Management of type 2 diabetes and its prescription drug cost before and during the economic crisis in Greece: an observational study

Abstract

BackgroundThe aim of the present study is to examine the clinical indices related to cardiovascular risk management of Greek patients with type 2 diabetes, before and after the major economic crisis that emerged in the country.MethodsIn this retrospective database study, the medical records of patients with type 2 diabetes treated at three diabetes outpatient centers of the national health system during 2006 and 2012 were examined. Only patients with at least six months of follow-up prior to the recorded examination were included. The prescription cost was calculated in Euros per patient-year (€PY).ResultsA total of 1953 medical records (938 from 2006 and 1015 from 2012) were included. There were no significant differences in adjusted HbA1c, systolic blood pressure and HDL-C, while significant reductions were observed in LDL-C and triglycerides. In 2012, a higher proportion of patients were prescribed glucose-lowering, lipid-lowering and antihypertensive medications. Almost 4 out of 10 patients were prescribed the new incretin-based medications, while the use of older drugs, except for metformin, decreased. A significant increase in the adjusted glucose-lowering prescription cost (612.4 [586.5-638.2] €PY vs 390.7 [363.5-418.0]; p < 0.001) and total prescription cost (1306.7 [1264.6-1348.7] €PY vs 1122.3[1078.1-1166.5]; p < 0.001) was observed. The cost of antihypertensive prescriptions declined, while no difference was observed for lipid-lowering and antiplatelet agents.ConclusionsDuring the economic crisis, the cardiovascular risk indices of Greek patients with type 2 diabetes being followed in public outpatient diabetes clinics did not deteriorate and in the case of lipid profile improved. However, the total prescription cost increased, mainly due to the higher cost of glucose-lowering prescriptions.

Adherence to the National Guidelines for Follow-Up Protocol in Subjects with Type 2 Diabetes Mellitus in Greece: The GLANCE Study

“…Additional barriers to adherence may include poor healthcare finances and resources, inadequate healthcare system infrastructure and logistic support, excessive physician workload and the fact that physicians often doubt the utility of guidelines [29]. During the financial crisis in Greece, it was reported that prescriptions for OHAs were not affected [30], but decreased income and unemployment were identified as the major factors affecting access to healthcare services [31]. Specifically, the concerns of subjects with T2DM about treatment costs may affect their adherence to treatment and frequency of prescription fulfilment or even influence physicians' prescription behaviour towards choosing less expensive treatment options [32].…”

Quality of diabetes care at the largest outpatient clinics in Vilnius

“…The average HbA1c in the T2DM was significantly better compared to that in the T1DM group – 7.0% vs 9.1%. The results of studies, conducted in T2DM subjects, showed an average HbA1c of 7.5% in Estonia, 6.8–7.2% in Spain, 6.7% in Germany, 7.0% in Greece, 7.1% in Belgium (9–12, 17, 19). Our study revealed a very poor glycaemic control in the T1DM which, however, is in line with the meta-analysis of the registers of 11 countries published by McKnight et al, where the median HbA1c in the T1DM varied from 7.4 to 9.4% (20).…”

“…Even a simple check such as a BW measurement showed a very poor performance, suggesting an insufficient attention for routine care measures. An insufficient performance of annual checks was also recorded in other countries: performance for BMI varied from 25 to 91%, BP from 67 to 99%, retinal screening from 28 to 58%, plasma creatinine from 27 to 92.5%, urinary microalbuminuria or albumin-creatinin ratio from 24 to 74%, foot examination from 33 to 85% in different studies (7–9, 15, 16, 18, 20, 22, 24, 25). The highest performance of annual checks was reported in UK, where annual national diabetes audits are performed (15).…”

Diabeto Priežiūros Klinikinis Auditas Vilniaus Universiteto Ligoninės Santariškių Klinikų Šeimos Medicinos Centre

“…Italijoje, Maltoje, Graikijoje, Belgijoje atliktų tyrimų metu nustatytas KMI svyravo 27,3-30,6 kg/m 2 ribose, tačiau nutukusių pacientų dalis šiuose tyrimuose buvo ženkliai mažesnė -28-42 proc. [10][11][12][13]. Šį skirtumą galėjo lemti skirtinga metodologija: minėtuose tyrimuose pacientai buvo sveriami, KMI skaičiuojamas ir registruojamas paciento konsultacijos metu, tuo tarpu mūsų tyrėjai anketas pildė remdamiesi tik medicinine dokumentacija, kur net 44 proc.…”

“…Belgijoje pasiekė -54 proc., Bosnijoje ir Hercegovinoje -26,5 proc. pacientų [12,13,14]. Italijos diabeto centruose, kuriuose gydosi 550 000 visų šalies pacientų, glikemijos kontrolės analizė diabetu sergantiems pacientams atliekama kasmet.…”