Caracterización y costes asociados al perfil del paciente con diabetes tipo 2 en tratamiento con metformina al que se le añade un segundo fármaco antidiabético oral: estudio de base poblacional / Characterization of and costs associated to the profile of patients with type 2 diabetes treated with metformin who are added a second oral antidiabetic drug: a population study

OBJETIVOS: Determinar el cumplimiento, control metabólico, complicaciones y costes sanitarios de los pacientes tratados con metformina que iniciaron un segundo fármaco antidiabético en pacientes con diabetes tipo 2 (DM2).Pacientes y métodos; Diseño observacional-multicéntrico de carácter retrospectivo. Se evaluaron pacientes de edad igual o superior a 30 años, en tratamiento con metformina y que iniciaron un segundo tratamiento antidiabético durante 2008-2009. Se establecieron 4 grupos de pacientes (metformina y otro antidiabético): a) inhibidores de la dipeptidil peptidasa 4 (IDPP4); b) sulfonilureas; c) glitazonas, y d) insulinas. Principales medidas: comorbilidad, control metabólico, cumplimiento y complicaciones. El seguimiento se realizó durante 2 años. El modelo de costes diferenció los costes sanitarios directos (atención primaria/especializada) e indirectos (productividad laboral). Análisis estadístico: modelos de regresión logística y ANCOVA, p < 0,05. RESULTADOS: Se seleccionaron 2.067 pacientes (edad media: 66,6 años; varones: 53,1%). Un 25,1% iniciaron un segundo tratamiento con IDPP4; 42,9% con sulfonilureas, 14,0% con glitazonas, y 18,0% con insulinas. A los 2 años de seguimiento, los pacientes tratados con IDPP4 mostraron un mayor cumplimiento terapéutico (70,3 vs. 59,9%, 60,3% y 58,4); mejor control de la DM2 (64,3 vs. 62,6%, 62,8 y 50,5%) y menor proporción de hipoglucemias (13,9 frente a 40,4%, 37,6% y 58,9%, respectivamente) (p < 0,001). El promedio/unitario de los costes totales fue de 2.321 € frente a 2.475 €, 2.724 €, y 3.164 €, respectivamente; p < 0,001. Las tasas de eventos cardiovasculares e insuficiencia renal fueron del 3,7; 6,4; 7,6, y 10,2%, respectivamente. CONCLUSIONES: Las sulfonilureas fueron los fármacos más utilizados. Los pacientes en tratamiento con IDPP4 presentaron mayor cumplimiento y control de la diabetes, con menores tasas de hipoglucemias y costes sanitarios

OBJECTIVES: To determine compliance, metabolic control, complications and healthcare costs of patients treated with metformin started a second antidiabetic drug in patients with type 2 diabetes (T2DM). PATIENTS AND METHODS: Design multicenter observational retrospective. Patients were evaluated ≥30 years (age), treated with metformin and started a second antidiabetic treatment during 2008-2009. There were 4 patient groups (metformin and another antidiabetic): a) dipeptidyl peptidase-4 inhibitors (IDPP4), b) sulfonylureas, c) glitazones and d) insulin. Main measures: comorbidity, metabolic control, compliance and complications. Patients were followed for 2 years. The cost model differed direct health costs (primary care / specialist) and indirect (labor productivity). Statistical analysis: logistic regression models and ANCOVA, p < 0.05. RESULTS: 2067 patients were included (mean age: 66.6 years male: 53.1%). 25.1% started a second treatment with IDPP4; 42.9% sulfonylureas, 14.0% glitazones and 18.0% insulin. At 2 years follow-up, patients treated with IDPP4 showed greater adherence vs. 70.3%. 59.9%, 60.3% and 58.4; better control of 64.3% vs. DM2. 62.6%, 62.8% and 50.5% and a decrease of 13.9% compared to hypoglycaemia 40.4%, 37.6% and 58.9% respectively (p < 0.001). The average / unit total costs was €2,321 vs. €2,475, €2,724 and €3,164, respectively, p < 0.001. Rates of cardiovascular events and renal failure were 3.7%, 6.4%, 7.6% and 10.2% respectively. CONCLUSIONS: Sulfonylureas were the most commonly used drugs. Patients treated with IDPP4 had higher compliance and control of diabetes, with lower rates of hypoglycaemia and healthcare costs

[Characterization of and costs associated to the profile of patients with type 2 diabetes treated with metformin who are added a second oral antidiabetic drug: a population study]. / Caracterización y costes asociados al perfil del paciente con diabetes tipo 2 en tratamiento con metformina al que se le añade un segundo fármaco antidiabético oral: estudio de base poblacional.

OBJECTIVES: To determine compliance, metabolic control, complications and healthcare costs of patients treated with metformin started a second antidiabetic drug in patients with type 2 diabetes (T2DM). PATIENTS AND METHODS: Design multicenter observational retrospective. Patients were evaluated ≥30 years (age), treated with metformin and started a second antidiabetic treatment during 2008-2009. There were 4 patient groups (metformin and another antidiabetic): a) dipeptidyl peptidase-4 inhibitors (IDPP4), b) sulfonylureas, c) glitazones and d) insulin. MAIN MEASURES: comorbidity, metabolic control, compliance and complications. Patients were followed for 2 years. The cost model differed direct health costs (primary care / specialist) and indirect (labor productivity). STATISTICAL ANALYSIS: logistic regression models and ANCOVA, p<0.05. RESULTS: 2067 patients were included (mean age: 66.6 years male: 53.1%). 25.1% started a second treatment with IDPP4; 42.9% sulfonylureas, 14.0% glitazones and 18.0% insulin. At 2 years follow-up, patients treated with IDPP4 showed greater adherence vs. 70.3%. 59.9%, 60.3% and 58.4; better control of 64.3% vs. DM2. 62.6%, 62.8% and 50.5% and a decrease of 13.9% compared to hypoglycaemia 40.4%, 37.6% and 58.9% respectively (p<0.001). The average / unit total costs was €2,321 vs. €2,475, €2,724 and €3,164, respectively, p<0.001. Rates of cardiovascular events and renal failure were 3.7%, 6.4%, 7.6% and 10.2% respectively. CONCLUSIONS: Sulfonylureas were the most commonly used drugs. Patients treated with IDPP4 had higher compliance and control of diabetes, with lower rates of hypoglycaemia and healthcare costs.