Abstract
Introduction and objective: In Colombia, Dipeptidyl-Peptidase IV (DPP4) inhibitors are recommended as second-best choice for type 2 diabetes mellitus treatment. However, no evaluation of the accomplishment or impact of this recommendation was performed. The objective was to determine the prescription of the DPP4 inhibitor according to the Colombian Clinicial Practice Guide regarding type 2 diabetes mellitus treatment, and its effects on glycosylated hemoglobin (HbA1c). Materials and methods: A descriptive study that included patients with type 2 diabetes mellitus who attended a first level between 2016 and 2018, had a prescription for DPP4 inhibitor and at least two control appointments. Variables included were sociodemographic, clinics, treatment and comorbidities. The unadjusted prescription was defined as the lack of accomplishment of Colombian guidelines. Descriptive statistics and X2 test were used for the comparison of categorical variables. A binary logistic regression model was applied. Results: 112 out of 207 patients accomplished inclusion criteria, of which 77 were women (68.8%). Also, 68.8% of the patients had an unadjusted prescription of the iDPP4. There was a 0.21% total reduction in HbA1c levels, with a mean of 198.2 ± 124 days between the first and second control measurement (reduction of 0.55% when the prescription was adjusted to the guidelines and 0.05% if it was unadjusted). Conclusion: There is a limited impact of DPP4 inhibitors regarding the reduction of HbA1c and metabolic control, and there is a slight follow-up to the Colombian guidelines in patients who attend a first level.
Highlights
Introduction and objectiveIn Colombia, Dipeptidyl-Peptidase IV (DPP4) inhibitors are recommended as secondbest choice for type 2 diabetes mellitus treatment
The application of these recommendations, besides generating changes in therapeutic behaviors of primary care physicians, has become a challenge for the health system considering the difference of cost between glibenclamide[7-13] and DPP4 inhibitors, which could be a significant barrier to applying these guidelines in daily clinical practice
Of 207 patients prescribed DPP4 inhibitor, 60 (28.9%) did not have access to the drug. This limitation may be even greater in municipalities far from large cities, where the delivery of drugs such as DPP4 inhibitors or sodium glucose co-transporter type 2 (SGLT2) inhibitors, recommended by the GPC, may be almost utopian; reports confirming this statement have not been published
Summary
The objective was to determine the prescription of the DPP4 inhibitor according to the Colombian Clinicial Practice Guide regarding type 2 diabetes mellitus treatment, and its effects on glycosylated hemoglobin (HbA1c). Materials and methods: A descriptive study that included patients with type 2 diabetes mellitus who attended a first level between 2016 and 2018, had a prescription for DPP4 inhibitor and at least two control appointments. Conclusion: There is a limited impact of DPP4 inhibitors regarding the reduction of HbA1c and metabolic control, and there is a slight follow-up to the Colombian guidelines in patients who attend a first level. It is often necessary to increase oral therapy in patients who do not achieve metabolic control goals by two or three fold, based on the HbA1c levels[5]
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