Diabetes In Colombia Research Articles

P132 CARDIOVASCULAR RISK ASSESSMENT IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES: A CROSS-SECTIONAL EPIDEMIOLOGICAL STUDY IN COLOMBIA (SNAPSHOT STUDY)

Background and objective: Cardiovascular (CV) risk is determined by an interplay of risk factors. The goal of the study was to assess CV risk in hypertensive patients with type 2 diabetes in Colombia. Methods: SNAPSHOT, a cross-sectional, observational, multicenter, epidemiological study, involved patients enrolled by 20 investigators (mostly cardiologists [75.0%] and internists [20.0%]) in Colombia. CV risk was assessed by investigators and compared to the calculated CV risk based on ESC 2021 (SCORE2&2-OP) guidelines. Results: The analysis set included 459 patients; mean age (SD) was 68.7 (10.5) years, most patients were female (58.0%), and overweight/obese (73.4%), 21.4% were former smokers and 2.4%, active smokers. A combination of risk factors (male gender, age ≥65years, BMI≥30 kg/m2, smoking) was reported for most patients: 43.8% of patients had 1 of these risk factors, 38.1% had 2 risk factors, 6.1% had 3 risk factors, and 0.2% had all 4 risk factors. Most patients (91.7%) had at least 1 comorbidity in addition to hypertension and type 2 diabetes. Overall, 85.6% of patients had dyslipidemia, 39.7% had chronic kidney disease, and 33.8% had at least one additional CV comorbidity, mainly coronary or other arterial revascularization (18.1%) and acute coronary syndromes (13.5%). 48.4% of patients had diabetes-related target organ damage. CV risk perceived by investigators was low (0.7%), moderate (20.9%), high (35.7%) or very high (42.7%), whereas calculated CV risk according to SCORE2&2-OP was either high (34.6%) or very high (65.4%) (Figure). The prevalence of high and very high CV risk was similar when calculated according to the 2016 (SCORE1) guidelines. Investigators estimated CV risk accurately versus SCORE2&2-OP in only 41.6% of patients, while they underestimated it in 47.9% of patients. Conclusions: Hypertensive patients with diabetes in Colombia are at very high risk of CV disease, but this risk is frequently underestimated by physicians. Enhancing physician education on guideline recommendations and treatment intensification could improve risk factor control.

P113 CARDIOVASCULAR RISK FACTOR CONTROL IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES: A CROSS-SECTIONAL EPIDEMIOLOGICAL STUDY IN COLOMBIA (SNAPSHOT STUDY)

Background and objective: Hypertension is the leading preventable cause of cardiovascular (CV) disease and frequently occurs with other risk factors such as elevated blood glucose and cholesterol. This study aimed to assess the control rates of blood pressure (BP), glycated haemoglobin (HbA1c), and LDL-cholesterol (LDL-C) according to CV risk in hypertensive patients with type 2 diabetes in Colombia. Methods: SNAPSHOT, a cross-sectional, observational, multicenter, epidemiological study, involved patients enrolled by 20 investigators (mostly cardiologists [75.0%] and internists [20.0%]) in Colombia. CV risk was assessed based on the European Society of Cardiology CV disease prevention 2021 (SCORE2&2-OP) guidelines. Results: The analysis set included 459 patients; mean age (SD) was 68.7 (10.5) years, most patients were female (58.0%), and overweight or obese (73.4%). Most patients (91.7%) had at least 1 comorbidity in addition to hypertension and type 2 diabetes, including dyslipidemia in 85.6% of patients. Hypertension was treated in 97.6% of patients and considered by investigators to be controlled in 72.8% of patients, whereas only 44.4% of patients were controlled according to guidelines. Type 2 diabetes was treated in 92.2% of patients and controlled in 55.5% according to guidelines. In the subset of patients with concomitant dyslipidemia, LDL-C was treated in 95.2% and controlled according to guidelines in 25.6% of patients. The proportion of patients controlled for both hypertension and diabetes was 24.0% and the proportion controlled on all three parameters was 9.5% (Figure). Single-pill combinations were used to treat diabetes in 39.7%, hypertension in 21.4%, and dyslipidemia in 16.8% of patients. Mean (SD) systolic and diastolic BP were 131.3 (18.0) and 77.5 (10.1)mmHg, respectively; mean (SD) HbA1c was 7.0 (1.5)%; and mean (SD) LDL-C was 91.0 (43.4)mg/dL. Conclusions: This study showed a substantial unmet medical need: control rates for BP, HbA1c, and LDL-C in Colombia fell short among patients examined, emphasizing the urgency for enhanced therapeutic strategies.

