Costo de la polifarmacia en el paciente con diabetes mellitus tipo 2

A, Luz María García; R, Enrique Villarreal; R, Liliana Galicia; G, Lidia Martínez; D, Emma Rosa Vargas

doi:10.4067/s0034-98872015000500008

“…Some studies also included other medicines: antibiotics35; pain relief/anti-inflammatory drugs35; gliflozin class drugs68; sulfonylureas68 69; metformin combinations (with glibenclamide,46 with DPP4i) 70. An additional study included medication costs per complication without breaking this out by specific medication 45*Indicated as (non-specific) insulin in study text.†Indicated as group of oral antidiabetic medications (non-specified per drug) in study text (excluding medicines for comorbidities such as CVD); any specifications included as footnotes here.‡Includes lipid-lowering medicines, antiplatelet, antihypertensive drugs.…”

Section: Resultsmentioning

confidence: 99%

“…Some studies also included other medicines: antibiotics35; pain relief/anti-inflammatory drugs35; gliflozin class drugs68; sulfonylureas68 69; metformin combinations (with glibenclamide,46 with DPP4i) 70. An additional study included medication costs per complication without breaking this out by specific medication 45…”

Section: Resultsmentioning

confidence: 99%

The costs of diabetes treatment in low- and middle-income countries: a systematic review

Moucheraud¹,

Lenz²,

Latkovic

³

et al. 2019

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IntroductionThe rising burden of diabetes in low- and middle-income countries may cause financial strain on individuals and health systems. This paper presents a systematic review of direct medical costs for diabetes (types 1 and 2) in low- and middle-income countries.MethodsFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases (PubMed, International Bibliography of Social Science, EconLit) were searched for publications reporting direct medical costs of type 1 and 2 diabetes. Data were extracted from all peer-reviewed papers meeting inclusion criteria, and were standardised into per-patient-visit, per-patient-year and/or per-complication-case costs (2016 US$).ResultsThe search yielded 584 abstracts, and 52 publications were included in the analysis. Most articles were from Asia and Latin America, and most focused on type 2 diabetes. Per-visit outpatient costs ranged from under $5 to over $40 (median: $7); annual inpatient costs ranged from approximately $10 to over $1000 (median: $290); annual laboratory costs ranged from under $5 to over $100 (median: $25); and annual medication costs ranged from $15 to over $500 (median: $177), with particularly wide variation found for insulin. Care for complications was generally high-cost, but varied widely across countries and complication types.ConclusionThis review identified substantial variation in diabetes treatment costs; some heterogeneity could be mitigated through improved methods for collecting, analysing and reporting data. Diabetes is a costly disease to manage in low- and middle-income countriesand should be a priority for the global health community seeking to achieve Universal Health Coverage.

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“…It can have a negative effect on the T2DM patient, their family/carer, the health system and the economy. In patients, it can adversely affect their adherence to medicines, quality of life and life expectancy, can lead to suboptimal blood glucose control and hospital admissions, and can increase severe hypoglycaemia risk and healthcare costs [10][11][12][13][14]. Studies conducted in different diabetes (including T2DM) populations and settings have reported a range of polypharmacy prevalence figures (6-85%) [15][16][17][18][19][20][21][22][23][24].…”

Section: Resultsmentioning

confidence: 99%

Prevalence and predictors of polypharmacy prescription among type 2 diabetes patients at a tertiary care department in Ningbo, China: A retrospective database study

Li

¹

,

Chattopadhyay

²

,

Xu

³

et al. 2019

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“…As far as the latter is concerned, it is also licit to attribute the low adherence rates to an absence of glycemic control, in spite of the pharmacological treatment (a range of 18-75% for HbA1c) (15,65-69). These factors substantially contribute to increasing costs for individuals, communities, and the State in terms of money, quality of life, and lives themselves (61,62,67-70).…”

Section: Discussionmentioning

confidence: 99%

Frequency of CYP2C9 (2, 3 and IVS8‑109A>T) allelic variants, and their clinical implications, among Mexican patients with diabetes mellitus type 2 undergoing treatment with glibenclamide and metformin

