Investigation of the need for a treatment strategy with SGLT2 inhibitors

88% of the participants prefer SGLT2 inhibitors to DPP4 inhibitors.

The benefits of SGLT2 inhibitors are superior to those of DPP4 inhibitors, but with better glycemic control and cardiovascular and renal protection. Photo: Shutterstock.

Seek the Latin American investigation team, Patients with type 2 diabetes prefer the pharmacological treatment with sodium-glucose-2 co-transporter inhibitors (SGLT2) treated with dipeptidyl peptidase-4 (DPP4) inhibitors.

These studies are published in Patient Preference and Adherence and support the need for clear discussions between patients and doctors before defining a treatment strategy.

José Esteban Costa Gil, MD, PhD, endocrinologist at the La Plata Cardiology Institute in La Plata, Argentina, commenting that to design the treatment where the therapeutic supplement can be improved “.

Costa, president of the Latin American Diabetes Association, added: “This is the best quality and security of medical athens“.

The study sample, taking into account the proportions of information el tratamiento, 88.2% of the participants prefer SGLT2 inhibitors to DPP4 inhibitors.

La Dra. Carmen Castillo Galindo, an endocrinologist in the City of Mexico with a high degree in diabetes, observes that these data allow interesting reflections. Based on experience, primary attenuation drugs in Mexico only prescribe DPP4 inhibitors. It is not up to the patient and a specialist to el tratamiento exchange of SGLT2 inhibitors. Galindo did not participate in the studio.

From here, Galindo suggests that the benefits of SGLT2 inhibitors are superior to those of DPP4 inhibitors, but one better glycemic control and for the benefits of cardiovascular and renal protection. This explains the tendency of specialists to prescribe SGLT2 inhibitors with high frequency, which is that patients with diabetes generally have cardiac or renal trauma and gain benefits. extra glycemic control.

“When the benefits of treatment with patients are discussed, it is clear that they are more likely to [beneficio]. Because it attributes the discrepancy between the patient preference and el tratamiento “as a result of which the patient does not give the options”, the specialist agrees.

This idea is in line with the observations of the authors of the study. Realtaron que the health team rarely spends time on patient preferencehaving the concurrence of the objectives of the salutations depend on the grain size of the acceptance and therapeutic complementarity.

What patients value

The multicenter study recorded 390 patients with type 2 diabetes in Mexico and Argentina. Between June and September 2020, patients complete a discreet choice questionnaire to indicate their preferences between el tratamiento with SGLT2 inhibitors y el tratamiento with DPP4 inhibitors.

In general, 88.2% of the participants prefer el tratamiento with SGLT2 inhibitors treated with DPP4 inhibitors. Además, Major participants, those with depression and obesity, high blood pressure, total high cholesterol and glycosylated hemoglobin (A1c) more than 7% only more probabilities of selecting SGLT2 inhibitors.

The most important reasons for a patient to qualify for medications are to reduce A1c and risk genital infection, respectively.

One possible explanation for patients preferring to be treated as A1c is to have control over type 2 diabetes. Doctors and patients need to be centered on monitoring and controlling A1c and not in a holistic setting abarque the risks and comorbidities associated with type 2 diabetes, say investigators.

On the other hand, patients do not want to import the risk of genital infertility as a secondary effect of treatment, but Castillo discusses importation to discuss all the details of treatment with patients.

“Practically, the only contraindication to prescribing SGLT2 inhibitors is in a patient who has a current urinary tract infection or who has a urinary tract disorder that is most susceptible to chronic urinary tract infections,” he said.

The importation of autonomy

The authors of the study conclude that the center of gravity in the patient, to search for a complete knowledge of the preferences and information needs of patients, mejoraría la personal satisfaction and la salud. However, there are ethical implications to consider.

Susana Vanoni, MD, PhD, is a bioethics expert and professor at the Faculty of Medicine of the National University of Córdoba, Argentina. “Respect for patient treatment preferences is an option based on the principle of autonomy, limited by distributive justice. But otherwise, It is important that the doctor dedicates time to explain the different regimes that provide a security profile. and similar efficiencies have been achieved at the expense of the principal costs and the cost to the recommendation “.

Factor values, such as experience in the use of treatments, may differ from what the individual discusses the options and narrows down the patient preferences.

“Among other factors: permanent professional education. Accessibility to permanent education is very lacking in the United States and, as a result, health centers do not involve professional training or inconsistent manners. for a more amplified debate. The pharmaceutical industry with a proportionate frequency to gas capacity“and can ask for possible conflicts of interest when there are medicines”, says Vanoni.

Podrían surgir conflicts of interest related to DPP4 inhibitors, said Castillo. “It’s a hypothesis, it’s not what it’s safe, but the DPP4 inhibitors are in the market at full speed, and although primary care physicians can be more acutumbrados or recetarlos, it is possible that they are not “Updated about the benefits of new treatments. If only patients are being treated in this way, they will not change.”

It is also a factor of medical-patient communication, including the duration of the consultation, which can be limited by institutional institutions, says Vanoni.

Another element that reduces the pace of communication between physician and patient is the administrative burden of supporting professional health professionals.. There is a complementary obligation, except for manual, extensive forms that justify therapeutic and diagnostic procedures. “It must be said that the preparation of a prescription in an electronic system which is not easy to use or has little connectivity”.

It is the first Latin American study to analyze the preference for oral treatment among patients with diabetes. The authors believe that the study can help professional health professionals educate their patients and make consistent decisions to improve the control of type 2 diabetes.

Where consulted here.