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.

Diabetes in South and Central America: an update.

The estimated population of the South and Central America (SACA) Region is 467.6 million and 64% is in the age range of 20-79 years but the population pyramid and age distribution are changing. The average prevalence of diabetes in the Region is 8.0% and is expected to reach 9.8% by the year 2035. Prevalence is much lower in rural settings than in urban and the differences attributed to lifestyle changes may be a target for intervention. The indigenous population is a particularly vulnerable group needing special attention. On average, 24% of the adult cases with diabetes are undiagnosed but in some countries this is still as high as 50%. Health expenditure due to diabetes in the Region is around 9% of the global total. Inadequate glycemic control, defined as HbA1c >7%, is a strong predictor of chronic complications which increase resource use in the Region and less than half of the patients enrolled in diabetes care programmes are at target. Fifty percent or more of the adult population is overweight/obese and around one third of the adult population has metabolic syndrome using regional cutoffs for waist circumference. The number of people with IGT is almost equal to those with diabetes presenting an additional challenge for prevention. Children with type 1 diabetes represent only 0.2% of the total population with diabetes but the incidence may be increasing. In many places they have limited access to insulin, and even when available, it is not used appropriately. The available epidemiological data provide the background to act in developing national diabetes programmes which integrate diabetes care with cardiovascular prevention and promote diabetes prevention as well.

Amenorrea primaria secundaria a disgenesia gonodal pura 46 xy (Síndrome de Swyer). Reporte de una caso / Secondary first amenorrhea a pure gonadal dysgenesis 46XY (Syndrome of Swyer) Report of a case

La disgenesia gonodal pura 46XY (Síndrome de Swyer) es una entidad rara, caracterizada por la presencia de estrías gonodales indiferenciadas en una paciente de fenotipo femenino que posee genitales femeninos hipoplásticos. La etiología no está muy clara, pero con frecuencia involucra trastornos genéticos a nivel de la región determinante del sexo del cromosoma Y. Se reporta el caso de una paciente abordada por amenorrea primaria a quien se le diagnosticó el sindrome de Swyer y se incluye una breve revisión bibliográfica