Essential diabetes medicines and health outcomes in 127 countries

Abstract

Aim: Diabetes is the ninth leading cause of death. Improving access to diabetes medicines may decrease mortality. Diabetes medicines on national essential medicines lists (NEMLs) vary considerably. We examine the association between diabetes population health outcomes relating to mortality and the listing of diabetes medicines on national essential medicine lists for 127 countries.Materials and methods: We conducted a cross-sectional study. We determined the number of diabetes medicines on NEMLs and used multiple linear regression to analyse the association between diabetes health outcomes and the number of medicines on NEMLs. We used linear regression to assess the association between diabetes health outcomes and the listing of or not listing of medicines that were listed by 25-75% of countries. Diabetes prevalence, gross domestic product (GDP) per capita and mean expenditure per person with diabetes were controlled for in all analyses.Results: The total number of diabetes medicines listed on NEMLs ranged from 0 to 16 (median: 4; interquartile range: 3-6). Diabetes health outcome scores were associated with the number of diabetes medicines on NEMLs [1.3-point increase (95% confidence interval, 95% CI 0.5-2.1) for every additional medicine on NEMLs; P = .002] and GDP per capita [19.5-point increase (95% CI 5.4-33.6) for every 10-fold increase in GDP; P = .003]. Diabetes expenditure was not associated with health outcome scores (P = .23). Increases in diabetes health outcomes score were associated with the listing of glimepiride (7.9-point increase, 95% CI 2.3-13.5, P = .006) and glipizide (5.8-point increase, 95% CI 0.03-11.6, P = .049) on NEMLs.Conclusions: Listing of diabetes medicines on NEMLs has the potential to improve population health outcomes related to mortality in countries with diverse incomes and diabetes prevalence without necessarily increasing diabetes health expenditure.diabetes, essential medicines, health equity, health outcomes, mortality 1 | INTRODUCTION Diabetes is the ninth major cause of death globally 1 and many patients with diabetes are still inadequately treated, particularly in low-and middle-income countries (LMICs). 2 The World Health Organization (WHO) has set a voluntary target of 80% availability and 50% use of affordable essential medicines to treat non-communicable diseases in the public and private sectors by 2025. 3 However, this target is only consistently met in high-income countries. 2 The International Diabetes Federation (IDF) conducted a global survey, in 2016,

Concordancia entre las listas de medicamentos esenciales y las guías para diabetes en América Latina y el Caribe

“…La correlación directa entre el ingreso per cápita y el número de fármacos en la LMN fue similar a la de otros estudios ( 22 , 30 ).…”

Global status of essential medicine selection: a systematic comparison of national essential medicine lists with recommendations by WHO

“…14 15 Future research continue to assess medicine listings on NEMLs by disease groups and for focused disciplinary as has been done for tobacco addiction, diabetes and heart disease among other topics. [16][17][18] Methodologically, we have used innovative methods including the ROC and F1 statistic that should be considered for future research on essential medicines. We propose that the F1 statistic be considered in analyses of EMLs in relation to the WHO MLEM, due to its ability to present a single measure in relation to the MLEM.…”

“…We use official listings, but our understanding of implementation of these lists to support access on the ground is still limited and further research required 14 15. Future research continue to assess medicine listings on NEMLs by disease groups and for focused disciplinary as has been done for tobacco addiction, diabetes and heart disease among other topics 16–18…”