Cuautle‐Rodríguez¹,

Rodríguez-Rivera²,

Andrés

³

et al. 2019

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The majority of Mexican patients with diabetes mellitus type 2 (DMT2) (67.9-85.0%) are prescribed sulphonylureas (SUs), which are metabolized by cytochrome P450 2C9 (abbreviated as CYP2C9 ). SUs are a type of oral anti-diabetic compound which inhibit ATP-sensitive potassium channels, thus inducing glucose-independent insulin release by the β-pancreatic cells. The wide variability reported in SU responses has been attributed to the polymorphisms of CYP2C9 . The present study aimed to describe CYP2C9 polymorphisms (*2 , *3 and IVS8-109T ) within a sample of Mexican patients with DMT2, while suggesting the potential clinical implications in terms of glibenclamide response variability. From a sample of 248 patients with DMT2 who initially consented to be studied, those ultimately included in the study were treated with glibenclamide (n=11), glibenclamide combined with metformin (n=112) or metformin (n=76), and were subsequently genotyped using a reverse transcription-quantitative polymerase chain reaction (PCR), end-point allelic discrimination and PCR amplifying enzymatic restriction fragment long polymorphism. Clinical data were gathered through medical record revision. The frequencies revealed were as follows: CYP2C9*1 / *1 , 87.5%; *1 / *2 , 6.5%; *1 / *3 , 5.2%; and CYP2C9 , IVS8-109A>T , 16.1%. Glibenclamide significantly reduced the level of pre-prandial glucose (P<0.01) and the percentage of glycated hemoglobin (%HbA1c; P<0.01) for IVS8-109A>T compared with combined glibenclamide and metformin treatment. Concerning the various treatments with respect to the different genotypes, the percentages obtained were as follows: Glibenclamide A / A , HbA1c<6.5=33.3%; glibenclamide + metformin A / A , HbA1c<6.5=24.6%; glibenclamide A / T , HbA1c<6.5=33.3%; glibenclamide + metformin A / T , HbA1c<6.5=25%; glibenclamide T / T , HbA1c<6.5=100%; and glibenclamide + metformin T / T , HbA1c<6.5=12.5%. Altogether, these results revealed that, although genetically customized prescriptions remain a desirable goal to increase the chances of therapeutic success, within the studied population neither allelic variants nor dosages demonstrated a clear association with biomarker levels. A key limitation of the present study was the lack of ability to quantify either the plasma concentrations of SU or their metabolites; therefore, further, precise experimental and observational studies are required.

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Costo de la polifarmacia en el paciente con diabetes mellitus tipo 2

Abstract: Medications represent less than 50% of total expenses of diabetic patients with polypharmacy.

Cited by 13 publications

References 6 publications

The costs of diabetes treatment in low- and middle-income countries: a systematic review

The costs of diabetes treatment in low- and middle-income countries: a systematic review

Prevalence and predictors of polypharmacy prescription among type 2 diabetes patients at a tertiary care department in Ningbo, China: A retrospective database study

Frequency of CYP2C9 (2, 3 and IVS8‑109A>T) allelic variants, and their clinical implications, among Mexican patients with diabetes mellitus type 2 undergoing treatment with glibenclamide and metformin

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Costo de la polifarmacia en el paciente con diabetes mellitus tipo 2

Abstract: Medications represent less than 50% of total expenses of diabetic patients with polypharmacy.

Cited by 13 publications

References 6 publications

The costs of diabetes treatment in low- and middle-income countries: a systematic review

The costs of diabetes treatment in low- and middle-income countries: a systematic review

Prevalence and predictors of polypharmacy prescription among type 2 diabetes patients at a tertiary care department in Ningbo, China: A retrospective database study

Frequency of CYP2C9 (*2, *3 and IVS8‑109A>T) allelic variants, and their clinical implications, among Mexican patients with diabetes mellitus type 2 undergoing treatment with glibenclamide and metformin

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Frequency of CYP2C9 (2, 3 and IVS8‑109A>T) allelic variants, and their clinical implications, among Mexican patients with diabetes mellitus type 2 undergoing treatment with glibenclamide and metformin