Therapeutic profile of patients with diabetes treated at the first level of health care

Abstract

Introduction: Diabetes mellitus type 2 (DM2) is a chronic metabolic disease frequently associated with late complications derived from progressive damage several tissues. When patients with DM2 do not respond adequately to non-pharmacological measures, anti-diabetic agents should be indicated to avoid the long-term risk of macro and microvascular complications. Objective: The aim of this study is to evaluate the therapeutic profile for DM2 in the first level of care in the health system in two different countries (Argentina and Paraguay). Methods: This study was an observational descriptive cross-section study. Variables considered were age, sex, date of disease debut, clinical signs of diabetes complications, blood pressure, abdominal circumference, anti-diabetic and anti-hypertensive drugs, and laboratory data. Results: Regarding medication, 30.6% of the patients were treated with biguanides (metformin) and 23.5% with oral hypoglycemic agents; 21.7% with a combination of both anti-diabetic groups; and 3.5% with other therapeutically options (glitazones, meglitinides, SGLT2 inhibitors, and GLP-1 agonist). All the cases of new drug indications were register in Argentina while in Paraguay; all drugs prescribed were considered essential medicines. Conclusion: Diabetes is a frequent disease that causes severe disabilities and death in the affected population. Although it exists several drugs for DM2 treatment, only a few of them follow the rational use of medicines guidelines, while other drugs might be unsafe and certainly more expensive than essential options. Since first level health-care therapeutic strategy plays a major role in avoiding complications from diabetes, countries with low or middle income such as Paraguay or Argentina should do efforts to provide to all patients a rational treatment. This work shows that not in all scenarios, this pattern is true.