinical performance (measured as changes to
HbA1c) is reported for Canada [86] and England [87,92]. In addition to direct finan-
cial figures, the impact of accuracy can also be expressed in QALYs [93]. In addition
to relating meter accuracy, short-term clinical outcomes, such as HbA1c, and
long-term outcomes and costs, in silico studies have also looked at the relationship
between compliance with ISO accuracy standards (ISO 15197:2003 and 15197:
2013) and costs [92].