[Rational treatment of diabetes mellitus in Siauliai and Telsiai regions, Lithuania].
OBJECTIVE
The evaluation of adherence to guidelines on rationality in prescribing reimbursed medicines for the treatment of diabetes mellitus.


METHODS
A retrospective evaluation of drug utilization in national public health insurance database and analysis of 906 case histories of diabetic patients in respect of nonadherence to guidelines.


RESULTS
A total of 184 (20.3%) case histories with 370 events were found to be nonadherent to: a) national guidelines on prescription of medicines (66.49%); b) authorized indications and contraindications (13.24%); c) insufficient monitoring (4.32%); d) nonadherence to the recommendations for prescription writing (11.35%); and e) nonadherence to the requirements for service provisions (4.6%). The analysis of nonadherence to national guidelines revealed: 1) failure to assess patient's height, weight, and body mass index (30.1%); 2) poor glycemia control (26%); 3) failure in referring to an endocrinologist in case of noncontrolled glycemia (17.5%); 4) monotherapy with long-acting insulin or started combined oral therapy without monotherapy (10.2%); 5) noncompliance with the recommendations of endocrinologist (8.5%); 6) unsubstantiated changes in diabetes mellitus treatment (4.1%). Thiazolidinediones are often administered in case of liver failure or without investigation of its function (60.4%) or in case of heart failure (29.2%).


CONCLUSIONS
1) Nonadherence was observed in 20.3% of cases; 2) the most frequent cause was nonadherence to guidelines (66.5%) and to authorized indications and contraindications (13.2%); 3) thiazolidinediones were prescribed in the presence of the contraindications. The areas for intervention are: 1) more active monitoring of glycemia; 2) the assessment of height, weight, and body mass index; and 3) the prescription of thiazolidinediones according to authorized indications and contraindications.
Maciulaitis
Romaldas
R
Department of Theoretical and Clinical Pharmacology, Kaunas University of Medicine, Kaunas, Lithuania. romaci@takas.lt
Ozoliene
Dalia
D
Pilviniene
Rugile
R
Preiksa
Romualdas Tomas
RT
D000284:Administration, Oral; D001786:Blood Glucose / Q000032:analysis; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D000075202:Contraindications; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D019983:Guideline Adherence; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007348:Insurance, Health; D008097:Lithuania; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012189:Retrospective Studies; D045162:Thiazolidinediones / Q000627:therapeutic use
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D045162:Thiazolidinediones