title: Management of type 2 diabetes and its prescription drug cost before and during the economic crisis in Greece: an observational study.
abstract: BACKGROUND
  The aim of the present study is to examine the clinical indices related to cardiovascular risk management of Greek patients with type 2 diabetes, before and after the major economic crisis that emerged in the country.
  
  
  METHODS
  In this retrospective database study, the medical records of patients with type 2 diabetes treated at three diabetes outpatient centers of the national health system during 2006 and 2012 were examined. Only patients with at least six months of follow-up prior to the recorded examination were included. The prescription cost was calculated in Euros per patient-year (€PY).
  
  
  RESULTS
  A total of 1953 medical records (938 from 2006 and 1015 from 2012) were included. There were no significant differences in adjusted HbA1c, systolic blood pressure and HDL-C, while significant reductions were observed in LDL-C and triglycerides. In 2012, a higher proportion of patients were prescribed glucose-lowering, lipid-lowering and antihypertensive medications. Almost 4 out of 10 patients were prescribed the new incretin-based medications, while the use of older drugs, except for metformin, decreased. A significant increase in the adjusted glucose-lowering prescription cost (612.4 [586.5-638.2] €PY vs 390.7 [363.5-418.0]; p < 0.001) and total prescription cost (1306.7 [1264.6-1348.7] €PY vs 1122.3[1078.1-1166.5]; p < 0.001) was observed. The cost of antihypertensive prescriptions declined, while no difference was observed for lipid-lowering and antiplatelet agents.
  
  
  CONCLUSIONS
  During the economic crisis, the cardiovascular risk indices of Greek patients with type 2 diabetes being followed in public outpatient diabetes clinics did not deteriorate and in the case of lipid profile improved. However, the total prescription cost increased, mainly due to the higher cost of glucose-lowering prescriptions.
authors.affiliation: First Department of Propaedeutic Medicine, Diabetes Center, Athens University Medical School, Laiko Hospital, Ag, Thoma 17, 11527 Athens, Greece. sliatis@med.uoa.gr.
authors.forename: Stavros
authors.initials: S
authors.lastname: Liatis
authors.forename: Stavroula
authors.initials: S
authors.lastname: Papaoikonomou
authors.forename: Asimina
authors.initials: A
authors.lastname: Ganotopoulou
authors.forename: Athanasia
authors.initials: A
authors.lastname: Papazafiropoulou
authors.forename: Constantinos
authors.initials: C
authors.lastname: Dinos
authors.forename: Marios
authors.initials: M
authors.lastname: Michail
authors.forename: Apostolos
authors.initials: A
authors.lastname: Xilomenos
authors.forename: Andreas
authors.initials: A
authors.lastname: Melidonis
authors.forename: Stavros
authors.initials: S
authors.lastname: Pappas