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Background. Type 2 diabetes mellitus (T2DM) and its complications are the major causes of long-term disability, significant performance loss, and premature mortality. Poor glycemic control, diabetes-related complications, and insulin therapy are associated with a significant increase in diabetes costs. The high cost of insulin analogues restricts reimbursement of their costs in some countries. Comprehensive clinical and economic assessments of different insulin analogues are the useful tool that may help policy-makers to set priorities in medicine provision within the existing system of healthcare funding. Aim — to compare the clinical and economic effectiveness of insulin degludec (100 U/mL) and insulin glargine (100 U/mL) in basal-bolus therapy for T2DM. Material and methods. Economic evaluation was based on cost effectiveness analysis (CEA), incremental cost-effectiveness ratio (ICER), cost effectiveness modelling (using 5-year time horizon), sensitivity analysis, and economic feasibility assessment. The clinical effectiveness was evaluated based on changes in the HbA1c level, frequency of severe hypoglycemia, and number of patient-years without complications. Only direct medical costs (costs for insulin therapy and treatment of severe hypoglycemia and diabetes-related complications) were analyzed. Results. The mean total direct medical costs amounted to 783,789 RUR/patient for degludec (of these, the cost of insulin therapy accounted for 68%) and 730,805 RUR/patient for glargine (of these, the costs for treatment of severe hypoglycemia and diabetes complications accounted for 62.58%). Degludec has a higher efficacy (additional HbA1c reduction by 0.52%), lower rate of severe hypoglycemia, and larger number of complication-free patient-years. Incremental costs (ICER) for degludec amounted to 101,236 RUR/patient (based on a decrease in the HbA1c level) and 353,224 RUR/patient (based on an increase in the number of complication-free patient-years); these values were 14.3- and 4.1-fold lower than the threshold of willingness-to-pay, respectively. Additional analysis of costs in patients with severe hypoglycemia rates of 3 and >3 events/patient/year demonstrated that the estimated mean total costs for insulin degludec were lower by 5 and 23%, respectively, than those for insulin glargine. Conclusion. Our findings demonstrate the clinical and cost benefits of insulin degludec in T2DM patients, which supports its broader use in routine clinical practice for achieving the best glycemic control with minimal adverse effects.

The objective of many research works in educational field of studies is the discovery of the natural student's motivation to study, timely personal development planning in order to make the best and individually adequate educational choice. For that purpose, the following studies have been performed: statistical analysis of the first year performance for a cohort of more than ten thousand students of the University of Alicante, data intellectual analysis, decision on alternative educational alternatives ranging for every students including the competence management (aptitudes, cognitive and social models). The ontology has been developed in order to rationalize, organize and automate the processes, procedures of the decision support system, based on the rules and precedents within the semantic net context notions of the study area.

[EN] The aim of this work is to help university applicants in their transition phase from high-school to tertiary education starting with their first life-long decision concerning their choice of the field of study. The construction of the decision support system has evolved into an ontology-based model. The model, as well as the decision making rules, have been formulated based on the research study of the cohort of 69000 students of the University of Alicante between 2010 and 2018. The educational and psychological processes have been studied in order to identify the pivot moments and the factors that may lead to an adequate decision making or to an objectively wrong decision which eventually ends up in a drop-out of studies. Analysing the existing methods of occupational and educational choice assistance, the method of John L. Holland on “A Psychological Classification of Occupations” has been selected as the most viable and convenient for this purpose. The Holland Codes have been adopted as a lingua franca of this ontology-based model. As a result, the ontology-based decision support system provides assistance in decision making using the Holland Code terminology and practically unlimited complexity of the object and data properties of and ontological presentation of knowledge., This work made use of the methods and models developed under the RFBR Grant 18-00-00238 "Methods and models of the intellectual decision support in innovative project management on the basis of knowledge of engineering".

