The Health System in Costa Rica: Focus on the Management of Diabetes Mellitus.

Costa Rica's health system was established in 1941 by the president at the time, Rafael Angel Calderon Guardia. Since then, the public health system has expanded, and a private system was also introduced. Diabetes management differs greatly between both systems, as well as the medications available. Publicly, the system faces many challenges when treating diabetes; including a limited range and selection of medications, as well as a blatant lack of support (nutritional, physical, and psychological). Privately, the costs adjacent to a diabetes diagnosis represent an unbearable burden to some patients, with medications such as a weekly dose of 1.0 mg of semaglutide representing approximately 47.5% of Costa Rica's minimum wage. Despite its flaws, both systems provide the Costa Rican population with options for treatment. The Caja Costarricense de Seguro Social covers around 90% of the population, which puts Costa Rica on par with developed countries.

Diabetes Second-Line Medication Prescription Patterns in Costa Rica and Panama: Evidence From the DISCOVER Registry.

AIM: This study aimed to describe the prescription patterns of second-line medications for patients with diabetes from selected centers in Costa Rica and Panama. METHODS: DISCOVER is a registry of patients with type 2 diabetes switching from first- to second-line medications. We analyzed medication choice and the reasons to switch for each country.  Results: A total of 219 patients were included during 2014-2016, 127 in Costa Rica and 92 in Panama. The most frequently prescribed first-line medication was metformin, followed by sulphonylureas in Panama, and a combination of metformin and dipeptidyl peptidase-4 inhibitor (iDPP4) in Costa Rica. DPP4 inhibitors plus metformin was the most commonly prescribed second-line medication, followed by metformin combined with sodium-glucose transport protein-2 inhibitor (iSGLT2) in Costa Rica and iDPP4 in monotherapy in Panama. The main reason to switch being efficacy. When choosing the second-line medication, the main reasons behind the switch were efficacy, weight loss, and hypoglycemia risk in both countries (tolerability being also common in Panama). CONCLUSIONS: According to the DISCOVER registry, in Costa Rica and Panama, efficacy is the most common reason to switch to second-line medication. Metformin plus iDPP4 was the most commonly prescribed agent.