Abstract
Objectives. To investigate trends of diabetes mellitus (DM) morbidity and antidiabetic drug utilization in Croatian primary health care (PHC) from 2005 to 2014. Method. Routinely collected morbidity data from all PHC units, presented in Croatian health-statistics yearbooks, were retrieved. Data on drug utilization were retrieved from the Annual Reports of the Croatian Agency for Medicinal Products and Medical Devices (ATC/DDD, antidiabetic, A10). Results. Total morbidity increased by 33.3% and DM increased by 65.6%, mostly in patients over age 65 (from 50% to 57%). Estimated DM prevalence in adults increased from 3.9% to 6.4%. Increased morbidity was followed by an even higher increase in drug utilization (120%). Metformin was first, with a constant increase (from 18% to 39%), followed by glimepiride, while glibenclamide use decreased. Total utilization of insulin increased even more, mostly for aspart (600%) and newly introduced glargine and detemir, while human insulin usage sharply decreased. Spending also increased, mostly for aspart (from 21% to 61% of total). Conclusions. Increased DM is followed by a higher increase in antidiabetic drug utilization; this trend will continue in the future. In Croatian PHC, metformin has primacy along with insulin analogues.
Highlights
Diabetes mellitus (DM) is a multifactorial disease that occurs in genetically susceptible individuals under the influence of environmental factors
Increased diabetes mellitus (DM) is followed by a higher increase in antidiabetic drug utilization; this trend will continue in the future
Only primary health care (PHC) doctors in Croatia are responsible for issuing drug prescriptions, including antidiabetics, which are reimbursed by the Croatian Health Insurance Fund (CHIF)
Summary
Diabetes mellitus (DM) is a multifactorial disease that occurs in genetically susceptible individuals under the influence of environmental factors. According to World Health Organization (WHO) data, an estimated 1.5 million deaths were directly caused by diabetes in 2012, mainly because of those complications [1]. In Croatia, with 4.28 million inhabitants, DM complications were the sixth leading cause of death in women and the eighth in men older than 65 years in 2010 [2]. In 2010 and 2011, DM with its complications was the fourth highest-ranking reason for the hospitalization of elderly men and the third highest for elderly women in Croatia [3]. According to the Global Burden of Disease project data, the disability-adjusted life-years related to DM increased by 20% in Croatia during the period of 1990– 2010 [4]
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