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For years, traditional techniques have been used for diabetes treatment. There are two major types of insulin: insulin analogs and regular insulin. Insulin analogs are similar to regular insulin and lead to changes in pharmacokinetic and pharmacodynamic properties. The purpose of the present research was to determine the cost-effectiveness of insulin analogs versus regular insulin for diabetes control in Yazd Diabetes Center in 2017.

In this descriptive–analytical research, the cost-effectiveness index was used to compare insulin analogs and regular insulin (pen/vial) for treatment of diabetes. Data were analyzed in the TreeAge Software and a decision tree was constructed. A 10% discount rate was used for ICER sensitivity analysis. Cost-effectiveness was examined from a provider's perspective.

QALY was calculated to be 0.2 for diabetic patients using insulin analogs and 0.05 for those using regular insulin. The average cost was $3.228 for analog users and $1.826 for regular insulin users. An ICER of $0.093506/QALY was obtained. The present findings suggest that insulin analogs are more cost-effective than regular insulin.

This study was conducted using a cost-effectiveness analysis to evaluate insulin analogs versus regular insulin in controlling diabetes. The results of study are helpful to the government to allocate more resources to apply the cost-effective method of the treatment and to protect patients with diabetes from the high cost of treatment.

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. GDM is defined as glucose intolerance of variable severity with onset or first recognition during pregnancy. The purpose of this paper is to produce information on prevalence, screening and diagnosis, pathophysiology and dietary, medical and lifestyle management of GDM.

This literature review aimed to document and record the results of the most updated studies published dealing with dietary, medical and lifestyle factors in managing GDM.

The prevalence of GDM differs worldwide based on population characteristics, race/ethnicity and diagnostic criteria. The pathophysiology of GDM is multifactorial and it is likely that genetic and environmental factors are associated with the occurrence of GDM. Medical nutritional therapy remains the mainstay of GDM management and aerobic and resistance physical activities are helpful adjunctive therapy when euglycemia is not attained by the medical nutritional therapy alone. When diet and exercise fail to achieve glycemic control, pharmacological agents such as insulin therapy and oral hypoglycemic medications are prescribed. Plasma glucose measurement is an essential part of glycemic control during pregnancy, as well as glycemic control can be evaluated using indicators of glycemic control such as hemoglobin A1c (HbA1c), glycated albumin and fructosamine.

This review is a comprehensive review that illustrates the effect of healthy diet, medical therapy and lifestyle change on improving GDM condition.

The purpose of this paper is to evaluate if slow release starch (SRS) could be used to control/limit hypoglycaemia in type 1 diabetics.

Ten type‐1 diabetic volunteers were fitted with continuous glucose monitors for two periods of 3 days when undertaking their normal routine or when consuming 60 g SRS before sleep.

The average number of nocturnal hypoglycaemic episodes where no SRS was consumed over 3 days was 2.7 ± 2.0 but only 0.7 ± 1.1 after SRS consumption before sleep. The duration of these events was equivalent to 318 ± 282 and 140 ± 337 min, respectively. Average nocturnal blood glucose concentration was 7.9 ± 1.4 mmol l⁻¹ without SRS consumption but increased to 9.7 ± 2.7 mmol l⁻¹ when SRS was consumed. These data were highly significant when subjected to analysis of variance (ANOVA) test on a subject by subject basis. The SRS may be used as a cost effective therapy to avoid hypoglycaemia in patients with type‐1 diabetes.

This paper reports for the first time the use of a physically modified waxy maize starch (SRS) to prevent/limit the incidence of nocturnal hypoglycaemia in type 1 diabetics.

Economics, business management

The case study is relevant for MBA, Master's and under graduate (economics, international and business economics) students.

Biocon is one of the top 20 companies from India in the Forbes list of “Best under a Billion” companies. It has emerged from being an enzyme-producing firm to a biotech powerhouse under the guidance of Ms Kiran M. Shaw. It is an innovative company with a varied scientific skill base and progressive manufacturing facilities for developing and commercializing biopharmaceuticals. This study attempts to explore the international foray of Biocon using the eclectic OLI framework. Entrepreneurship, need for integrated business model, innovation, quality control, etc. constituted the ownership (O) factors, important for Biocon to earn the more than compensating advantage in the overseas market. The locational factors were less important in case of Biocon as the global expansion was driven by a motive of either market seeking or cashing in on the cost advantage of its operations. The dominant mode of entry has been the joint ventures. The overseas patterns exhibited by Biocon can be captured fully by the O-L-I framework.

To understand the economic theory of OLI and the ownership, locational and internalisation advantages, link the OLI framework with the international foray of Biocon, Biocon's internationalization journey, major overseas deals signed and the economic rationale behind the deals.

Teaching notes are available for educators only. Please contact your library to gain login details or e-mail support@emeraldinsight.com to request teaching notes.