Combining GLP-1 analogs and insulin has complementary benefits, but long-term data are sparse. In the LEADER cardiovascular (CV) outcomes trial (N=9340; median follow-up 3.8 years; NCT01179048), rates of major CV events and hypoglycemia were lower when liraglutide vs. placebo was added to standard care (frequently including insulin) in patients with type 2 diabetes (T2D) at high risk for CV disease, and there were improvements in control of glycemia, body weight, systolic blood pressure (SBP) and lipids. This post-hoc subgroup analysis assessed these outcomes by baseline insulin use: no insulin vs. basal-only vs. other. At baseline, 5171 (55%) patients were not on insulin treatment, 3159 (34%) were on basal-only insulin and 1010 (11%) were treated with other insulin regimens (9.7% premix). Insulin use at baseline was balanced overall between randomized treatment groups, but fewer patients randomized to liraglutide (29%) vs. placebo (43%) initiated in-trial insulin. In the basal-only subgroup, liraglutide reduced A1C vs. placebo (estimated treatment difference [ETD]: −0.48%, 95% CI: −0.57; −0.38), with a significant reduction in severe hypoglycemia rate (estimated rate ratio: 0.42, 95% CI: 0.26; 0.68). Liraglutide also reduced weight (ETD: −2.5 kg, 95% CI: −3.0; −2.1) and there were trends for reductions in SBP (ETD: −1.1 mmHg, 95% CI: −2.4; 0.1) and LDL cholesterol (ETD: -1.3 mg/dL, 95% CI: -3.6; 1.0). The CV risk reduction observed with liraglutide in the full trial population was similar in the basal-only subgroup (estimated hazard ratio: 0.84, 95% CI: 0.70; 1.00). Results were similar in the no-insulin subgroup. There was heterogeneity in the results for the smaller, other insulin subgroup with reductions in A1C and weight, but no significant differences in other endpoints. In conclusion, in basal insulin-treated patients with T2D and high CV risk, treatment with liraglutide improved glycemic control, reduced body weight and halved the severe hypoglycemia risk, with a similar CV risk reduction to patients not on insulin. Disclosure C. Tack: Advisory Panel; Self; Merck Sharp & Dohme Corp., Novo Nordisk A/S, AstraZeneca. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Novo Nordisk A/S. S. Jacob: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH, AstraZeneca, Eli Lilly and Company. Board Member; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk Foundation. Advisory Panel; Self; MSD K.K.. Speaker's Bureau; Self; MSD K.K., Menarini Group, Roche Diabetes Care Health and Digital Solutions. C. Desouza: Consultant; Self; Novo Nordisk A/S, Sanofi. Research Support; Self; Merck & Co., Inc.. Advisory Panel; Self; Medscape. S.C. Bain: Research Support; Self; Novo Nordisk Inc., AstraZeneca. M.A. Nauck: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Fractyl Laboratories, Inc., GlaxoSmithKline plc., Berlin-Chemie AG, Merck Sharp & Dohme Corp., Novo Nordisk A/S. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Berlin-Chemie AG, Merck Sharp & Dohme Corp., Medscape, Novo Nordisk A/S. Research Support; Self; AstraZeneca, Berlin-Chemie AG, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, GlaxoSmithKline plc., Novo Nordisk A/S. Consultant; Self; Nordic Bioscience, Empros. J. Petrie: Advisory Panel; Self; Novo Nordisk A/S. Other Relationship; Self; Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Pfizer Inc.. Consultant; Self; Novo Nordisk A/S. Research Support; Self; Merck KGaA, Itamar Medical Ltd., Janssen Pharmaceuticals, Inc.. Other Relationship; Self; Diabetes UK, Applied Clinical Intelligence Ltd, Bayer AG, QuintilesIMS. N.R. Poulter: Advisory Panel; Self; AstraZeneca, Novo Nordisk A/S, Amgen Inc.. Research Support; Self; Servier. Speaker's Bureau; Self; AstraZeneca, Novo Nordisk A/S, Amgen Inc., Servier. Other Relationship; Self; International Society of Hypertension. R.E. Pratley: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eisai Inc., GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Ligand Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Pfizer Inc., Sanofi-Aventis, Takeda Development Center Americas, Inc. H. Stegmann: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. H. Bosch-Traberg: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. E. Startseva: Employee; Self; Novo Nordisk A/S. B. Zinman: Consultant; Self; Novo Nordisk A/S, Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Sanofi, Merck & Co., Inc., Abbott.