Incremental Healthcare Costs of Diabetes Mellitus in a Middle-Income Country Using Administrative Healthcare Data

ObjectivesTo estimate the incremental medical cost of diabetes mellitus using information from administrative databases in Colombia. MethodsWe carried out a retrospective cohort study with administrative health databases from Colombian population affiliated in the contributory health insurance scheme. We used an operative definition to select the cohort with diabetes. Incremental cost and cost ratio of diabetes were estimated using an inverse probability weighting of treatment approach to find the causal effect of having the disease. Weights were calculated by a propensity score method using a Random Forest model. The flexibility of this machine learning algorithm allows to have a better specification and bias reduction. Additionally, we reported incremental costs and cost ratios with confidence intervals using bootstrapping and analyzed costs by age groups and complications associated with diabetes. ResultsThe estimated prevalence of diabetes was 2834 per 100 000 cases, in 2018. The group with diabetes was comprised 634 015 people and the control group 1 524 808. The calculated annual direct medical cost was $860, for which the incremental cost was $493 and the cost ratio 2.34. The incremental annual cost for some type of complication ranges from $1239 to $2043, renal complication being the most expensive. Incremental cost by age groups ranges from $347 to $878, being higher in younger people. ConclusionsAlthough the cost of diabetes in Colombia ranges among the global averages and is similar to other Latin-American countries, a greater incremental cost was found in patients with renal, circulatory, and neurologic complications.

Glycemic Control and Body Weight Reduction with Once-Weekly Semaglutide in Colombian Adults with Type 2 Diabetes: Findings from the COLIBRI Study.

Type 2 diabetes is a prevalent condition. The change in glucose control and body weight with the use of once-weekly semaglutide was evaluated in individuals with Type 2 diabetes in Colombia. This was a real-world, multi-centre, single-arm study involving adults in Colombia with Type 2 diabetes treated with once-weekly subcutaneous semaglutide for approximately 26 weeks. The primary endpoint assessed the change in glycated hemoglobin (HbA1c) from baseline to end of study. Secondary endpoints included changes in body weight from baseline to end of study. The study also explored the proportion of participants achieving predefined HbA1c targets and weight-loss responses at the end of the study. Data from 225 patients across 11 centers were collected. Most patients were women (65%), and the mean age of the population was 57 years with a median HbA1c of 7.6% and a median body weight of 86 kg. After approximately 26 weeks, semaglutide was associated with a significant reduction in HbA1c of -0.88 and a body weight reduction of -4.04kg. The proportion of patients with HbA1c < 7% increased from 32 to 66% at end of study. Patients treated with once-weekly semaglutide experienced a clinically significant reduction in HbA1c and body weight. These results are in line with previous clinical trials.

IDF23-0511 Increased urban prevalence of diabetes in Colombia after the COVID-19 pandemic

IDF23-0511 Increased urban prevalence of diabetes in Colombia after the COVID-19 pandemic

Clinical inertia in newly diagnosed type 2 diabetes mellitus among patients attending selected healthcare institutions in Colombia

BackgroundThe burden of disease of diabetes in Colombia have increased in the last decades. Secondary prevention is crucial for diabetes control. Many patients already treated remain with poor glycemic control and without timely and appropriate treatment intensification. This has been called in the literature as Clinical Inertia. Updated information regarding clinical inertia based on the Colombian diabetes treatment guidelines is needed.ObjectiveTo measure the prevalence of clinical inertia in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients in healthcare institutions in Colombia, based on the recommendations of the current official guidelines.MethodsAn observational and retrospective cohort study based on databases of two Health Medical Organizations (HMOs) in Colombia (one from subsidized regimen and one from contributory regimen) was conducted. Descriptive analysis was performed to summarize demographic and clinical information. Chi-square tests were used to assess associations between variables of interest.ResultsA total of 616 patients with T2DM (308 for each regimen) were included. Median age was 61 years. Overall clinical inertia was 93.5% (87.0% in contributory regimen and 100% in subsidized regimen). Patients with Hb1Ac ≥ 8% in the subsidized regimen were more likely to receive monotherapy than patients in the contributory regimen (OR 2.33; 95% CI 1.41–3.86).ConclusionsIn this study, the prevalence of overall clinical inertia was higher in the subsidized regime than in the contributory regime (100% vs 87%). Great efforts have been made to equalize the coverage between the two systems, but this finding is worrisome with respect to the difference in quality of the health care provided to these two populations. This information may help payers and clinicians to streamline strategies for reducing clinical inertia and improve patient outcomes.

