González-Clemente José Miguel, Font Beatriu, Lahoz Raquel, Llauradó Gemma, Gambús Gemma
Servicio de Diabetes, Endocrinología y Nutrición, Hospital de Sabadell, Corporación Sanitaria Parc Taulí, Instituto Universitario Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España.
Novartis Farmacéutica S. A., Barcelona, España.
Med Clin (Barc). 2014 Jun 6;142(11):478-84. doi: 10.1016/j.medcli.2013.02.032. Epub 2013 Apr 23.
To study clinical inertia in the management of oral hypoglycemic agents (OHA) in non-insulin treated patients with type 2 diabetes mellitus (T2DM) in Spain.
Epidemiological, cross-sectional, retrospective (2 years), multicenter study. Clinical inertia was measured as the total number of patients without OHA treatment intensification divided by the total number of patients with inadequate HbA1c values (≥7%), multiplied by 100. Total clinical inertia (TCI) was the absence of OHA treatment intensification in all visits with a HbA1c≥7% values in the previous 2 years; partial clinical inertia (PCI) occurred when this absence only occurred in some of these visits. We assessed OHA treatment compliance with the Morisky-Green test.
We included 2,971 patients, 1,416 adequately controlled (HbA1c<7%) and 1,555 inadequately controlled (HbA1c≥7%). PCI prevalence was 52.5%(95% confidence interval [95% CI] 52.4-52.6%) while TCI prevalence was 12.8% (95% CI 12.2-13.8%). PCI was lower in patients adequately controlled as compared with those inadequately controlled (31.4% vs. 71.8%; P<.001). PCI was associated with sedentary lifestyle, hypertension and higher prevalence of micro and macrovascular complications. Only 38.0% of patients were compliant with the OHA treatment, being this percentage even lower in subjects with ICP. Two variables were independently associated with ICP: female sex (odds ratio [OR] 1.43; 95% CI 1.09-1.86%) and a shorter duration of DM2 (OR 0.98; 95% CI 0.95-0.99).
One out of 2 patients with T2DM and treated with OHA without insulin suffer from PCI. Only 4 out of 10 patients are compliant with OHA treatment. Female sex and a shorter duration of T2DM are independently associated with PCI.
研究西班牙非胰岛素治疗的2型糖尿病（T2DM）患者口服降糖药（OHA）管理中的临床惰性。
进行流行病学、横断面、回顾性（2年）、多中心研究。临床惰性的衡量方法为未强化OHA治疗的患者总数除以糖化血红蛋白（HbA1c）值不达标（≥7%）的患者总数，再乘以100。总临床惰性（TCI）是指在过去2年中所有HbA1c≥7%的就诊中均未强化OHA治疗；部分临床惰性（PCI）是指仅在部分此类就诊中出现未强化治疗的情况。我们采用Morisky-Green测试评估OHA治疗依从性。
我们纳入了2971例患者，其中1416例控制良好（HbA1c<7%），1555例控制不佳（HbA1c≥7%）。PCI患病率为52.5%（95%置信区间[95%CI]52.4 - 52.6%），而TCI患病率为12.8%（95%CI 12.2 - 13.8%）。与控制不佳的患者相比，控制良好的患者PCI较低（31.4%对71.8%；P<.001）。PCI与久坐不动的生活方式、高血压以及微血管和大血管并发症的较高患病率相关。只有38.0%的患者依从OHA治疗，在有PCI的患者中这一比例更低。有两个变量与PCI独立相关：女性（比值比[OR]1.43；95%CI 1.09 - 1.86%）和DM2病程较短（OR 0.98；95%CI 0.95 - 0.99）。
每2例接受OHA治疗而非胰岛素治疗的T2DM患者中就有1例存在PCI。每10例患者中只有4例依从OHA治疗。女性和较短的T2DM病程与PCI独立相关。
