Pharmacogenetics and Pharmacoeconomics Exploration Diabetes

Pharmacogenetics and Pharmacoeconomics Exploration
Introduction
It is important to note, from the onset, that according to the Centers for Disease Control and Prevention – CDC (2018), it is estimated that in the U.S., 30.3 million people have been diagnosed with diabetes thus far. As CDC further points out, within the last two decades, the number of persons diagnosed with the condition has increased by a multiple of 3. This is a clear indicator of the existing need for interventions seeking to salvage the situation. In the long-term, the treatment as well as management of diabetes also happens to be rather costly. According to the American Diabetes Association – ADA (2018), “the estimated total economic cost of diagnosed diabetes in 2017 was $327 billion.” Each year, there are approximately 1.5 million new diagnoses made for diabetes. This text seeks to explore pharmacogenetics and pharmacoeconomics principles in relation to pharmacological treatment as well as patient outcomes. In so doing, the management of type 2 diabetes will be the primary focus. This is more so the case given that type 2 diabetes accounts for a vast majority of diabetes cases.
Discussion
Diabetes presents a staggering economic as well as social burden. As a matter of fact, in 2018, diabetes was listed as a leading cause of death – with the condition assuming the 7th position in this case (CDC, 2018). Further, it is important to note that as Cohen (2010) observes, in the year 2017, the condition used up a total of $245 billion in direct and direct costs. As various research studies conducted in the past have indicated, comorbid conditions usually get in the way of the effective treatment and management of diabetes. Some of the more common comorbid conditions include, but they are not limited to, coronary artery disease, hypertension, and hyperlipidemia. It should be noted that failure to effectively manage the said conditions often causes a significant increase in the cost burden, while at the same time reducing the quality of life. For instance, given that cardiovascular disease has been linked to a high number of deaths amongst persons with diabetes, the management of the former could lead to better outcomes for the latter. As Cohen (2010) points out, outcomes could also be worsened by a wide range of other factors. For instance, depression could result in poor-self management and failure to properly adhere to the treatment regimen. It therefore follows that the quality of life and glycemic outcomes can in this case be enhanced via the effective management of the comorbid conditions. The economic burden would also be reduced as a consequence.
Antidiabetic pharmaceutical choices are routinely impacted upon by a wide range of global trends. These could be inclusive of “increasing numbers of patients with diabetes, with increasing costs of caring for people with diabetes, and an ever-present focus on the costs of pharmaceuticals…” (Rascati, 2013, p. 201). It is important to note that the authors further observe, the said costs are largely expected to increase going forward as the growing incidence of diabetes mirrors new medications development pace. Pharmacoeconomics permits the application of health economics methodologies as well as principles in diverse pharmaceutical settings. For this reason, the main focus in this case is the assessment and evaluation of the incremental benefits of intervention vis-à-vis the associated costs. .
According to Cohen (2010), “pharmacogenetics and pharmacogenomics investigate the influence of genetic and genomic variations on drug response in individuals” (73). Pharmacogenomics, on the other hand, seeks to assess and evaluate medication responses and the inherent genetic mediators. As far as pharmacogenomics is concerned, studies conducted in the past have indicated that the same does play an important role in the further enhancement of pharmacotherapy outcomes in a variety of conditions. Various agents having different side effect profiles, efficacy, as well as mechanism of action and pharmacokinetics make up the pharmacotherapy for type 2 diabetes. Towards this end, it would be prudent to take into consideration thiazolidinediones, sulfonylureas, and metformin. Two of the thiazolidinediones for the management of type two diabetes include rosiglitazone and pioglitazone. It is important to note that as a result of the risk the medications carry with regard to triggering or causing fractures, heart failure, and edema, they are listed as 5th line agents by the AACE. The medications are, however, listed as second-line agents by the ADA. In essence, thiazolidinediones “increase insulin sensitivity via activation of peroxisome proliferator-activated receptor” (Lecka-Czernik and Fowlkes, 2015, p. 130). When it comes to sulfonylureas, it should be noted that they happen to be some of the most frequently prescribed drugs in the treatment as well as management of type 2 diabetes. However, as Cohen (2010) observes, the introduction of new medications into the diabetes treatment equation has rendered their utilization less frequent, and perhaps somewhat controversial. This is more so the case given that the risk of hyperglycemia is minimal with newer medications. Basically, sulfonylureas “function as insulin secretagogues… activates sulfonylurea receptors on the surface of pancreatic ? cells and stimulates exocytosis of insulin from vesicles” (Lecka-Czernik and Fowlkes, 2015, p. 135).
Lastly, we have metformin. When it comes to the treatment of type 2 diabetes, two premier organizations – i.e. the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) – regard these as first-line monotherapy. Unlike is the case with thiazolidinediones, there are several observational studies conducted in the past that have indicated that metformin does no present any significant fracture risk. Essentially, “metformin mechanism of insulin sensitization includes activation of hepatic and muscle AMP-activated protein kinase (AMPK), which results in suppression of fatty acid oxidation in liver and increase in muscle glucose uptake” (Lecka-Czernik and Fowlkes, 2015, p. 129). The World Health Organization (WHO) considers metformin to be an essential medicine. For this reason, it is consistent with expectations on the comparative cost-effectiveness, safety as well as efficacy fronts (Lecka-Czernik and Fowlkes, 2015). Having assessed the relevant agents as far as the pharmacotherapy of type 2 diabetes is concerned, it is important to note that in recent years, varies newer agents that lower glucose have been introduced. These are inclusive of, but are not limited to GLP1 agonist and SGLT2 inhibitors. Extensive studies are, however, yet to be done for some of the newer medications.
Conclusion
In the final analysis, it should be noted that as Rascati (2013) observes, “the fields of pharmacogenetics and pharmacogenomics have become important practical tools to progress goals in medical and pharmaceutical research and development.” The treatment of type 2 diabetes mellitus continues to be a rather complex undertaking. This is particular the case taking into consideration not only the comorbidities and complications, but also the various treatment options and risk factors. Thus, it is important to note that diabetes continues to pose a significant economic as well as social burden for the country. There is sufficient evidence to the effect that the treatment of some of the conditions closely linked to diabetes (i.e. cardiovascular conditions) continues to improve with pharmacogenomic testing. As it has been pointed out elsewhere in this text, the economic burden of diabetes happens to be immense. With this in mind, the relevance of subjecting pharmacogenomics as well as pharmacogenetic treatment approaches to economic evaluations cannot be overstated.

References
American Diabetes Association – ADA (2018). Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 41(5), 917-928.
Cohen, N. (2010). Pharmacogenomics and Personalized Medicine. New York, NY: Humana Press.
Centers for Disease Control and Prevention – CDC (2019). About Diabetes. Retrieved from https://www.cdc.gov/diabetes/basics/diabetes.html
Lecka-Czernik, B & Fowlkes, J.L. (Eds.). (2015). Diabetic Bone Disease: Basic and Translational Research and Clinical Applications. Belmont, CA: Springer
Rascati, K. (2013). Essentials of Pharmacoeconomics (2nd ed.). New York, NY: Lippincott Williams & Wilkins.