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

  1. F. López-Simarro 1
  2. I. Moral 2
  3. A. Aguado-Jodar 3
  4. C. Cols-Sagarra 4
  5. J. Mancera-Romero 5
  6. M. Alonso-Fernández 6
  7. S. Miravet-Jiménez 1
  8. C. Brotons 2
  1. 1 ABS Martorell Urbano. Institut Català de la Salut, Martorell, Barcelona, España
  2. 2 Investigación Biomédica Sant Pau (IIB-Sant Pau), Barcelona, España
  3. 3 CAP Sagrada Familia, Consorci Sanitari Integral, Barcelona, España
  4. 4 ABS Martorell Rural, Martorell, Barcelona, España
  5. 5 Centro de Salud Ciudad Jardín, Málaga, España
  6. 6 Centro de Salud de La Eria, Oviedo, España
Journal:
Semergen: revista española de medicina de familia

ISSN: 1138-3593

Year of publication: 2018

Issue: 8

Pages: 579-585

Type: Article

DOI: 10.1016/J.SEMERG.2017.10.002 DIALNET GOOGLE SCHOLAR

More publications in: Semergen: revista española de medicina de familia

Sustainable development goals

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.

Bibliographic References

  • I. Vinagre, M. Mata-Cases, E. Hermosilla, R. Morros, F. Fina, M. Rosell, et al. Control of glycemia and cardiovascular risk factors in patients with type 2 diabetes in primary care in Catalonia (Spain) Diabetes Care., 35 (2012), pp. 774-779 CrossRefView Record in ScopusGoogle Scholar
  • S.S. Casagrande, J.E. Fradkin, S.H. Saydah, K.F. Rust, C.C. Cowie The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988-2010 Diabetes Care., 36 (2013), pp. 2271-2279 View Record in ScopusGoogle Scholar
  • I. Vinagre, I. Conget Situación actual del control de la diabetes mellitus tipo 2 en España. Identificación de las principales barreras en la práctica clínica diaria Med Clin (Barc)., 141 (2013), pp. 3-6 Google Scholar
  • L.S. Phillips, W.T. Branch, C.B. Cook, J.P. Doyle, I.M. el-Kebbi, D.L. Gallina, et al. Clinical inertia Ann Intern Med., 135 (2001), pp. 825-834 CrossRefView Record in ScopusGoogle Scholar
  • A.J. Scheen, D. Giet Targeting inertia and therapy non-compliance: New challenge for improving medical practice performance Rev Med Liege., 65 (2010), pp. 229-231 View Record in ScopusGoogle Scholar
  • F. López-Simarro, C. Brotons, I. Moral, C. Cols-Sagarra, A. Selva, A. Aguado-Jodar, et al. Inertia and treatment compliance in patients with type 2 diabetes in primary care Med Clin (Barc)., 138 (2012), pp. 377-384 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • F. López-Simarro, C. Brotons, I. Moral, A. Aguado-Jodar, C. Cols-Sagarra, S. Miravet-Jiménez Concordance between two methods in measuring treatment adherence in patients with type 2 diabetes Patient Prefer Adherence, 10 (2016), pp. 743-750 View Record in ScopusGoogle Scholar
  • J.A. Schmittdiel, C.S. Uratsu, A.J. Karter, M. Heisler, U. Subramanian, C.M. Mangione, et al. Why don’t diabetes patients achieve recommended risk factor targets? Poor adherence versus lack of treatment intensification J Gen Intern Med., 23 (2008), pp. 588-594 CrossRefView Record in ScopusGoogle Scholar
  • A.J. Farmer, L.R. Rodgers, M. Lonergan, B. Shields, M.N. Weedon, L. Donnelly, et al. MASTERMIND Consortium. Adherence to oral glucose-lowering therapies and associations with 1-year HbA1c: A retrospective cohort analysis in a large primary care database Diabetes Care, 39 (2016), pp. 258-263 View Record in ScopusGoogle Scholar
  • A.J. Scheen, D. Giet Targeting inertia and therapy non-compliance: New challenge for improving medical practice performance Rev Med Liege., 65 (2010), pp. 229-231 View Record in ScopusGoogle Scholar
  • M. Vernet Vernet, M.J. Sender Palacios, L. Bautista Galí, P. Larrosa Sàez, J. Vargas Sánchez Inercia terapéutica en el manejo de pacientes con diabetes mellitus tipo 2 en el ámbito de la Atención Primaria Semergen., 42 (2016), pp. 152-157 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • R. Grant, A.S. Adams, C.M. Trinacty, F. Zhang, K. Kleinman, S.B. Soumerai, et al. Relationship between patient medication adherence and subsequent clinical inertia in type 2 diabetes glycemic management Diabetes Care., 30 (2007), pp. 807-812 CrossRefView Record in ScopusGoogle Scholar
  • M. Heisler, M.M. Hogan, T.P. Hofer, J.A. Schmittdiel, M. Pladevall, E.A. Kerr When more is not better: Treatment intensification among hypertensive patients with poor medication adherence Circulation., 117 (2008), pp. 2884-2892 View Record in ScopusGoogle Scholar
  • D.G. Pittman, C. Fenton, W. Chen, S. Haffner, M. Pendergrass Relation of statin nonadherence and treatment intensification Am J Cardiol., 110 (2012), pp. 1459-1463 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • F. Ismail-Beigi, E. Moghissi, M. Tiktin, I.B. Hirsch, S.E. Inzucchi, S. Genuth Individualizing glycemic targets in type 2 diabetes mellitus: Implications of recent clinical trials Ann Intern Med, 154 (2011), pp. 554-559 CrossRefView Record in ScopusGoogle Scholar
  • H. Teoh, P. Home, L.A. Leiter Should A1C targets be individualized for all people with diabetes? Arguments for and against Diabetes Care., 34 (Suppl 2) (2011), pp. S191-S196 CrossRefView Record in ScopusGoogle Scholar
  • J. Mancera-Romero, F. Carramiñana-Barrera, L. Muñoz-González, P. Guillén-Álvarez, D. Murillo-García, M.R. Sánchez-Pérez, e investigadores del estudio AVANZA Satisfacción de las personas con diabetes mellitus tipo 2 tras iniciar tratamiento con insulina Semergen., 42 (2016), pp. 298-306 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • E.A. Kerr, B.J. Zikmund-Fisher, M.L. Klamerus, U. Subramanian, M.M. Hogan, T.P. Hofer The role of clinical uncertainty in treatment decisions for diabetic patients with uncontrolled blood pressure Ann Intern Med., 148 (2008), pp. 717-727 CrossRefView Record in ScopusGoogle Scholar
  • S.L. Daugherty, J.D. Powers, D.J. Magid, F.A. Masoudi, K.L. Margolis, P.J. O’Connor, et al. The association between medication adherence and treatment intensification with blood pressure control in resistant hypertension Hypertension., 60 (2012), pp. 303-309 View Record in ScopusGoogle Scholar
  • R. Vigen, S. Shetterly, D.J. Magid, P.J. O’Connor, K.L. Margolis, J. Schmittdiel, et al. A comparison between antihypertensive medication adherence and treatment intensification as potential clinical performance measures Circ Cardiovasc Qual Outcomes., 5 (2012), pp. 276-282 View Record in ScopusGoogle Scholar