RESUMO
INTRODUCTION: Therapeutic education is an essential part in the management of type 2 diabetes mellitus (T2D). Implementing a therapeutic education program with the participation of a diabetes specialist nurse (DSN) addressed to patients with T2D using more than 2 insulin injections and sub-optimal metabolic control in primary care (PC) could improve health care and clinical outcomes. Our purpose was to evaluate the clinical, educational and patient satisfaction outcomes of this program. MATERIAL AND METHODS: A prospective, longitudinal study was performed with an evaluation before and after the intervention. The program had a duration of 6 months and included individual on-site, phone and group visits. RESULTS: 184 subjects were included and 161 were finally evaluated. 89.4% were included due to sub-optimal metabolic control and 10.6% because of repeated hypoglycemia. In the first group, the mean reduction in HbA1c was -1.34%±1.45% without any increase in hypoglycemia episodes. In the second group, a significant reduction in hypoglycemia episodes/week was observed (2.52±1.66 vs. 0.53±1.06; p<0.05) without any increase in HbA1c. Learning skills, lifestyle, adherence to care, and the perception of quality of life had significantly improved at 6 months (p<0.05). The overall program was positively evaluated by patients, the role of DSN being considered essential by 98% of the responders. CONCLUSION: A structured therapeutic education program, including a DSN, addressed to insulin treated T2D patients attending primary care facilities and with sub-optimal metabolic control is associated with beneficial effects in terms of clinical, educational and patient satisfaction endpoints.
Assuntos
Diabetes Mellitus Tipo 2 , Insulina , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Estudos Longitudinais , Atenção Primária à Saúde , Estudos Prospectivos , Qualidade de VidaRESUMO
INTRODUCTION: Therapeutic education is an essential part in the management of type 2 diabetes mellitus (T2D). Implementing a therapeutic education program with the participation of a diabetes specialist nurse (DSN) addressed to patients with T2D using more than 2insulin injections and sub-optimal metabolic control in primary care (PC) could improve health care and clinical outcomes. Our purpose was to evaluate the clinical, educational and patient satisfaction outcomes of this program. MATERIAL AND METHODS: A prospective, longitudinal study was performed with an evaluation before and after the intervention. The program had a duration of 6 months and included individual on-site, phone and group visits. RESULTS: 184 subjects were included and 161 were finally evaluated. 89.4% were included due to sub-optimal metabolic control and 10.6% because of repeated hypoglycemia. In the first group, the mean reduction in HbA1c was -1.34±1.45% without any increase in hypoglycemia episodes. In the second group, a significant reduction in hypoglycemia episodes/week was observed (2.52±1.66 vs. 0.53±1.06; P<.05) without any increase in HbA1c. Learning skills, lifestyle, adherence to care, and the perception of quality of life had significantly improved at 6 months (P<.05). The overall program was positively evaluated by patients, the role of DSN being considered essential by 98% of the responders. CONCLUSION: A structured therapeutic education program, including a DSN, addressed to insulin treated T2D patients attending primary care facilities and with sub-optimal metabolic control is associated with beneficial effects in terms of clinical, educational and patient satisfaction endpoints.
RESUMO
La diabetes mellitus tipo 2 (DM2) es una enfermedad crónica de alta prevalencia, con un alto coste social y un gran impacto sanitario determinado por el desarrollo de complicaciones agudas y crónicas. Entre el 6,3 y el 7,4% del presupuesto de nuestro sistema nacional de salud se dedica a la atención de los pacientes con esta enfermedad, principalmente centrado en hospitalizaciones y fármacos no hipoglucemiantes, lo que representaría un gasto anual de 1.290 a 1.476 € por paciente. A pesar de los nuevos fármacos para el tratamiento de la DM2, de la evidencia científica y de las guías nacionales e internacionales disponibles para poder conseguir los objetivos de control glucémico, este es complejo y todavía insuficiente. Los principales motivos que se barajan como implicados en la no consecución de objetivos en el paciente con DM2 son la inercia terapéutica (presente en un 40% en nuestro medio en pacientes con HbA1c > 7%), el incumplimiento terapéutico por parte del paciente, los problemas inherentes al sistema sanitario y la historia natural de la enfermedad
Type 2 diabetes mellitus (DM2) is a highly prevalent chronic disease with major social and healthcare repercussions due to the development of acute and chronic complications. The care of patients with DM2 represents between 6.3% and 7.4% of the budget of the Spanish national health service and is mainly centered on hospital admissions and hypoglycemic agents, leading to an annual expenditure of 1,290 € to 1,476 € per patient. The attainment of glycemic targets remains complex and inadequate, despite new drugs for the treatment of DM2, the available scientific evidence, and national and international guidelines. The main causes proposed for failure to achieve these targets in DM2 are clinical inertia (found in 40% of physicians in Spain treating patients with HbA1c > 7%), poor treatment adherence, the problems inherent to the health system, and the natural history of the disease
