[PDB74] Ethical dilemmas of pharmacological treatment and self management of diabetes: a review of the literature

[PDB74] Ethical dilemmas of pharmacological treatment and self management of diabetes: a review of the literature

2009 Value in health

Jensen, R.C.Ã | Kaas, C. | Toumi, M. | Hemels, M. | Volume: 12, Issue: 7, Pages: A415,

OBJECTIVES: There is increasing focus on the ethical analysis in Health Technology
Assessments (HTA). Due to the escalating epidemic of diabetes, diabetes has become
an urgent health concern. We therefore systematically reviewed published articles
describing the ethical aspects of pharmacological treatment and self management
of diabetes. METHODS: PubMed was searched from inception to 2009 using the
following combinations of keywords: ethics AND diabetes NOT screening NOT
transplant. Articles were initially screened for relevance by reading title and abstract.
If deemed appropriate, by two independent reviewers, full copies of the remaining
articles were retrieved for further review. RESULTS: Out of 336 articles, only six
studies were deemed appropriate. The main reason for this high level of rejected articles
was that the majority of identified articles commented on the ethical approval in
connection to conducting clinical studies rather than on the ethical aspects of implementing
and using the specific technology. One study described the ethical concern
related to the costly late complications of diabetes compared to preventing late complications
by prescribing and reimbursing insulin. Other ethical issues concerned
self management and the transferral of responsibility from physician to patient and
the patient’s capabilities for self management. For people with impaired glucose tolerance
there were also ethical issues related to initiating a preventive pharmacological
treatment of the “otherwise well”. Lastly, there is an ethical issue between the normative
gold standard for a healthy and moral lifestyle and a culture of self that values
authenticity and originality. CONCLUSIONS: Due to the escalating prevalence
of diabetes and emphasis on ethical analysis in HTAs, both payers and the industry
needs to get a better understanding of the ethical aspects of self management and
pharmacological treatment of diabetes. More research should be allocated towards
investigating the ethical aspects of self management and pharmacological treatment
of diabetes.