MDRD is the eGFR equation most strongly associated with 4-year mortality among patients with diabetes in Colombia

IntroductionWe compared the association of glomerular filtration rate (GFR) estimated with the Cockcroft-Gault, Modification of Diet in Renal Disease study (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), or the new...

Prevalence of gestational diabetes in Colombia: a systematic review and comparative study

Introducción: Las mujeres embarazadas con diabetes mellitus gestacional DMG tienen un mayor riesgo de tener resultados adversos materno-infantiles. Objetivo: estimar la prevalencia de DMG en Colombia de acuerdo con los criterios de la Asociación Internacional de Grupos de Estudio de diabetes y embarazo IADPSG. Materiales y métodos: se realizó una revisión sistemática mediante búsquedas en las bases de datos PubMed/Medline y Cochrane en inglés y español. La evaluación de la calidad se hizo mediante la metodología GRADE. Resultados: en la revisión sistemática se incluyó un total de 7 artículos con 37795 participantes colombianas. La prevalencia de DMG en Colombia fue de 8,7%. Conclusiones: hasta donde sabemos, esta revisión sistemática es el primer estudio en estimar la prevalencia de DMG en mujeres en Colombia según criterios de la Asociación Internacional de Grupos de Estudio de diabetes y embarazo IADPSG. Los resultados sugieren una prevalencia DMG en Colombia en la media mundial. Hay que tener cuidado con estos resultados porque podría haber subregistros.

210-LB: Impact of COVID-19 Pandemic on the Outcomes of Patients with Diabetes in Colombia

Objective: Aside the direct health implications of COVID-19, pandemic has had multiple consequences, especially in chronic patients. This paper aimed to evaluate the impact of the COVID-19 pandemic on mortality and the search for health care of patients with diabetes in Colombia. Methods: Nationwide ecological panel study of secondary data from the Colombian official records of mortality and medical attentions due to diabetes between 2015 and 2021. Hospitalizations, ambulatory and emergency care visits, as well as death rates were assessed once adjusted by the availability of specialized health institutions and rurality. Results: During the COVID-19 pandemic, the mortality rate from diabetes increased by 30.4% (pre-pandemic average by semester: 7.73 deaths per 100,000 inhabitants; pandemic average: 10.08 deaths per 100,000 inhabitants), the average rate of medical attention increased by 67.2% (pre-pandemic: 3163 per 100.000; pandemic: 5290 per 100.000), in which, ambulatory care arose by 44.6% and hospitalizations by 42.3%. Rurality was inversely associated with health visits, and the availability of tertiary care institutions was associated with both diabetes mortality and medical consultations. Conclusions: Beyond the direct effect of the COVID-19 virus on patients with diabetes, their overall health outcomes worsened during pandemic. Availability of high specialized health facilities is related to the number of medical consultations, which suggests that people who did not have access to specialized health services were neglected. Actual and total impact of COVID-19 pandemic in patients with diabetes remains unclear. Disclosure J. Moreno-montoya: None. S. Ballesteros: None. J. De la hoz-valle: None.

IDF2022-0653 MDRD is the eGFR equation most strongly associated with four-year mortality among patients with diabetes in Colombia

IDF2022-0653 MDRD is the eGFR equation most strongly associated with four-year mortality among patients with diabetes in Colombia

Design and Usability of an Avatar-Based Learning Program to Support Diabetes Education: Quality Improvement Study in Colombia.

