Alvis-Guzman Nelson, Romero Martín, Salcedo-Mejia Fernando, Carrasquilla-Sotomayor Maria, Gómez Lina, Rojas Mónica María, Urrego Juan Camilo, Beltrán Claudia Catalina, Ruíz Jaime Enrique, Velásquez Adriana, Orengo Juan Carlos, Pinzón Adolfo
Universidad de la Costa, Cl. 58 #55 - 66, Barranquilla, Atlántico, Colombia.
Grupo de Investigación en Economía de la Salud, Universidad de Cartagena, Cartagena, Colombia.
Diabetol Metab Syndr. 2024 Feb 15;16(1):42. doi: 10.1186/s13098-023-01245-0.
The burden of disease of diabetes in Colombia have increased in the last decades. Secondary prevention is crucial for diabetes control. Many patients already treated remain with poor glycemic control and without timely and appropriate treatment intensification. This has been called in the literature as Clinical Inertia. Updated information regarding clinical inertia based on the Colombian diabetes treatment guidelines is needed.
To measure the prevalence of clinical inertia in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients in healthcare institutions in Colombia, based on the recommendations of the current official guidelines.
An observational and retrospective cohort study based on databases of two Health Medical Organizations (HMOs) in Colombia (one from subsidized regimen and one from contributory regimen) was conducted. Descriptive analysis was performed to summarize demographic and clinical information. Chi-square tests were used to assess associations between variables of interest.
A total of 616 patients with T2DM (308 for each regimen) were included. Median age was 61 years. Overall clinical inertia was 93.5% (87.0% in contributory regimen and 100% in subsidized regimen). Patients with Hb1Ac ≥ 8% in the subsidized regimen were more likely to receive monotherapy than patients in the contributory regimen (OR 2.33; 95% CI 1.41-3.86).
In this study, the prevalence of overall clinical inertia was higher in the subsidized regime than in the contributory regime (100% vs 87%). Great efforts have been made to equalize the coverage between the two systems, but this finding is worrisome with respect to the difference in quality of the health care provided to these two populations. This information may help payers and clinicians to streamline strategies for reducing clinical inertia and improve patient outcomes.
在过去几十年中，哥伦比亚糖尿病的疾病负担有所增加。二级预防对于糖尿病控制至关重要。许多已接受治疗的患者血糖控制不佳，且未及时进行适当的治疗强化。这在文献中被称为临床惰性。需要基于哥伦比亚糖尿病治疗指南的有关临床惰性的最新信息。
根据现行官方指南的建议，测量哥伦比亚医疗机构中新诊断的2型糖尿病（T2DM）患者的临床惰性患病率。
基于哥伦比亚两个健康医疗组织（HMO）（一个来自补贴方案，一个来自缴费方案）的数据库进行了一项观察性回顾性队列研究。进行描述性分析以总结人口统计学和临床信息。使用卡方检验评估感兴趣变量之间的关联。
共纳入616例T2DM患者（每个方案各308例）。中位年龄为61岁。总体临床惰性为93.5%（缴费方案中为87.0%，补贴方案中为100%）。补贴方案中Hb1Ac≥8%的患者比缴费方案中的患者更有可能接受单药治疗（OR 2.33；95%CI 1.41 - 3.86）。
在本研究中，补贴方案中总体临床惰性的患病率高于缴费方案（100%对87%）。为使两个系统的覆盖范围均等已做出了巨大努力，但这一发现对于向这两类人群提供的医疗保健质量差异而言令人担忧。这些信息可能有助于支付方和临床医生简化减少临床惰性的策略并改善患者结局。
