Mal control de la diabetes tipo 2 en un centro de salud de atención primaria: factores modificables y población diana / Uncontrolled type 2 diabetes in primary care health center: Modifiable factors and target population
Aten. prim. (Barc., Ed. impr.)
; 53(9): 102066, Nov. 2021. tab, graf
Article
in Es
| IBECS
| ID: ibc-208197
Responsible library:
ES1.1
Localization: ES15.1 - BNCS
RESUMEN
Objetivos:
Detectar factores modificables y poblaciones diana asociados al mal control de la diabetes tipo 2 (DM2) en atención primaria.Diseño:
Estudio descriptivo transversal restrospectivo. Emplazamiento Centro de salud de Barranco Grande, Tenerife. Participantes selección aleatoria de pacientes con DM2 atendidos por 12 médicos de familia y 12 enfermeras. Mediciones principales Además del control de la DM2, se obtuvieron datos sociodemográficos, clínicos, hábitos de vida y seguimiento de medidas preventivas y terapéuticas. Tras análisis bivariado, se ajustó un modelo multivariado multinivel tomando el cupo médico-enfermero como efecto mixto de segundo nivel y el resto como variables de primer nivel.Resultados:
Fueron reclutados 587 pacientes (46,5% mujeres), tratados con 1,9±1,1 fármacos antidiabéticos, con 4,1% de incumplimiento terapéutico, y padeciendo un 13,8% inercia terapéutica. El 23,7% mostraba mal control de DM2, siendo peor (p<0,05) en sexo masculino, edad <65 años, evolución DM2 ≥5 años, dieta inadecuada, síndrome metabólico, ratio triglicéridos/HDL≥3, complicaciones de la DM2, índice Charlson<5, visitas a enfermera<3/año, sin ECG en el último año y mayor número de fármacos prescritos para DM2. El cupo médico-enfermero se asoció al mal control con un coeficiente intraclase de 0,01.Conclusiones:
Los hombres menores de 65 años con larga evolución de DM2 son población diana para intensificar intervenciones. El incumplimiento terapéutico, dieta inadecuada, falta de adhesión a los protocolos de seguimiento y ratio triglicéridos/HDL>3 son factores sobre los que intervenir. La asociación del cupo médico-enfermero con el control de la DM2 es débil, probablemente por adecuado seguimiento de los programas preventivos.(AU)ABSTRACT
Aims:
To detect modifiable factors and target populations associated with uncontrolled type 2 diabetes in primary care.Design:
Retrospective cross-sectional descriptive study. Location Health center of Barranco Grande, Tenerife.Participants:
Random selection of patients with DM2 attended by 12 family doctors and 12 nurses. Main Measurements In addition to the control of DM2, sociodemographic, clinical data, lifestyle and follow-up of preventive and therapeutic measures were obtained. After bivariate analysis, a multilevel multivariate model was adjusted by taking the quota of patients assisted by each physician as a second-level mixed-effect variable and the rest as first-level variables.Results:
587 patients were recruited (46.5% female), treated with 1.9-1.1 antidiabetic drugs, with 4.1% therapeutic non-compliance, and suffering 13.8% therapeutic inertia. 23.7% showed poor DM2 control, being significantly worse (p<0.05) in male sex, age <65 years, evolution DM2 -5 years, work-active, upper-middle studies, inadequate diet, metabolic syndrome, ratio TG/HDL-3, complications of DM2, Charlson index<5, nursing visits <3/year, without ECG in the last year, and more drugs prescribed for DM2. The doctor-nurse quota was associated with poor control with an intraclass coefficient of 0.01.Conclusions:
Men under 65 years of age with DM2 evolution longer than 5 years are a target population to intensify interventions. Therapeutic non-compliance, inadequate diet, lack of adherence protocols and ratio TG/HDL>3 are the main modifiable factors on which to intervene. The association of the doctor-nurse quota with the control of DM2 is weak, probably due to adequate follow-up of preventive programs.(AU)Key words
Full text:
1
Collection:
06-national
/
ES
Database:
IBECS
Main subject:
Preventive Health Services
/
Socioeconomic Factors
/
Risk Factors
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Diabetes Mellitus, Type 2
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Habits
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Hypoglycemic Agents
Limits:
Female
/
Humans
/
Male
Country/Region as subject:
Europa
Language:
Es
Journal:
Aten. prim. (Barc., Ed. impr.)
Year:
2021
Document type:
Article