期刊论文详细信息
Globalization and Health
Diabetes in Argentina: cost and management of diabetes and its complications and challenges for health policy
Juan J Gagliardino1  Jorge F Elgart1  Joaquín E Caporale1 
[1] CENEXA – Centro de Endocrinología Experimental y Aplicada (UNLP – CONICET La Plata, PAHO/WHO Collaborating Centre for Diabetes), Facultad de Ciencias Médicas UNLP, La Plata, Argentina
关键词: Diabetes management;    Prevalence;    Argentina;    Costs;    Diabetes;   
Others  :  805231
DOI  :  10.1186/1744-8603-9-54
 received in 2012-07-23, accepted in 2013-10-10,  发布年份 2013
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【 摘 要 】

Background

Diabetes is an expensive disease in Argentina as well as worldwide, and its prevalence is continuously rising affecting the quality of life of people with the disease and their life expectancy. It also imposes a heavy burden to the national health care budget and on the economy in the form of productivity losses.

Aims

To review and discuss a) the reported evidence on diabetes prevalence, the degree of control, the cost of care and outcomes, b) available strategies to decrease the health and economic disease burden, and c) how the disease fits in the Argentinian health care system and policy. Finally, to propose evidence-based policy options to reduce the burden of diabetes, both from an epidemiological as well as an economic perspective, on the Argentinian society. The evidence presented is expected to help the local authorities to develop and implement effective diabetes care programmes.

Methodology

A comprehensive literature review was performed using databases such as MEDLINE, EMBASE and LILACS (Latin American and Caribbean Health Sciences). Literature published from 1980 to 2011 was included. This information was complemented with grey literature, including data from national and provincial official sources, personal communications and contacts with health authorities and diabetes experts in Argentina.

Results

Overall diabetes prevalence increased from 8.4% in 2005 to 9.6% 2009 at national level. In 2009, diabetes was the seventh leading cause of death with a mortality rate of 19.2 per 100,000 inhabitants, and it accounted for 1,328,802 DALYs lost in the adult population, mainly affecting women aged over fifty. The per capita hospitalisation cost for people with diabetes was significantly higher than for people without the disease, US$ 1,628 vs. US$ 833 in 2004. Evidence shows that implementation of combined educative interventions improved quality of care and outcomes, decreased treatment costs and optimised the use of economic resources.

Conclusions

Based on the evidence reviewed, we believe that the implementation of structured health care programmes including diabetes education at every level, could improve quality of care as well as its clinical, metabolic and economic outcomes. If implemented across the country, these programmes could decrease the disease burden and optimise the use of human and economic resources.

