Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Luigi Vanvitelli University, Naples, Italy.
Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Luigi Vanvitelli University, Naples, Italy.
Endocrine. 2018 Jul;61(1):23-27. doi: 10.1007/s12020-017-1517-9. Epub 2018 Jan 10.
Despite the availability of many new treatment options for type 2 diabetes, the proportion of patients achieving the HbA1c target < 7.0% remains around 50%. We put forward the hypothesis that the unchanged HbA1c results, observed in the last decade in type 2 diabetes patients, are also a consequence of medication nonadherence and clinical inertia. Poor medication-taking behavior is usually defined as medication nonadherence and is responsible for uncontrolled hemoglobin A1c level in 23% of cases. Medication nonadherence may also affect clinical outcomes, as diabetic patients with good adherence (≥80%) had a significant 10% lower rate of hospitalization events and a significant 28% lower rate of all-cause mortality when compared with patients with poor adherence (<80%). Residual vascular risk may be defined as the risk of macrovascular (major cardiovascular events) and microvascular (retinopathy, nephropathy, neuropathy) complications that remains after intensive and successful glycemic control in type 2 diabetes. For major cardiovascular events, risk reduction following intensive glycemic control is 9% and, therefore, residual vascular risk is 91%. For microvascular complications, as nephropathy, residual vascular risk is as high as 80%. Residual vascular risk remains high in type 2 diabetes despite intensive glycemic control. Medication nonadherence by the diabetic patient and clinical inertia by the clinician may have contributed to the high level of residual vascular risk (both macro and microvascular) of type 2 diabetic patients.
尽管有许多新的治疗选择可用于 2 型糖尿病，但达到 HbA1c 目标<7.0%的患者比例仍保持在 50%左右。我们提出假设，在过去十年中，2 型糖尿病患者的 HbA1c 结果保持不变，也是药物依从性差和临床惰性的结果。药物服用行为不良通常被定义为药物不依从，在 23%的情况下导致血红蛋白 A1c 水平不受控制。药物不依从也可能影响临床结果，因为依从性好（≥80%）的糖尿病患者与依从性差（<80%）的患者相比，住院事件发生率显著降低 10%，全因死亡率显著降低 28%。残余血管风险可定义为 2 型糖尿病患者在强化和成功血糖控制后仍存在的大血管（主要心血管事件）和微血管（视网膜病变、肾病、神经病变）并发症的风险。对于主要心血管事件，强化血糖控制后的风险降低 9%，因此残余血管风险为 91%。对于微血管并发症，如肾病，残余血管风险高达 80%。尽管进行了强化血糖控制，2 型糖尿病患者的残余血管风险（大血管和微血管）仍然很高。糖尿病患者的药物不依从和临床惰性可能导致 2 型糖尿病患者的残余血管风险（大血管和微血管）居高不下。
