Clinical inertia was defined 15 years ago as the doctor's failures in the initiation or intensification of the treatment when indicated.It was evident what has been called therapeutic inertia, although the clinic can affect other elements of the care process, such as diagnosis and monitoring.
Both clinical and therapeutic inertia are a serious problem that affects all health in general, difficult to solution, since it is required of greater training of professionals, greater awareness of these in the application of guides and consensus, butIt is necessary above all incentive of professionals and time willingness in the management of their consultations.
Thus, professionals agree on the term of therapeutic inertia such as the failures that are commented on in the beginning or the intensification of the treatment, when necessary for the patient, even knowing that they are indicated or recommended and is fundamental in the control of the patient with type diabetes with diabetes2.
problems
In this sense, it is one of the main causes of poor glycemic control and can prevent the benefits of adequate treatment.
The general objective of achieving an HBA1c & Lt;7% is reasonable as long as the treatment does not entail an unacceptable risk of serious hypoglycemia or other adverse effects.
Intensive treatment (HBA1C & LT; 6.5%) could be more beneficial in younger patients, at the beginning of the disease and without comorbidities.
In elderly patients, long evolution and presence of comorbidities or complications or with a history of severe hypoglycemia, an objective of HBA1C & LT;7.5% or even 8% would be more prudent.
self -care
Therefore, it is necessary to reinforce the medical-patient relationship.It is important to involve the patient in their self -care and in the improvement of therapeutic compliance.Initially, educational interventions will be frequent until the implementation of basic guidelines by the patient who will be reinforced periodically, should be used short and easy to read, informing about the results of their controls and jointly agreing the strategy forachieve the proposed objectives.It would also be convenient to involve the main caregiver, if there are limitations in the patient's autonomy.
And when the doctor manages to identify and understand the important problems of his patients, he is able to generate greater satisfaction with the care received and to achieve greater adherence to treatment.In fact, some studies have shown that there is an improvement in the glycemia of diabetic patients when their doctors learned communicational skills that allowed them to focus more on the patient.
In the cases of diabetic patients who live alone and are of advanced age the medical-patient relationship acquires vital importance.The continuous and numerous home visits are a basic and fundamental support to deepen more in the medical-patient relationship, which eventually translates into a better therapeutic compliance.
change of step
When changing the therapeutic step, some aspects must be taken into account.Of course, being of choice the IDPP-4, ISGLT2, AGLP1, since they improve insulin sensitivity, reduce or have a neutral effect on weight, minimize the risk of hypoglycemia and, in addition, they have a very favorable effect on the systemcardiovascular.Sulfonylureas and glinids could only be used when the risk of hypoglycemia is low and/or the A1C & GT; 8.5% and never glibenclamid.
Despite the multiple consensus and clinical practice guides of the main scientific societies that have been promoted as one of the methods forMoving medicine based on evidence to practice, it is necessaryprevious cardiovascular.
Therefore, the escalation in the modification of the treatment is being made as the patient is not within the therapeutic objectives pursued, taking into account the age and the presence of comorbidities.
In this context, it must be borne in mind that the management of type 2 diabetic is already complicated, since hyperglycemia and other cardiovascular risk factors must be controlled at the same time.Therefore, it would be important that the doctors could dedicate more time to consult these patients, since many times, the additional concerns they express during the visit, make it a challenge by having to solve different problems and make different recommendations, preventing thatThe entire consultation process is developed correctly.It is clear that as the reasons for consultation increase, the chances of changes in treatment decrease.The involvement of other professionals, such as pharmacists, nursing, diabetic associations ... could improve the management of people with type 2 diabetes.
For the elaboration of this article, the collaboration of the doctors specialized in General Medicine Carlos Alberto Názara Otero, Francisco Becoña de la Torre, Alberto Pérez Freijomil, Carlos Jesús Gonzalo Sánchez, José Iglesias Fernández and Javier Sáez-Torres Viso, of theCasa del Mar health center, in Marín;SADA HEALTH SPECIALISTS;Carlos Vicente Díaz Sueiraras, Fernando Prieto García, Manuel Antonio Ramos Rodríguez, José Antonio Perosanz Bartolomé, María Cruz Grandal Amor and Dolores Recarey García, from the Fontenla Health Center, in Ferrol, and José Maria Pardo Hortal, Elisa Fernández Vázquez, Cecilia Curies Arcos, Luis Delgado Charro, María José Nuñez Vazquez and María Teresa González Rodríguez, of the Xinzo de Limia Health Center, Xinzo de Limia, in Ourense.
