The awareness of type 2 diabetes is decisive for their care and good control.That the patient understands the basic pathophysiology of diabetes and the importance of good glycemic control is key to their evolution.Therefore, from the first moment, the doctor and the patient have to be co -responsible for the disease, where the patient's sociocultural level can influence the understanding of pathophysius, since the clinical experience shows that it generally influences theGood metabolic control of the disease.
It is also necessary to take into account linguistic barriers and the lack of educational content adapted to the different cultures of patients in relative issues medication, diet, exercise and glycemic control.
It is important that in control visits health professionals ensure that they have understood the important control of diabetes well to reduce complications, especially cardiovascular risk.
breach
In this sense, from the beginning the patient has to understand that therapeutic breach can cause the development of other pathologies.An importance of importance is the complications associated with cardiovascular risk factors that affect the patient's quality of life.
Many times, breach is because the patient does not understand the medication guidelines, which must offer simple and clear indications.Here the monitoring visits are also of the utmost importance, where it can be verified that it has understood the guidelines and must be insisted on healthy habits and lifestyles.A continuous relationship between blood glucose and the incidence and progression of microvascular complications has been established.Thus, the UKPDS study has demonstrated in type 2 diabetics a 37% decrease in microvascular complications with a 1% reduction on the HBA1C figure previously present.In the same study it is demonstrated that strict control of blood pressure (figures below 130/85 mmHg) decreases the risk of retinopathy progression by 34%, regardless of blood glucose values.
treatment
Therefore, therapeutic options to minimize cardiovascular risk are based on three points: diet, physical exercise and pharmacological treatment.The latter must contemplate the control and treatment of obesity, arterial hypertension, hypercholesterolemia, antiday, as primary prevention in men over 50 years old or women over 60 years of age who have at least one cardiovascular risk factor, HTA, smoking, dyslipremia or microalbuminuria.
In this sense, both the ADA/EASD recommend that the glycemic objectives be less ambitious in the elderly with short life expectation, high morbidity, poli medication or high risk of hypoglycemia, considering HBA1C acceptable between 7.6 and 8.5.
In conclusion, the cardiometabolic control of patients with DM2 must be improved and achieve the therapeutic objectives of the largest possible number of cardiovascular risk factors.To achieve, there is a good therapeutic arsenal, such as IDPP4, glycosurids, antihypertensives, statins, fibrates, among others, which should adjust to the personal characteristics of each patient.
For the elaboration of this article, the collaboration of the doctors specializing in Family Medicine Antoni Vericat Roure, Ramón Noguera Rodríguez and Ana Guarch Ibáñez, of the Sacred Family Primary Care Center, of Barcelona;Ramón Victoriano Ruiz Sales, Sonia Vidal Asensio Asunción Salat Neighborhood,José María Vendrell Parera, Marta Piñol Margalef Yjosep María Farre Marimon, from the El Vendrell Health Center, in Tarragona;Primary care doctors Inma Pellicer Garrido, María Teresa Aubia Vendrell and María Rosa Calderer Cardona;Specialists in General Medicine Fauri Tamayo, Waldo Pérez, Yolanda Durán and Jesús López, Terrassa, and family doctor Juan Cerda Perarnau, Jordi Bermudez Pohl and Edurne Serra de Renobales.
Source: www.elmedicoinctivo.com
