Impacto de la inercia terapéutica y del grado de adherencia al tratamiento en los objetivos de control en personas con diabetes

Resumen

Objetivo

El objetivo de este estudio fue analizar el impacto de la baja adherencia terapéutica (AT) y la inercia terapéutica de los profesionales (IT) sobre el mal control glucémico y de los factores de riesgo cardiovasculares en personas con DM2.

Material y métodos

Estudio transversal realizado en atención primaria. Se incluyeron 320 personas con DM2. Se valoró si cumplían los objetivos de control (HbA1c ≤ 7%, PA ≤ 130/80 mmHg, LDL ≤ 100 mg/dl). Se consideró falta de AT la retirada de farmacia < 80% de las recetas prescritas e IT la no modificación del tratamiento en personas mal controladas.

Resultados

Presentaron buen control de HbA1c, PA y cLDL el 62,5, el 40,9 y el 35,9%, respectivamente. Las personas mal controladas presentaron cifras de AT menores y la IT no se relacionó con la AT. En sujetos mal controlados para HbA1c, presentaban IT el 25,8%, el 24,8% mala AT y el 11,9% estaban afectados por ambos comportamientos. Para cLDL, el 3,6% presentaban mala AT, el 70,4% IT y el 16,0% mala AT e IT (p < 0,001). Respecto a la PA, el 3,5% tenían mala AT, el 54,6% IT y el 21,5% presentaban mala AT e IT (p < 0,01).

Conclusiones

La falta de AT y la IT han estado implicadas en un porcentaje elevado de personas con DM2 mal controladas. La IT ha resultado de gran relevancia en el presente estudio.

Abstract

Objective

The purpose of this study was to analyse both the impact of low therapeutic adherence (TA) and therapeutic inertia (TI) on poor blood glucose control and on risk factors for heart disease in patients with DM2.

Material and methods

A cross-sectional study was conducted in a Primary Halth Care centre. A total of 320 patients with DM2 were included and an assessment was made of control goals (HbA1c ≤ 7%, blood pressure ≤ 130/80 mmHg, and LDL-cholesterol ≤ 100 mg/dl). A pharmacy retrieval < 80% was considered as a lack of TA and the non-modification of treatment in badly controlled patient as TI.

Results

The percentage of patients with good control of HbA1c, blood pressure and LDL-cholesterol was 62.5%, 40.9%, and 35.9%, respectively. Lower figures of TA were present in poorly controlled patients, and TI was not found to be related to TA. In the patients with poor HbA1c control, 25.8% had TI, 24.8% poor TA, and 11.9% had both of them. As regards LDL-cholesterol, 3.6% presented poor TA, 70.4% showed TI, and 16% with poor TA and TI (P < .001). As for blood pressure, 3.5% of patients had poor TA, 54.6% had TI, and 21.5% of them had poor TA as well as TI (P < .01).

Conclusions

Lack of therapeutic adherence and therapeutic inertia were found in a high percentage of poorly-controlled DM2 patients with bad control. Therapeutic inertia was found to be of great relevance in this study.