This quality improvement study, entitled Avatar-Based LEarning for Diabetes Optimal Control (ABLEDOC), explored the feasibility of delivering an educational program to people with diabetes in Colombia. The aim was to discover how this approach could be used to improve awareness and understanding of the condition, the effects of treatment, and strategies for effective management of blood-glucose control. Individuals with diabetes were recruited by Colombian endocrinologists to a human-centered study to codesign the educational program, using the Double Diamond model. Participants contributed to two phases. The first phase focused on gathering unmet educational needs and choice of curriculum. Three prototypes were developed as a result. During phase 2, a different group of participants engaged with the program for several weeks, before reporting back. Thirty-six participants completed a Web survey during phase 1, and five were also interviewed by telephone. The majority (33 of 36; 91%) were receptive to the prospect of educational interventions and ranked the chosen topic of hypoglycemia highly. In phase 2, the three prototypes were tested by 17 participants, 10 of whom also gave feedback in focus groups. The response was overwhelmingly positive, with 16 of 17 (94%) stating they would use a program like this again. The 3D version was the most highly rated. Immersive, avatar-based programs, delivered through smartphone, have the potential to deliver educational information that is trusted, engaging, and useful. Future work includes expansion of the curriculum, evaluation with a larger group, and exploration of the prospective role of artificial intelligence in personalizing this form of educational intervention.

EE16 Chronic Kidney Disease in Type 2 Diabetes in Colombia: A Cost of Illness Analysis

EE16 Chronic Kidney Disease in Type 2 Diabetes in Colombia: A Cost of Illness Analysis

Achievement of treatment goals among adults with diabetes in Colombia, 2015–2019: Results from a national registry

AimsTo assess the achievement of essential treatment goals among patients with diabetes in Colombia. MethodsWe analyzed data from a nationwide registry of all individuals with diagnosed diabetes, hypertension or CKD assisted by the health system. We explored the prevalence of treatment goals (HbA1c < 7% [<53 mmol/mol], systolic blood pressure (SBP) < 130 mmHg and LDLc < 100 mg/dL), and their variations by race and type of health insurance, between July 1, 2015, and June 30, 2019. ResultsWe studied 1 352 846 patients with diagnosed diabetes. The prevalence of HbA1c < 7% (<53 mmol/mol) remained steady at 52%, systolic blood pressure (SBP) < 130 mmHg was also stable at 80–82%. Meanwhile, the prevalence of both LDLc < 100 mg/dL and non-HDLc < 130 mg/dL increased by 6 percentage points. Achievement of the triple HbA1c + SBP + LDLc goal was only 21.4% in 2015, increasing to 24.4% by 2019. Goal achievement was consistently lower among patients of black race, especially for HbA1c (5% lower than other races), but also for the SBP, LDLc and joint goals. Patients under third-party insurance reached better HbA1c, SBP, and LDLc control. ConclusionsAchievement of treatment goals of patients with diabetes in Colombia remains substantially low, despite improvements in LDLc control.

A Cross-Sectional Analysis of the Stigma Surrounding Type 2 Diabetes in Colombia.

Type 2 diabetes is a global epidemic, and many people feel stigmatized for having this disease. The stigma is a relevant barrier to diabetes management. However, evidence in this regard is scarce in Latin America. This study aimed to analyze the level of stigma surrounding type 2 diabetes in the Colombian population and its relationships with sociodemographic, clinical, psychosocial variables and behaviors related to management of the disease (self-management behaviors). This cross-sectional study included 501 Colombian adults with type 2 diabetes. We estimated the relation between stigma and selected variables through linear regression models. Additionally, we analyzed the mediator role of psychosocial variables in the relationship between stigma and self-management behaviors through structural equation models. A total of 16.4% of patients showed concerning levels of stigma. The time elapsed since diagnosis (β = −0.23) and socioeconomic status (β = −0.13) were significant predictors of the level of stigma. Stigma was negatively correlated with self-efficacy (β = −0.36), self-esteem (β = −0.37), and relationship with health care provider (β = −0.46), and positively correlated with stress (β = 0.23). Self-efficacy, self-esteem, and the relationships with health care providers had a mediation role in the relationship between stigma and self-management behaviors. These variables would be part of the mechanisms through which the perception of stigma harms self-management behaviors. The stigma of type 2 diabetes is frequent in the Colombian population and negatively associated with important aspects of disease management.