The case provides an introduction to how currency mismatches create exposures, why and how companies hedge (or do not hedge) those exposures, alternate valuation models and the use of foreign currency convertibles in funding a global expansion program. The case highlights the ambitious growth strategy of Wockhardt, a global biopharmaceutical company. In a bid to dominate the biopharmaceutical market, Wockhardt grew aggressively by acquiring companies all over the world. This expansion was funded by a mix of secured loans (bank borrowings) and unsecured loans including foreign currency (US dollar denominated) convertible bonds (FCCBs). Due to deteriorating business and economic conditions, the company experienced a sharp decline in profitability and stock price resulting in a debt overhang. The company had to restructure its capital structure in March 2009 to escape bankruptcy. Since FCCB holders did not agree to restructure the terms of the instrument, the company had to turn to senior lenders to restructure debt. The company’s management is faced with several options to deal with financial distress. The case asks students to evaluate those options. The case can be used to teach hedging foreign currency exposures, design of capital structure in rapidly evolving industries and dangers of financing R&D intensive ventures with convertible debt denominated in foreign currencies.

The case is based on secondary data sources. Information statements filed with the Securities Exchange Board of India, the company’s website, press releases and security analyst reports formed the basis for this case. Supplementary information was gathered from the CAPITALINE database, and websites of the Bombay Stock Exchange and the National Stock Exchange of India. Sources of information are documented appropriately in the case and teaching note. No names in the case have been disguised. The authors have no personal relationship with the company.

The case is suitable for courses in corporate finance, mergers and acquisitions, international financial management, corporate restructuring and valuation at the graduate level. It can also be used in executive education programs.

The case provides an introduction to how currency mismatches create exposures, why and how companies hedge (or do not hedge) those exposures, alternate valuation models, the use of foreign currency convertibles in funding a global expansion program and the alternatives in corporate restructuring. Suitable references are provided in the teaching note.

The purpose of this paper is to show how science-industry R&D cooperation (SIRC) generates effects on the strategy developed by firms to appropriate the benefits of innovations. Given the plurality of cooperation patterns between firms and public R&D institutions and the variety of appropriation mechanisms used by firms to protect generated knowledge or to strengthen their market position, this paper investigates to what extent different forms of cooperation are associated with different effects on appropriation strategy.

As evidence of this, the authors carry out a multiple case study, covering nine biopharmaceutical Argentine firms whose innovation projects are developed in cooperation with public R&D institutions. Using critical dimensions identified by public-private R&D cooperation literature, the paper analyzes the characteristics of cooperation in the cases studied, looking for different patterns. Given the existence of various appropriation mechanisms identified by appropriability literature, the paper analyzes how firms use (or not) those mechanisms within the specific context of jointly generated innovation.

The paper shows that SIRC generates opposing effects on the various appropriation mechanisms used by firms, both challenging and strengthening them. Likewise, the identification of three cooperation patterns in Argentine biopharmaceutical sector, namely, contract R&D, internalization and coordination, allows appreciating how each pattern affects differently the appropriation mechanisms used by firms, being the coordination one, the most functional to the appropriation strategy of firms analyzed.

The arguments presented here are necessarily limited to the biopharmaceutical Argentine sector, which is strategic to the country, for accumulated capabilities in scientific and business aspects. The analysis could be enriched by extending it to other industries with similar innovation characteristics and to other countries, where patents have a similar weight (emerging countries) or a different one (developed countries).

Innovation and public-private collaboration policies may benefit from the analysis presented here, which helps to assess advantages and challenges of different SIRC logics on firms’ appropriation issues and to considerate which aspects allow cooperation and appropriation combining in a more virtuous form.

There is no paper that explicitly examines the effects generated by different SIRC patterns on the appropriation strategy of firms, conceived as a combination of different mechanisms which may include patents but is not limited to them.

Purpose – Although the US has lagged behind international developments in health technology assessment (HTA), renewed interest in HTA in the US has been fueled by the appropriation of $1.1 billion comparative effectiveness research (CER) in 2009 and the debate over health care reform.

Approach – To inform CER practices in the US, we present case studies of HTA from England/Wales and Germany: contrasting methods; relevance to the US; and impact on innovation.

Findings – The National Institute of Health and Clinical Excellence (NICE) was established in 1999 to inform trusts within the National Health Service of England and Wales. It uses cost-effectiveness analysis to guide the allocation resource across preventative and curative interventions. In Germany, the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) was established in 2004 to inform reimbursement and pricing policies for the statutory sickness funds set by the Gemeinsamer Bundesausschuss (G-BA). IQWiG evaluates competing technologies within specific therapeutic areas, placing more weight on clinical evidence and the relative efficiency of competing therapies.

Practical implications – Although having deep political and cultural antecedents, differences between NICE and IQWiG can be explained by perspective: the former guiding resource allocation across an entire system (macro-evaluation), the latter focusing on efficiency within the bounds of a particular therapeutic area (micro-evaluation). Given the decentralized nature of the US health care system, and the relative powers of different medical specialties, the IQWiG model presents a more suitable case study to guided CER efforts in the US.