Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernandez, San Juan de Alicante, Spain.
Medicina de Familia, Centro de Salud Porto do Son. Porto do Son, La Coruña, Spain.
Endocrinol Diabetes Metab. 2022 Mar;5(2):e00320. doi: 10.1002/edm2.320. Epub 2021 Dec 28.
Studies on treatment adherence to glucose-lowering drugs among patients with type 2 diabetes (T2D) including concomitant treatment for other cardiovascular risk factors are scarce. We aimed to estimate the prevalence of good adherence to all medications used to control diabetes, hypertension and dyslipidemia and to analyse cardiometabolic control and its associated factors in T2D patients in the primary care (PC) setting.
Observational, retrospective study conducted in adult patients with T2D who were followed in the PC setting in Spain. Patients were classified as adherent in a particular category if the summary of the proportion of days covered (PDC) for a particular medication category was ≥80% and were considered globally adherent if the PDC was ≥80% for each of the 3 medication categories.
A total of 457 evaluable patients were recruited, among which 321 patients (70.3%, 95% CI 65.8 to 74.4) were adherent to the three drug categories. The proportion of patients controlled for the 3 cardiometabolic risk factors was 31% according to the contemporary clinical practice guideline criteria, 58% according to investigator judgment and 36% when the objective for HbA1c was individualized. In a multivariate analysis, presenting comorbidities was associated with a lower likelihood of showing adequate control of dyslipidemia (odds ratio [OR] 0.25, 95% CI, 0.16-0.40) and the three cardiometabolic factors as a whole (OR 0.43, 95% CI 0.26-0.70). In a post hoc analysis, therapeutic inertia was found to be greater for dyslipidemia and hypertension than for T2D.
Despite a relatively high adherence to all medications for treating diabetes, hypertension and dyslipidemia in patients with T2D in the PC setting in Spain, the control of cardiometabolic risk factors as a whole is far from optimal. This could be related, at least in part, to the high frequency of comorbidity of these patients.
关于 2 型糖尿病（T2D）患者服用降糖药物的治疗依从性研究，包括同时治疗其他心血管风险因素的研究较少。我们旨在评估同时控制糖尿病、高血压和血脂异常的所有药物的良好依从率，并分析西班牙初级保健（PC）环境中 T2D 患者的心脏代谢控制及其相关因素。
这是一项在西班牙 PC 环境中接受治疗的成年 T2D 患者中进行的观察性、回顾性研究。如果特定药物类别覆盖天数比例（PDC）的摘要≥80%，则将患者分类为该类别中的依从者，如果每种药物类别中的 PDC≥80%，则将患者视为总体依从者。
共纳入 457 例可评估患者，其中 321 例（70.3%，95%CI 65.8 至 74.4）对 3 种药物类别均有依从性。根据当代临床实践指南标准，3 种心脏代谢风险因素得到控制的患者比例为 31%，根据研究者判断为 58%，当 HbA1c 的目标为个体化时为 36%。在多变量分析中，患有合并症与血脂异常（比值比 [OR] 0.25，95%CI 0.16-0.40）和 3 种心脏代谢因素整体（OR 0.43，95%CI 0.26-0.70）得到适当控制的可能性较低相关。在事后分析中，发现血脂异常和高血压的治疗惰性大于 T2D。
尽管西班牙 PC 环境中 T2D 患者同时服用治疗糖尿病、高血压和血脂异常的所有药物的依从性相对较高，但作为一个整体，心脏代谢风险因素的控制远不理想。这可能至少部分与这些患者合并症的高频率有关。