Semaglutide Once Weekly In Persons with Type 2 Diabetes: Real-World Analysis of the Colombian Diabetes Registry (COL-REAL 1 Study)

Background: Glucagon like peptide-1 receptor agonists (GLP-1 RA) are injectable glucose lowering therapies that induce insulin secretion, control glucagon secretion, delay gastric emptying and reduce appetite. Semaglutide, in the subcutaneous formulation, became the newest GLP-1 RA available in Colombia from 2020, nevertheless, to better understand the impact of semaglutide treatment in a real-world setting, we will examine the short-term changes in metabolic, cardiovascular and body weight control in adults with diabetes in Colombia who initiate once-weekly semaglutide. Methods: This is a retro-prospective observational study used data from adults patients in Cali-Colombia with T2D who were naïve to GLP-1 RA therapy, initiated semaglutide therapy as usual standard of care between February and November 2020, who maintained semaglutide therapy during followup, were eligible for analysis. The primary outcome was mean change in HbA1c and weight at three to six-month follow-up. Results: In the final analytic cohort (n=30), there was a statistically significant reduction at three month in HbA1c (%) of -2.43 ± 1.89% (mean ± SD) (p<0.001) and weight of -3.57 ± 16.08 kg (p<0.001). At six-month follow-up the reduction in HbA1c of -3.44 ± 1.29% (p<0.001) and weight of -8.43 ± 16.47 kg (p<0.001), with no significant change in self-reported incidence of hypoglycemia. Conclusions: This retrospective observational study demonstrated that GLP-1 RA naïve adults with T2D initiating semaglutide in a real-world clinical practice had a statistically and clinically significant reduction in HbA1c and body weight after three to six months, with no significant change in reported incidence of adverse events.

Time trends of diabetes in Colombia from 1998 to 2015: the recent stagnation in mortality, and educational inequities

To study the observed trends in Diabetes Mellitus (DM) mortality rates according to educational level, age group and sex in Colombia between 1998 and 2015. A cross-sectional study was conducted based in official databases. Age-standardized mortality rates were calculated by age-gropus, educational level, sex and year. Rate Ratios (RR) were estimated with higher educational level as reference. The Relative Index of Inequality (RII) was estimated. Joinpoint regressions were applied to identify inflexion points in mortality trends, and Percent Annual Change (APC) between inflexion points. 124,198 deaths caused by DM among adults (25+ years) were analysed, 57% among women (71,093); 74% of deaths occurred among those older than 45 years, especially senior adults (65+). The highest adjusted mortality rates were for those with primary and secondary educational levels. The highest mortality occurred in adult women (65 years or more) with primary education level. Relative Index of Inequality was higher for women than for men along the period. Educational levels were found to be strongly associated with death by DM in adults (25+). Intersectoral actions are required to influence the risk factors and to improve the treatment of the disease in groups with lower levels of education.

Survey on hypoglycemia among insulin-treated patients with diabetes: The Colombian International Operations Hypoglycemia Assessment Tool population

Introduction:The non-interventional International Operations Hypoglycemia Assessment Tool (IO-HAT) study assessed the incidence of hypoglycemia in patients with insulin-treated diabetes across nine countries, including a cohort of patients in Colombia.Materials and methods:Hypoglycemia incidence among patients with insulin-treated diabetes was assessed across 26 sites in Colombia. Hypoglycaemic events (any, nocturnal or severe) were reported in self-assessment questionnaires (SAQ) and patient diaries based on capillary blood glucose measurement or symptoms. Retrospective events (severe events 6 months before baseline and any event 4 weeks before baseline) were recorded in SAQ, Part 1, and prospective events (4 weeks from baseline) were recorded in SAQ, Part 2, and patient diaries. Differences in hypoglycemia incidence reported in the retrospective and prospective periods were assessed using two-sided tests.Results:Of the 664 patients assessed, 213 had type 1 diabetes (T1D) and 451 had type 2 diabetes (T2D). Nearly all patients experienced at least one hypoglycaemic event in the prospective period (97.1% T1D; 93.3% T2D). Rates of hypoglycemia (events per person- year, PPY) were higher prospectively than retrospectively for any hypoglycemia (T1 D: 121.6 vs. 83.2, p<0.001; T2D: 28.1 vs. 24.6, p=0.127) and severe hypoglycemia (T 1D: 15.3 vs. 9.2, p=0.605; T 2 D: 9.5 vs. 3.5 p=0.040).Conclusion: These results, the first from a patient-reported dataset on hypoglycemia in insulin-treated patients with diabetes in Colombia, show that patients reported higher rates of any hypoglycemia during the prospective period.

