Mcewan, Phil;
Foos, Volker;
Roberts, Geraint;
Jenkins, Robert H;
Evans, Marc;
Wheeler, David C;
Chen, Jieling;
(2025)
Beyond glycated haemoglobin: Modelling contemporary management of type 2 diabetes with the updated Cardiff model.
Diabetes, Obesity and Metabolism
, 27
(4)
pp. 1752-1761.
10.1111/dom.16141.
(In press).
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Abstract
Aims: Recommendations on the use of newer type 2 diabetes (T2D) treatments (e.g., SGLT2 inhibitors and GLP-1 receptor agonists [RA]) in contemporary clinical guidelines necessitate a change in how T2D models approach therapy selection and escalation. Dynamic, person-centric clinical decision-making considers factors beyond a patient's HbA1c and glycaemic targets, including cardiovascular (CV) risk, comorbidities and bodyweight. This study aimed to update the existing Cardiff T2D health economic model to reflect modern T2D management and to remain fit-for-purpose in supporting decision-making. Materials and Methods: The Cardiff T2D model's therapy selection/escalation module was updated from a conventional, glucose-centric to a holistic approach. Risk factor progression equations were updated based on UKPDS90; the cardio-kidney-metabolic benefits of SGLT2i and GLP-1 RA were captured via novel risk equations derived from relevant outcomes trial data. The significance of the updates was illustrated by comparing predicted outcomes and costs for a newly diagnosed T2D population between conventional and holistic approaches to disease management, where the latter represents recent treatment guidelines. Results: A holistic approach to therapy selection/escalation enables early introduction of SGLT2i and GLP-1 RA in modelled pathways in a manner aligned to guidelines and primarily due to elevated CV risk. Compared with a conventional approach, only considering HbA1c, patients experience fewer clinical events and gain additional health benefits. Conclusions: Predictions based on a glucose-centric approach to therapy are likely to deviate from real-world observations. A holistic approach is more able to capture the nuances of contemporary clinical practice. T2D modelling must evolve to remain robust and relevant.
| Type: | Article |
|---|---|
| Title: | Beyond glycated haemoglobin: Modelling contemporary management of type 2 diabetes with the updated Cardiff model |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/dom.16141 |
| Publisher version: | https://doi.org/10.1111/dom.16141 |
| Language: | English |
| Additional information: | © 2025 AstraZeneca and The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Endocrinology & Metabolism, cardiovascular disease, GLP-1, health economics, pharmaco-economics, SGLT2 inhibitor, CARDIOVASCULAR OUTCOMES TRIALS, LIFETIME HEALTH OUTCOMES, COMPLICATIONS, SIMULATE, NIDDM |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Renal Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10208276 |
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