Padrões Regionais na Prescrição de Antidiabéticos em Portugal: Oito Anos de Evidência do Mundo Real (2017 - 2024) (Estudo TREND-8 REGIONS)

Ana Rita Leite; Célia Ramalho; Daniel Ramos; Mafalda Marcelino; Miguel Melo; Paula Freitas; Tiago Maricoto; Fátima Pinto; Sónia do Vale; Eduardo Calçada; João Sérgio Neves

doi:10.20344/amp.24706

Authors

Ana Rita Leite Serviço de Endocrinologia, Diabetes e Metabolismo. Unidade Local de Saúde de São João. Porto. & RISE-Health. Serviço de Cirurgia e Fisiologia. Faculdade de Medicina. Universidade do Porto. Porto. https://orcid.org/0000-0002-4111-3787
Célia Ramalho Departamento de Medical Affairs. BIAL - Portela & CA, S.A. Trofa. &epartamento de Medicina da Comunidade, Informação e Decisão em Saúde. Faculdade de Medicina. Universidade do Porto. Porto. https://orcid.org/0009-0002-5886-2984
Daniel Ramos Departamento de Desenvolvimento Clínico. BIAL - Portela & CA, S.A. Trofa. https://orcid.org/0009-0004-0738-9968
Mafalda Marcelino Serviço de Endocrinologia. Hospital das Forças Armadas. Lisboa.
Miguel Melo Serviço de Endocrinologia, Diabetes e Metabolismo. Unidade Local de Saúde de Coimbra. Coimbra. & Faculdade de Medicina. Universidade de Coimbra. Coimbra.
Paula Freitas Faculdade de Medicina. Universidade do Porto. Porto. & Centro de Responsabilidade Integrado de Obesidade. Unidade Local de Saúde de São João. Porto. https://orcid.org/0000-0002-8732-8046
Tiago Maricoto Unidade de Saúde Familiar Beira Ria. Unidade Local de Saúde da Região de Aveiro. Gafanha da Nazaré. & RISE-Health. Departamento de Ciências Médicas. Faculdade de Ciências da Saúde. Universidade da Beira Interior. Covilhã. https://orcid.org/0000-0002-4201-9565
Fátima Pinto Serviço de Medicina Interna. Hospital da Horta. Horta.
Sónia do Vale Faculdade de Medicina. Universidade de Lisboa. Lisboa. & Serviço de Endocrinologia, Diabetes e Metabolismo. Unidade Local de Saúde Santa Maria. Lisboa. & Instituto de Saúde Ambiental. Faculdade de Medicina. Universidade de Lisboa. Lisboa. https://orcid.org/0000-0001-9287-4095
Eduardo Calçada Departamento de Medical Affairs. BIAL - Portela & CA, S.A. Trofa.
João Sérgio Neves Serviço de Endocrinologia, Diabetes e Metabolismo. Unidade Local de Saúde de São João. Porto. & RISE-Health. Serviço de Cirurgia e Fisiologia. Faculdade de Medicina. Universidade do Porto. Porto. https://orcid.org/0000-0002-8173-8255

DOI:

https://doi.org/10.20344/amp.24706

Keywords:

Diabetes Mellitus, Type 2/drug therapy, Drug Prescriptions, Hypoglycemic Agents/therapeutic use, Portugal, Practice Patterns, Physicians/trends

Abstract

Introduction: The nationwide TREND-8 study revealed significant changes in antidiabetic prescribing patterns in Portugal between 2017 and 2024, with marked increases in the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA). The aim of the TREND-8 REGIONS study was to analyze variations across regions and healthcare settings.
Methods: This nationwide, cross-sectional, retrospective study analyzed antidiabetic drug prescriptions in Portugal between 2017 and 2024, stratified by healthcare setting (primary care, public hospitals, and private institutions) and geographic region (North, Center, Lisbon, Alentejo, Algarve, Madeira, and the Azores).
Results: Biguanides remained the most prescribed antidiabetic class across all regions, despite there being a uniform national decline in the proportion of prescriptions (2.3%/year), accounting for 37.5% of prescriptions in 2024. Insulin prescriptions showed a proportional decline across all regions (-5.3%/year), representing 7.5% of prescriptions in 2024, with significantly lower proportions in Madeira (5.5%; p < 0.001). The SGLT2i class exhibited the largest increase (34.5%/year), with modest regional variation. It accounted for 29.3% of total prescriptions in 2024; lower proportions were observed in Alentejo (27.5%; p = 0.002). The GLP-1RA class showed the second highest increase (24.1%/year), more pronounced in Alentejo (34.4%/year; p < 0.001) and Azores (38.4%/year; p < 0.001), accounting for 4.9% of prescriptions in 2024. Their proportion was higher in the Azores (7.1%) and Lisbon (5.6%) and lower in Alentejo (4.0%), Center (4.3%), and Madeira (4.4%) (all p < 0.05). Across healthcare settings, GLP-1RA prescribing increased more in primary care (32.0%/year), although the highest proportion of prescribing was observed in private institutions (10.4% of prescriptions in 2024). The greatest increase in SGLT2i prescribing occurred in primary care (35.4%/year), while public hospitals accounted for the highest proportion of prescriptions (34.5%) in 2024.
Conclusion: The TREND-8 REGIONS study showed an evolution that is consistent with international recommendations across the different regions of Portugal and healthcare settings analyzed, with only slight variability observed in GLP‑1 RA prescribing.

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