Early Life Displacement Due to Armed Conflict and Violence, Early Nutrition, and Older Adult Hypertension, Diabetes, and Obesity in the Middle-Income Country of Colombia.

Objective: We examine the importance of early life displacement and nutrition on hypertension (HTN) and diabetes in older Colombian adults (60+ years) exposed to rapid demographic, epidemiological, and nutritional transitions, and armed conflict. We compare early life nutritional status and adult health in other middle- and high-income countries. Method: In Colombia (Survey of Health, Wellbeing and Aging [SABE]-Bogotá), we estimate the effects of early life conditions (displacement due to armed conflict and violence, hunger, low height, and not born in the capital city) and obesity on adult health; we compare the effects of low height on adult health in Mexico, South Africa (Study on Global Ageing and Adult Health [SAGE]), the United States, and England (Health and Retirement Study [HRS], English Longitudinal Study of Ageing [ELSA]). Results: Early life displacement, early poor nutrition, and adult obesity increase the risk of HTN and diabetes in Colombia. Being short is most detrimental for HTN in Colombian males. Discussion: Colombian data provide new evidence into how early life conditions and adult obesity contribute to older adult health.

RNASEH1 gene variants are associated with autoimmune type 1 diabetes in Colombia.

In a previous work, we found linkage and association of type 1 diabetes (T1D) to a 12 known gene region at chromosome 2p25 in Colombian families. Here, we present further work on this candidate region. Seventeen SNPs located on the 12 candidate genes, in 100 familial trios set, were tested by ARMS-tetraprimer-PCR or PCR-RFLP. Five extra SNPs in the vicinity of rs10186193 were typed. A replica phase included 97 novel familial trios, in whom diabetes-related auto-antibodies (AABs) were tested in sera of the patients. In addition to transmission disequilibrium tests, haplotype analyses were carried out using the unphased software. SNP rs10186193 (at RNASEH1 gene) showed association with T1D (P=0.005). The additional five SNPs revealed that rs7607888 (P=2.03×10-7), rs55981318 (P=0.018), and rs1136545 (P=1.93×10-9) were also associated with T1D. Haplotype analysis showed association for rs55981318-rs10186193 (P=0.0005), rs7563960-rs7607888 (P=0.0007), rs7607888-rs1136545 (P=9.21×10-10), and rs1136545-rs11538545 (P=6.67×10-8). In contrast, the new set of 97 familial trios tested for SNPs rs55981318, rs10186193, and rs7607888 did not support the previous finding; however, by combining the sample (197 trios), evidence of association of T1D with rs55981318 and rs7607888 was conclusive. In addition, a two-loci haplotype analysis of the combined sample showed significant association of RNASEH1 with T1D (P=3.1×10-5). In conclusion, our analyses suggest that RNASEH1 gene variants associate with susceptibility/protection to T1D in Colombia.

Clinical and economic benefits of integrated pump/CGM technology therapy in patients with type 1 diabetes in Colombia

ObjectiveTo assess the long-term clinical and economic impact of integrated pump/CGM technology therapy as compared to multiple daily injections (MDI), for the treatment of type 1 diabetes (T1D) in Colombia. MethodsThe CORE Diabetes Model was used to simulate a hypothetical cohort of patients with T1D. Mean baseline characteristics were taken from a clinical study conducted in Colombia and a healthcare payer perspective was adopted, with a 5% annual discount rate applied to both costs and outcomes. ResultsThe integrated pump/CGM improved mean life expectancy by 3.51 years compared with MDI. A similar increase occurred in mean quality-adjusted life expectancy with an additional 3.81 quality-adjusted life years (QALYs). Onset of diabetes-related complications was also delayed as compared to MDI, and mean survival time free of complication increased by 1.74 years with integrated pump/CGM. Although this increased treatment costs of diabetes as compared to MDI, savings were achieved thanks to reduced expenditure on diabetes-related complications. The estimated incremental cost-effectiveness ratio (ICER) for SAP was Colombian Pesos (COP) 44,893,950 (approximately USD$23,200) per QALY gained. ConclusionsImproved blood glucose control associated to integrated pump/CGM results in a decreased incidence of diabetes-related complications and improves life expectancy as compared to MDI. Using recommended thresholds from the World Health Organization and previous coverage decisions about health technologies in Colombia, it is a cost-effective alternative to MDI for the treatment of type 1 diabetes in Colombia.