Poor Glycaemic Control—Identifying Variables Associated with Therapeutic Inertia and Lack of Therapeutic Adherence

Abstract

Two main causes of poor glycaemic control has been describe in diabetic patients: lack of patient adherence to antidiabetic drugs and lack of treatment intensification by the physician.

Aim: To analyse variables associated to therapeutic inertia(TI) or lack of adherence in diabetic patients with poor glycaemic control in Spanish primary care.

Methods: Observational cross sectional nationwide study. 48 primary care physicians (PCP) from the Spanish working group on diabetes mellitus from the Sociedad Española de Medicina de Familia. 4patients randomly selected from each surgery. Individualized glycemic targets were calculated according to the algorithm from Cahn A et al (Diabetes Care 2016). TI was defined as a patient with good adherence, according to PCP opinion, but with poor individualized glycaemic control (GC).

Results: 60.5% of patients had good GC (group A), and 39.5% had poor control, 22.1% due to TI (group B) and 17.4% due to poor therapeutic adherence (PTA) (Group C). All three group of patients differ according to the following variables, respectively: age (69.5 vs. 70.5 vs. 63.8 years; p=0.000); HbA1c (6.27 vs. 7.75 vs. 8.46%; p=0.000); number of antidiabetic drugs (1.3 vs. 2.0 vs. 2,1; p=0.000); prevalence of osteoarthritis (50.5 vs. 44.4 vs. 29,7%; p=0.013); risk of hypoglycaemia (66.7 vs. 64.3 vs. 37.5%; p=0.000); physicians time (years) in the practice (12.5 vs. 15.3 vs. 11.5 years; p=0.000). No differences were found in number of comorbidities, gender, cognitive impairment, micro or macro vascular complications, cancer, thyroid dysfunction, dyslipidemia, arterial hypertension, COPD, anxiety, or depression.

Conclusions: 39.5% of diabetic patients have poor glycaemic control according to individualized targets; 22.1% due to TI and 17.4% due to poor therapeutic adherence. Patients with TI compared to patients with PTA were older, with lower A1c, higher risk of hypos, higher prevalence of ostheoartritis and with a PCP with more years in the practice.