A Diabetes Mellitus em Portugal: Relevância da Terapêutica Farmacológica Adequada

Abstract

Diabetes is a major public health problem in Portugal, with a estimated prevalence of 13,1% in the population aged between 20 and 79 years old, which corresponds to more than 1 million individuals who suffer from this disease. Diabetes has an overwhelmingly high social, economic and human cost. Indeed, costs associated with diabetes represent in Portugal approximately 10% of the total expenditure in Health and 0,9% of the country’s GDP. In particular, costs with antidiabetic medication have been steadily increasing in the past years, as new and more expensive therapeutic classes are launched into the market. For these reasons diabetes represents a serious threat to the sustainability of health care systems. “Diabetes in Portugal” was the subject of a reflection meeting which aimed to promote a debate on the contribution of oral antidiabetic medicines to a comprehensive approach to diabetes management, current guidelines and their applicability in clinical practice while taking into consideration specific characteristics of each patient and strategies to ensure patients’ access to new therapeutics. A broad consensus was reached among the experts that participated in this meeting regarding the need for effective community-based diabetes prevention programs. The implementation of such programs may require a significant investment, but avoidance or delaying progression of diabetes has enormous benefits in terms of the overall health of the population, with the potential of considerable savings for the health system. Experts also agreed that, due to the complex nature of diabetes, the disease is best managed by a multidisciplinary approach. Such an integrated care team should include physicians, nurses, pharmaceutics, dieticians and social workers. Diabetes care should be provided in an individualized or patient-centred manner, taking into account individual needs and preferences, in order to improve therapeutic effectiveness and optimize outcomes. In the management of diabetes, lifestyle modifications and medication adherence are paramount. As such, patients should receive structured education about their condition and be actively involved in the treatment decision making. Finally, prescription of innovative therapeutics should not be influenced by their costs. Treatment choices should be evidence-based and made accordingly with the needs of the patients. However, costly innovative therapeutics are one of the main drivers of health spending growth, leading to their thorough cost-effectiveness assessed by competent authorities.