The Real-Life Effectiveness and Care Patterns of Diabetes Management Study for Balkan Region (Slovenia, Croatia, Serbia, Bulgaria): A Multicenter, Observational, Cross-Sectional Study.

INTRODUCTION: Recent large randomized controlled trials highlighted the clinical significance of hypoglycemic episodes in the treatment of diabetes. The present survey was conducted to provide information from real-life practice on the incidence of hypoglycemia in type 2 diabetic patients treated with sulfonylureas. METHODS: This multicenter, observational, cross-sectional study collected data on incidence of side effects of sulfonylurea-based therapy in type 2 diabetic patients in four countries of the Balkan region (Slovenia, Croatia, Serbia, Bulgaria) from October 2014 to June 2015. RESULTS: Of the 608 who participated in the study, 573 patients (mean age 67.2 years, mean body mass index 29.9 kg/m2) met the inclusion/exclusion criteria. More than 90% of the patients were treated with the newer generation sulfonylureas-gliclazide or glimepiride-either as monotherapy or as dual therapy in combination with metformin. In total, 210 patients (36.6%) reported hypoglycemic episode(s) in the last 6 months. Mild episodes were reported by 132 patients (62.8%), moderate by 66 (31.2%), severe by 8 patients (4.0%), and very severe by 4 patients (2%), respectively. Overall, 171 patients (28.2%) reported body weight increase during the previous year. The mean reported body weight gain in this group of patients was 4.2 kg (SD 2.7, median 3). Among them, 68.1% gained less than 5 kg, 25.0% gained 5-9 kg, and the rest gained more than 10 kg. CONCLUSION: Although newer generation sulfonylureas are generally considered safe in terms of hypoglycemia, our data indicates their use is associated with substantial risk of hypoglycemia and weight gain. Clinicians should be mindful of these findings when prescribing SUs and inform patients about the risk of hypoglycemia. FUNDING: Merck Sharp & Dohme.

Nine-year trends in the morbidity of mental disorders and psychotropic drug utilization in Croatia: over-diagnosis and over-utilization?

Overall drug overuse, including psychotropic, is the Croatian reality. Therefore, in between 2000 and 2012, the interventions to control drug overspending were undertaken. The main aims of the study are: to determine the morbidity trends of mental disorders registered in family medicine (FM), the trends in psychotropic drug utilization and to identify whether the trends of utilization have any relation to the interventions. The results indicate that mental disorders represent a high disease burden in Croatia. It was also present a higher burden of psychotropic drug utilization; second ranked in the total drug utilization during the nine-year follow up period. The utilization of psycholeptic's, was even higher; from 2004 to 2008; those drugs were ranked first in terms of utilization. Between 20-25% of Croatia's total health care budget is usually spent on drugs. The interventions that are currently being implemented to control drug utilization have not brought about any changes.

[GP's intervention in changing lifestyle behavior of adipose patients]. / Utjecaj lijecnika obiteljske medicine na promjene zivotnih navika pretilih pacijenata.

BACKGROUND: Obesity and physical inactivity (silent epidemic) are the dominant causes of insulin resistance. Obesity is a major public health concern, associated with high morbidity and mortality. The disease is the result of an increased energy intake in relation to its expenditure. Lifestyle modification is the main goal of primary and secondary prevention of chronic diseases including obesity. Although changing an individual's lifestyle may be perceived difficult, evidence suggests that intensive and repeated counseling by general practitioners (GP) can stimulate patients to become more physically active and to switch to healthy diet. According to WHO data, 300 million people with body mass index (BMI) 30 were recorded in the world in 2005. AIM: To investigate the efficiency of GP intervention for lifestyle modification in adipose patients from the respective catchment population. METHOD: During the 2001-2004 period, 135 obese patients (BMI 30) from a GP practice attended educational program for lifestyle modification. The program lasted for 6 months, was based on a small group work and used behaviorism as a key element in therapy for obesity. Each group session took about one hour, started with a short physician's lecture on healthy lifestyle, and continued with group discussion in which every participant showed his/her own dietary and physical activity diary for the last week and received advice on how to improve and achieve better results. At the end of the session, every participant set his/her own priorities for the next week. Outpatient control of the parameters of BMI, waist circumference, nutrition and physical activity personal records was performed on a weekly basis. RESULTS: There were 135 patients, 94 (70%) women and 41 (30%) men, mean age was 48 years. The heaviest man had 160 kg and lost 18 kg during the intervention period. The heaviest woman had 129 kg and lost 15 kg during the intervention period. BMI decreased in men by 9% (from 34.6 kg/m2 to 31.7 kg/m2; p < 0.001), and in women by 8.1% (from 34.9 kg/m2 to 32.1 kg/m2; p < 0.001). Thus, 42. 2% of the extreme obesity group (BMI > 40) and obesity group subjects switched to a lower group. Waist circumference decreased by 7.5 cm in men and by 8.4 cm in women (p < 0.001). The highest cholesterol level was 8.8 mmol/L in men and 8.6 mmol/L in women. Cholesterol decreased by 0.8 mmol/L in both men and women. Fasting blood glucose was 8.3 mmol/L in men and 8.6 mmol/L in women, and decreased by 1.4 mmol/L in men and by 0.5 mmol/L (p < 0.001) in women. CONCLUSION: GPs are familiar with their patients and have a critical role in the assessment and advising of an appropriate lifestyle. GP recommendations can be a valuable source of motivation for the patient. Small group work coordinated by GP is more effective in changing lifestyle. Lifestyle modification program is a suitable therapeutic choice in the GP management of obesity. Medically based education in the form of small group work based on behaviorism proved its efficiency in treating obese patients in a GP practice.