【 授权许可】

   
2013 Caporale et al.; licensee BioMed Central Ltd.

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【 参考文献 】
  • [1]Ferrante D, Linetzky B, Konfino J, King A, Virgolini M, Laspiur S: Encuesta Nacional de Factores de Riesgo 2009: Evolución de la epidemia de enfermedades crónicas no trasmisibles en Argentina. Estudio de Corte Transversal. Rev Argent Salud Publica 2011, 2:34-41.
  • [2]Araújo GTB, Caporale JE, Stefani S, Pinto D, Caso A: Is equity of access to health care achievable in Latin America? Value Health 2011, 14:S8-S12.
  • [3]Dirección de Información Parlamentaria. Congreso de la Nación: Programa Médico Obligatorio - Legislación Nacional vigente. http://www1.hcdn.gov.ar/dependencias/dip/documentos/RL.109.05.00-1.pdf webcite
  • [4]Hernández RE, Cardonnet L, Libman C, Gagliardino JJ: Prevalence of diabetes and obesity in an urban population of Argentina. Diabetes Res Clin Practice 1987, 3:277-283.
  • [5]Ministerio de Salud de la Nación: Vigilancia de Enfermedades No Transmisibles. Buenos Aires, Argentina: Boletín Epidemiológico Periódico (Edición Especial); 2004.
  • [6]Dirección de Estadísticas e Información de Salud. Ministerio de Salud: Evolución de la mortalidad según causas. Argentina - Período 1997–2006. http://www.deis.gov.ar/publicaciones/Archivos/Serie12nro6.pdf webcite
  • [7]Dirección de Estadísticas e Información de Salud. Ministerio de Salud: Agrupamiento de causas de mortalidad por division politico territorial de residencia, edad y sexo. Argentina - año 2009. http://www.deis.gov.ar/publicaciones/Archivos/Boletin131.pdf webcite
  • [8]Murray CJM, Lopez AD: The Global Burden of Disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2016. Cambridge: Harvard University Press; 1996.
  • [9]Caporale JE, Gagliardino JJ: Costos de atención de la diabetes tipo 2 en Argentina. Un análisis de sensibilidad probabilístico. Rev Soc Argent de Diabetes 2010, 44:349-357.
  • [10]Elgart J, Caporale JE, Pfirter G, González L, Siri F, Gagliardino JJ: Estimación del costo asociado a la pérdida de productividad por mortalidad atribuible a la diabetes en Argentina [abstract]. Value in Health 2009, 12(7):A505.
  • [11]Borruel MA, Mas IP, Borruel GD: Estudio de carga de enfermedad. Argentina. Buenos Aires: Ministerio de Salud de la Nación; 2010. http://www.msal.gov.ar/fesp/images/stories/recursos-de-comunicacion/publicaciones/Estudio_de_carga_FESP_Imprenta.pdf webcite
  • [12]Gagliardino JJ, de la Hera M, Siri F, Grupo de Investigación de la Red QUALIDIAB: Evaluación de la calidad de la asistencia al paciente diabético en América Latina. Rev Panam Salud Pública/Pan Am J Public Health 2001, 10:309-317.
  • [13]Gagliardino JJ, de la Hera M, Siri F: Evaluación preliminar de la calidad de atención de personas con diabetes en Argentina. Rev Soc Argent de Diabetes 2001, 35:121-133.
  • [14]Chan JC, Gagliardino JJ, Baik SH, Chantelot JM, Ferreira SR, Hancu N, Ilkova H, Ramachandran A, Aschner P, IDMPS Investigators: Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS). Diabetes Care 2009, 32:227-233.
  • [15]Ringborg A, Cropet C, Jonsson B, Gagliardino JJ, Ramachandran A, Lindgren P: Resource use associated with type 2 diabetes in Asia, Latin America, the Middle East and Africa: results from the International Diabetes Management Practices Study (IDMPS). Int J Clin Pract 2009, 63:997-1007.
  • [16]Luongo AM, López González E, Garcia AB, González CD, Ruiz ML, Burlando G, Ruiz M: Evaluación del tratamiento de la diabetes tipo 2 realizado por especialistas en Argentina. Revista ALAD 2011, 1:78-87.
  • [17]Ministerio de Salud y Acción Social: Programa Nacional de Diabetes (PRONADIA). http://www.msal.gov.ar/ent/images/stories/programas/pdf/resolucion-301-99-probacion-pronadia.pdf webcite
  • [18]Gagliardino JJ: Hyperglycemia and chronic complications in type 2 diabetes: the challenge of its prevention within the framework of cost-effectiveness and health equity. Dialogue 1998 Third Quarter5-8.
  • [19]Gagliardino JJ, Martella A, Etchegoyen GS, Caporale JE, Guidi ML, Olivera EM, González C: Hospitalization and re-hospitalization of people with and without diabetes in La Plata, Argentina: comparison of their clinical characteristics and costs. Diab Res Clin Pract 2004, 65:51-59.
  • [20]Gagliardino JJ, Olivera E, Etchegoyen GS, Guidi ML, Caporale JE, Martella A, de la Hera M, Siri F, Bonelli P: PROPAT: a study to improve the quality and reduce the cost of diabetes care. Diab Res Clin Pract 2006, 72:284-291.
  • [21]Caporale JE, Calvo H, Gagliardino JJ: Costos de atención en personas con diabetes previos y posteriores a su hospitalización. Rev Panam Salud Publica 2006, 20:361-368.
  • [22]Gagliardino JJ, Kleinebreil L, Colagiuri S, Flack J, Caporale JE, Siri F, Clark C Jr: Comparison of clinical-metabolic monitoring and outcomes and coronary risk status in people with type 2 diabetes from Australia, France and Latin America. Diabetes Res Clin Pract 2010, 88:7-13.
  • [23]Gagliardino JJ, Werneke U, Olivera EM, Assad D, Regueiro F, Díaz R, Pollola J, Paolasso E: Characteristics, clinical course and in-hospital mortality of non-insulin-dependent diabetic and nondiabetic patients with acute myocardial infarction in Argentina. J Diab Comp 1997, 11:163.
