Machado-Duque Manuel Enrique, Ramírez-Riveros Adriana Carolina, Machado-Alba Jorge Enrique
Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Facultad Ciencias de la Salud, Universidad Tecnológica de Pereira, Colombia.
Fundación Universitaria del Área Andina, S.E.S. Hospital de Caldas, Manizales, Colombia.
Int J Clin Pract. 2017 Jun;71(6). doi: 10.1111/ijcp.12954. Epub 2017 May 19.
To establish the effectiveness of antidiabetic therapy and the frequency of clinical inertia in the management of type 2 diabetes mellitus in Colombia.
A cross-sectional study with follow-up of patients who had been treated for at least 1 year and were receiving medical consultation for antidiabetic treatment. Effectiveness was established when haemoglobin-A1c levels were <7% and when clinical inertia was reached, which was defined as no therapeutic modifications despite not achieving management controls. Sociodemographic, clinical and pharmacological variables were evaluated, and multivariate analyses were performed.
In total, 363 patients with type 2 diabetes mellitus were evaluated, with a mean age of 62.0±12.2 years. A total of 1,016 consultations were evaluated, and the therapy was effective at the end of the follow-up in 57.9% of cases. Clinical inertia was found in 56.8% of patients who did not have metabolic control. The most frequently prescribed medications were metformin (84.0%), glibenclamide (23.4%) and insulin glargine (20.7%). Moreover, 57.6% of the patients were treated with two or more antidiabetic medications. Having metabolic control in the first consult of the follow-up was a protective factor against clinical inertia in the subsequent consultations (OR: 0.08; 95%CI: 0.04-0.15; P<.001).
The effectiveness of treatment for patients with type 2 diabetes mellitus has increased in Colombia, and for the first time, clinical inertia was identifiable and quantifiable and found in similar proportions to other countries. Clinical inertia is a relevant condition given that it interferes with the possibility of controlling this pathology.
确定哥伦比亚2型糖尿病管理中抗糖尿病治疗的有效性及临床惰性的发生率。
一项横断面研究，对接受治疗至少1年且正在接受抗糖尿病治疗医学咨询的患者进行随访。当糖化血红蛋白水平<7%时确定治疗有效，当达到临床惰性时（定义为尽管未实现管理目标但未进行治疗调整）确定存在临床惰性。评估社会人口统计学、临床和药理学变量，并进行多变量分析。
共评估了363例2型糖尿病患者，平均年龄为62.0±12.2岁。共评估了1016次咨询，随访结束时治疗有效的病例占57.9%。在未达到代谢控制的患者中，56.8%存在临床惰性。最常处方的药物是二甲双胍（84.0%）、格列本脲（23.4%）和甘精胰岛素（20.7%）。此外，57.6%的患者接受了两种或更多种抗糖尿病药物治疗。随访首次咨询时达到代谢控制是后续咨询中防止临床惰性的保护因素（比值比：0.08；95%置信区间：0.04-0.15；P<0.001）。
在哥伦比亚，2型糖尿病患者的治疗有效性有所提高，并且首次发现临床惰性是可识别和可量化的，其发生率与其他国家相似。鉴于临床惰性会干扰控制这种疾病的可能性，因此它是一个相关问题。
