Long-acting insulin in a public health system: analysis of compliance with clinical protocol in public pharmacies/Insulina de acao prolongada no sistema publico de saude: analise da adesao ao protocolo clinico em farmacias publicas

• Published in: Ciência & saude coletiva 2021-06, Vol.26 (6), p.2301
• Main Authors: de Andrade, Tadeu Uggere, Moreira, Fabricio Soares, Cassaro, Karla Oliveira dos Santos, Cruz, Manuela Ma, Brasil, Girlandia Alexandre, de Lima, Ewelyne Miranda, Lenz, Dominik, Endringer, Denise Coutinho
• Format: Article
• Language: Portuguese
• ISSN: 1413-8123
• DOI: 10.1590/1413-81232021266.06592019

Diabetes mellitus (DM) is a chronic disease marked by elevated blood glucose levels. Controlling DM involves adequate diet, physical exercises, medicines and monitoring the blood glucose and glycated hemoglobin (HbA1c) levels. This was a retrospective study of the process of dispensing long-acting insulin analogues to users with diabetes (types 1 and 2) who were registered at high-cost public pharmacies in public health system in a southeast state of Brazil, that sought to evaluate the fulfillment of the criteria of all the clinical protocol to provide these analogs. Of the 987 users registered in the health service, 315 met the inclusion criteria for the study. The evaluation of the dispensing processes of the long-acting insulin analogues revealed that the inclusion, exclusion, and suspension criteria of the protocol related with these insulin analogues were in some extend only partially fulfilled. Additionally, there was no difference between the initial and final fasting glycemic and HbA1c levels. It is concluded that the established criteria for dispensing long-acting insulin analogues were partly fulfilled by pharmacies, compromising the rational use of these analogues. It can directly impact the cost of maintaining the public health service and users' health. Key words Insulin long-acting, Diabetes mellitus, Clinical protocols Diabetes mellitus (DM) e uma doenca cronica marcada por niveis sanguineos elevados de glicose. O controle do DM envolve dieta adequada, exercicios fisicos, medicamentos e monitoramento dos niveis sanguineos de glicose e de hemoglobina glicada (HbAlc). Trata-se de um estudo retrospectivo do processo de dispensacao de analogos de insulina de acao prolongada a usuarios com diabetes (tipos 1 e 2) cadastrados em farmacias publicas de alto custo do sistema publico de saude de um estado do Sudeste do Brasil, que buscou avaliar o cumprimento dos criterios do protocolo clinico para fornecimento desses analogos. Dos 987 usuarios cadastrados no servico de saude, 315 preencheram os criterios de inclusao. A avaliacao dos processos de dispensacao dos analogos de insulina de acao prolongada revelou que os criterios de inclusao, exclusao e suspensao do protocolo dos analogos de insulina eram parcialmente cumpridos. Alem disso, nao houve diferenca entre os niveis inicial e final de glicemia em jejum e HbA1c. Conclui-se que os criterios estabelecidos para dispensacao de analogos de insulina de acao prolongada foram parcialmente cumpridos pelas