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Efficacy and Direct Medical Costs of Metformin-Glibenclamide Treatment in Ecuadorian Population with Type II Diabetes Mellitus during the COVID-19 Pandemic

Author(s): R. Zambrano, Maria Del Carmen Cabezas*, G. Loor, Nicole Aguirre and Camila Mino
Department of Internal Medicine, Hospital General Napoleon Davila Cordova, Chone 130703, 1Department of Medicine, School of Medicine, Pontificia Universidad Catolica del Ecuador, Quito 170143, Ecuador, 2Department of Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom

Correspondence Address:
Maria Del Carmen Cabezas, Department of Medicine, School of Medicine, Pontificia Universidad Catolica del Ecuador, Quito 170143, Ecuador, E-mail:

Type II diabetes mellitus is one of the most prevalent endocrinological diseases with a high economic impact worldwide. Coronavirus disease 2019 pandemic was declared by the World Health Organization in March 2020 with lockdowns representing an important change in the assessment of type II diabetes mellitus. This study was a retrospective and economic impact analysis of the efficacy and direct costs of type II diabetes mellitus in ambulatory patients treated with metformin plus glibenclamide during the coronavirus disease 2019 pandemic in an Ecuadorian second level hospital. Data collected included demographic characteristics, drug regimen, laboratory tests, diabetes complications, comorbidities and hospitalization stay. Estimates of costs were based on the National Public Procurement Service and the Rate of Benefits for the National Health System. The mean difference in glycated hemoglobin, fasting glucose and weight after 6 and 12 mo of treatment was also analyzed. In total, 39 patients (21 females and 18 males) were enrolled. Medical consultations costs amounted to 8004.00 USD (205.23 USD per patient) with 213 (84.5 %) consultations dedicated to diabetic control (5.5±2.7 consultations per patient/year). All patients required hospitalization and emergency care at least once, which represented a total cost of 77 812.73 USD (1995.20 USD per patient) and 3448.56 USD (88.42 USD per patient), respectively. After 12 mo, fasting glucose [-58.8 mg/dl (95 % confidence interval -19.7 to -97.9 mg/dl; p=0.004)] and glycated hemoglobin levels [-1.05 % (95 % confidence interval -0.16 % to -1.93 %; p=0.02)] significantly decreased. The total annual direct costs were 110 634.81 USD, while the cost per patient was 2836.79 USD. Moreover, metformin plus glibenclamide significantly reduced fasting glucose and glycated hemoglobin levels, but not according to international recommendations. The economic impact of type II diabetes mellitus management during coronavirus disease 2019, however, was considerable mainly due to complications and prolonged stay hospitalizations.

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