  • [24]Gagliardino JJ, Jadzinsky M, Cédola NV, Alvariñas J, Hernández RE, Sederay M, Sinay I, Clark C Jr: Diabetes y otros factores de riesgo cardiovascular. Prevención y tratamiento. La PLata, Argentina: Magenta; 2005.
  • [25]Gagliardino JJ, Olivera EM, Etchegoyen GS, González C, Guidi ML: Evaluación y costos del proceso de atención de pacientes diabéticos. Medicina 2000, 60:880-888.
  • [26]Caporale JE, Elgart J, Pfirter G, Martínez P, Viñes G, Insúa JT, Gagliardino JJ: Hospitalization costs for heart failure in people with type 2 diabetes: cost-effectiveness of its prevention measured by simulated preventive treatment. Value Health 2011, 14:S20-S23.
  • [27]Caporale JE, Elgart JF, Gagliardino JJ: The cost of diabetes care programs for type 2 diabetes in Argentina: a probabilistic sensitivity analysis. Primary Health Care: Open Access 2011, 1:105. doi:10.4172/phcoa.1000105
  • [28]Olivera E, Pérez Duhalde E, Gagliardino JJ: Costs of temporary and permanent disability induced by diabetes. Diabetes Care 1991, 14:593-596.
  • [29]Gagliardino JJ, Arrechea V, Assad D, Gagliardino GG, González L, Lucero S, Rizzuti L, Zufriategui Z, Clark C Jr: Type 2 diabetes patients educated by other patients perform at least as well as patients trained by professionals. Diabetes Metab Res Rev 2013, 29(2):152-160.
  • [30]Gagliardino JJ, Etchegoyen G: A model educational program for people with type 2 diabetes: a cooperative Latin American implementation study (PEDNID-LA). Diabetes Care 2001, 24:1001-1007.
  • [31]Gagliardino JJ, Lapertosa S, Pfirter G, Villagra M, Caporale JE, Gonzalez CD, Elgart J, González L, Cernadas C, Rucci E, Clark C Jr, PRODIACOR: Clinical, metabolic and psychological outcomes and treatment costs of a prospective randomized trial based on different educational strategies to improve diabetes care (PRODIACOR). Diabet Med 2013,  . doi:10.1111/dme.12230. Epub ahead of print
  • [32]Ministerio de Salud de la Nación: Guía Práctica Clínica Nacional sobre Prevención, Diagnóstico y Tratamiento de la Diabetes Mellitus Tipo 2. Buenos Aires; 2009.
  • [33]UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998, 12:352-837.
  • [34]Kahn SE, Haffner SM, Heise MA, Herman WH, Holman RR, Jones NP, Kravitz BG, Lachin JM, O’Neill MC, Zinman B, Viberti G: Glycemic durability of Rosiglitazone, Metformin, or Glyburide Monotherapy. N Engl J Med 2006, 355:2427-2443.
  • [35]Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, Marre M, Cooper M, Glasziou P, Grobbee D, Hamet P, Harrap S, Heller S, Liu L, Mancia G, Mogensen CE, Pan C, Poulter N, Rodgers A, Williams B, Bompoint S, de Galan BE, Joshi R, Travert F, ADVANCE Collaborative Group: Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008, 358:2560-2572.
  • [36]Gaede P, Lund-Andersen H, Parving H-H, Pedersen O: Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008, 358:580-591.
  • [37]Duckworth W, Abraira C, Moritz T, Reda D, Emannele N, Reaven PD, Zieve FJ, Marks J, Davis SN, Hayward R, Warren SR, Goldman S, McCarren M, Vikek ME, Henderson WG, Huang GD: Intensive glucose control and complications in American veterans with type 2 diabetes. N Engl J Med 2009, 360(2):129-139.
  • [38]Gagliardino JJ, Puppo R, Barragán H: Costos directos en diabetes. Estrategias para disminuir su repercusión socio económica. Rev. Soc. Argent. Diabetes 1989, 23:28.
  • [39]Gagliardino JJ, Olivera EM: Aspectos socioeconómicos de la diabetes mellitus en la Argentina: diagnóstico epidemiológico. In Epidemiología y atención de la salud en la Argentina. Edited by Lemus JD. OPS, AMA: Buenos Aires; 1993.
  • [40]Gagliardino JJ, Olivera EM, Barragán H, Puppo RA: A simple economic evaluation model for selecting diabetes health care strategies. Diabet Medicine 1993, 10:351-354.
  • [41]Gagliardino JJ, Williams R, Clark CM Jr: Using hospitalization rates to track the economic costs and benefits of improved diabetes care in the Americas. A proposal for healthy policy makers. Diabetes Care 2000, 23:1844-1846.
  • [42]Sereday M, Damiano M, Lapertosa S: Complicaciones crónicas en personas con diabetes mellitus tipo 2 de reciente diagnóstico. Endocrinol Nutr 2008, 55:64-68.
  • [43]Gagliardino JJ, González C, Caporale JE: The diabetes-related attitudes of health care professionals and persons with diabetes in Argentina. Revista Panamericana de Salud Pública/Pan American Journal of Public Health 2007, 22:304-307.
  • [44]Álvarez A, Basile R, Bertaina V, Caporale J, Castelli M, Giménez L, Guntsche E, Litwak L, Lijteroff G, Masciottra F, Sinay I, Gagliardino JJ: Prevención primaria de Diabetes Tipo 2. Estado actual del conocimiento. Revista de la ALAD 2011, 1:17-28.
  • [45]Lindström J, Tuomilehto J: The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care 2003, 26:725-731.
  • [46]Glümer C, Carstensen B, Sandbaek A, Lauritzen T, Jørgensen T, Borch-Johnsen K: A Danish diabetes risk score for targeted screening: the Inter99 study. Diabetes Care 2004, 27:727-733.
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