Insulin initiation in type 2 diabetes: is there a difference in doctors’ prescription in the private and public sector in Tunisia?

Abstract

Background: The management of type 2 diabetes is the prerogative of any practitioner and is guided by several recommendations, but it remains subject to some barriers, in particular economic.

Objective: Compare insulin initiation in both private and public sectors.

Design: a transversal a cross sectional study

Setting: outpatient department of the national institute of nutrition of tunis,

Participants: 100 patients followed in the private sector and 100 in the public sector

Results: Patients had the following characteristics: mean age 58 years in both groups. Public patients compared to private patients were more likely to be female (67 vs. 49, p=0.01) and have less clinic visits per year (2.96/year vs 3.63 /year p<0.0001). In the public sector, after the diagnosis of diabetes, insulin was initiated earlier than the private sector, 6 years for the public and 10 years for the private, with p<0.0001.

The private sector stood out with the use of analogues, a conventional regimen and lower doses of insulin in the moment of initiation(p<0.0001). Compliance, knowledge and self-monitoring of blood glucose were better in private.

Side effects such as: weight gain, severe hypoglycaemia and lipodystrophies were more important in public sector.

Conclusion: private health sector offers a wider choice for the needs of diabetic patients but this advantage is compromised by higher prices as compared to public facilities. Financing and cost of drugs needs to be addressed, either by means of health insurance or other mechanisms, in this era of increasing prevalence of diabetes mellitus worldwide.