López-Simarro Flora, Brotons Carlos, Moral Irene, Cols-Sagarra Cèlia, Selva Anna, Aguado-Jodar Alba, Miravet-Jiménez Sònia
Área Básica de Salud Martorell, Martorell, Barcelona, España.
Med Clin (Barc). 2012 Apr 14;138(9):377-84. doi: 10.1016/j.medcli.2011.07.023. Epub 2011 Oct 28.
Therapeutic inertia (TI) and therapeutic compliance (TC) are 2 important barriers in achieving the therapeutic objectives recommended for patients with diabetes mellitus type 2 (DM2). This study analyzes the TI in patients with DM2 who do not achieve the glycemic, blood pressure (BP) and LDL-cholesterol (c-LDL) control goals, the patients' TC and the relationship between TI and TC.
This is a descriptive study conducted in a Primary Health Care center. We included 320 diabetic patients. Objectives of control were HbA1c ≤ 7%, blood pressure (BP) ≤ 130/80 mm Hg, c-LDL ≤ 100 mg/dl, TI (when the objectives of control were not reached and the professional did not change the treatment) and TC (by counting withdrawals of pharmacy prescriptions).
The objectives of control for HbA1c, BP and c-LDL were reached by 66.4, 43.2 and 40.5% of patients, respectively. There was TI in the 86.4% of patients for c-LDL, in 76.7% for BP and in 40.6% for HbA1c. The percentage of therapeutic non-compliance was of 36.1, 37.5 and 32.0% for antidiabetic, antihypertensive and lipid lowering drugs, respectively. Elderly patients were better compliants. TI and TC were not associated. We did not find differences in the level of control, TI, use of drugs and TC by sex.
TI and TC play an important role in the non-consecution of the control objectives in diabetic patients, especially regarding BP and lipids. TC is not related to TI.
治疗惰性（TI）和治疗依从性（TC）是实现2型糖尿病（DM2）患者推荐治疗目标的两个重要障碍。本研究分析了未达到血糖、血压（BP）和低密度脂蛋白胆固醇（c-LDL）控制目标的DM2患者的TI、患者的TC以及TI与TC之间的关系。
这是一项在初级卫生保健中心进行的描述性研究。我们纳入了320例糖尿病患者。控制目标为糖化血红蛋白（HbA1c）≤7%、血压（BP）≤130/80 mmHg、c-LDL≤100 mg/dl、TI（当未达到控制目标且专业人员未改变治疗方案时）和TC（通过计算药房处方的停药情况）。
分别有66.4%、43.2%和40.5%的患者达到了HbA1c、BP和c-LDL的控制目标。86.4%的患者在c-LDL方面存在TI，76.7%在BP方面存在TI，40.6%在HbA1c方面存在TI。抗糖尿病、抗高血压和降脂药物的治疗不依从率分别为36.1%、37.5%和32.0%。老年患者的依从性更好。TI与TC无关。我们未发现性别在控制水平、TI、药物使用和TC方面存在差异。
TI和TC在糖尿病患者未实现控制目标方面起着重要作用，尤其是在血压和血脂方面。TC与TI无关。
