Fear of hypoglycemia, weight gain and treatment complexity are the main barriers for proper control of blood sugar levels (blood glucose).
28% of people with diabetes are difficult to administer insulin at prescribed hours or with meals.
A 1% reduction of glycosylated hemoglobin means reducing the risk of death associated with diabetes2 by 21 percent.
It is estimated that in our country 56% of people with diabetes do not have an optimal level of glycosylated hemoglobin (HBA1C) 1.And this is currently one of the main challenges that must be overcome around diabetes for its impact on the quality of life and socio -health costs that this problem has associated.
On this has emphasized Dr. Esteban Jódar, head of the Department of Endocrinology and Nourish, in the 4th edition of Diabetes Experience Day that has just been held in Madrid."It is important to achieve adequate metabolic control to avoid long -term chronic complications (ocular, renal ...), without causing interactions with treatment (hypoglycemia, weight gain) and allowing a normal life to the person with diabetes," warns this expert.
Insulin treatment is one of the ways to reach the goal to have a good level of glycosylated hemoglobin.Being a progressive disease, both therapeutic regimes and dosing should be modified if the patient does not achieve satisfactory glucose levels.And it is that "good glycemic control reduces the risk of complications associated with diabetes and improves the quality of life," says Dr. Jódar.
Specifically, a 1% reduction of glycosylated hemoglobin means reducing microvascular complications by 37%, 21% the risk of death associated with diabetes and 14% The possibility of suffering a myocardial infarction.2
Dr. Jódar clarifies that the general optimum threshold of HBA1C is 7%, but must be individualized according to the characteristics of each person with diabetes, "which is good for some, can be harmful to others."
However, both health professionals and people with diabetes meet barriers when intensifying insulin treatment to achieve adequate glycemic control: concern for weight gain, fear of hypoglycemia and complexity of guidelinesof treatment
an obstacle career
The diagnosis of diabetes involves acquiring the commitment to control blood sugar levels (glycemia) for life.As Dr. Jódar explains, getting it depends on many factors, "life habits (food, exercise, stress), medication, the existence of complications and, in addition, the course of the disease that can make the treatment more complex".
Each type of diabetes has its peculiarities.Regarding hypoglycemia, “depending on insulin external to the body complicates the control more and causes a greater risk of occurring from the time of the diagnosis of type 1 diabetes, while in the case of type 2 diabetes the risk ofoccur is longer term. ”In fact, 75.5% of doctors would treat the diabetes of their patients in a more intense way if there was not so much concern to experience hypoglycemic episodes.3
On the other hand, he adds, “obesity also complicates the management of diabetes, although with peculiarities.For example, although it is a problem that accompanies the diagnosis and complicates the management of type 2 diabetes, it is usually common for years of years ofIntensive Treatment Treatment Type 2 ”.
To this we must unite that people with diabetes frequently do not administer the dose of insulin or do not do so according to what has been prescribed."Barriers that, together with the lack of flexibility of treatment on some occasions and the need to control everything that is eaten, prevent good adhesion to treatment," says Dr. Jódar.A situation that leads to 28% of people with diabetes is difficult to administer insulin at prescribed hours or with meals4, while 22% plan their daily activities conditioned by the administration schedule of their insulin5.
As this specialist clarifies, when the patient who uses insulin does not reach the therapeutic objectives, the intensification stage of his treatment arrives and “intensifying the treatment can involve increasing the dose of insulin but, more frequently it is to initiate an additional therapy to the treatment that the personWith diabetes it has until that moment.And, in general, the increase in insulin dose is limited by the risk of causing hypoglycemia. ”
minimize barriers
In the words of this expert, it is important to look for treatment alternatives adapted to the life of each patient so that an effective glycemic control that improves their quality of life is achieved.In this sense, he says that "therapeutic arsenal to treat diabetes has grown remarkably and, especially for people with type 2 diabetes, we have very good options that help limit problems for adequate glycemia control."
In addition, Dr. Jódar highlights the need to invest more time in patient education."It is everyone's job, professionals and people with diabetes, improve adherence to treatments, and for this we must use more time to explain the benefits and how to log in," he concludes.
References
Vinegar I, ET.AL.Care Diabetes 2012; 51: 774–9.UKPDS, United Kingdom Prospective Diabetes Study.Peyrot et al.Diabetic Medicine 2012; 29: 682–89.Peyrot et al.Diabet Med 2012; 29: 682–9.Peyrot et al.Care diabetes 2010; 33: 240–5.
