It is estimated that between 10 and 15 percent of the Spanish adult population has diabetes.The increase in obesity is one of the two most determining factors in increasing the prevalence of DM2 in Spain.
In our country, obesity has doubled in the last two decades with estimates that reach 50 percent prevalence.
The increase in body adiposity, especially of intrabdominal fat, favors insulin -resistance that over time entails the apoptosis of pancreatic beta cells and an increase in factors that favor cardiovascular disease.
To this we must add sedentary lifestyle, more and more marked as a result of technology and changes in diet, with an increase in the consumption of foods rich in sugars and fats that intervene in the increase in body weight.
Thus, the combination of physical inactivity, the deficiency in insulin secretion and insulinorrence due to excess adiposity in some cases has increased the prevalence of DM2 in Spain.
cardiovascular disease
In this context, we must highlight the relationship between DM2 and cardiovascular diseases (ECV) is increasingly identified.In fact, diabetic macroangiopathy is the most important CDV, but it is not alone.Patients with coronary heart disease and advanced heart failure (class III of the [NYHA]) have a higher risk of developing DM2.Arterial hypertension, acute myocardial infarction and stroke are also related to DM2 and its treatment.The association of several factors in metabolic syndrome makes the risks of the arteriosclerotic process very high in DM patients.
In primary consultations, an increase in prevalence in cases of metabolic syndrome and DM2 is being observed.Within metabolic syndrome, insulin resistance is the most important factor.The factors that increase ECVs are associated with DM2 and all of them act negatively in the evolution of both diseases.These factors are smoking, sedentary lifestyle, bad habits, HTA, LDLC, TG, ...
control objectives
Therefore, it is advisable to control DM2 patients with an HBA1C between 6.5 and 7.5 md/dl, LDLC below 100 mg/dl in healthBelow 150 mg/dl, HTA between 80/120, which allows reducing risks very effectively.
The choice of pharmacological treatment must be framed within a global strategy that has several factors, such as the evolution time that serves to intuit the insulin reserves of the patient and therefore choose the most appropriate drugs according to their mechanism of action;the existence of obesity;the age that will mark the objective of control and security aspects;The existence of vascular complications that helps raise objectives and seek additional effects of some drugs, and therapeutic compliance that could take into account beliefs, polypharmacy, sociocultural and work situation.
Communication
In this context, medical-patient communication is not only important but necessary.The contact between the two improves adherence to treatment, which entails less assistance to the professional, less side effects and less complications.
The dialogue between the two allows to know not only the patient itself, but also their guidelines for social and food behavior.The greatest inconvenience is the time that can be dedicated to this contact with the patient that greatly hinders this communication.
Therefore, this communication is very important, since it facilitates the control of patients in a preventive way.Communication betweenDoctors and nursing is also key, it already allows to detect in certain patients treatment abandonments or misuse of them.
Nursing-medical communication reduces the loss of time due to redundancies of protocols and helps to know patients from another point of view.The nurse is one more link in the health system.
