Inércia clínica na intensificação da terapia com insulina em pacientes com Diabetes mellitus tipo 2 de um centro de diabetes público, terciário e com limitações no arsenal terapêutico farmacológico

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dc.audience.educationlevelMestrado
dc.contributor.advisorChacra, Antonio Roberto [UNIFESP]
dc.contributor.advisor-coDib, Sergio Atala [UNIFESP]
dc.contributor.advisor-coLatteshttp://lattes.cnpq.br/3659437526996462pt_BR
dc.contributor.advisorLatteshttp://lattes.cnpq.br/1283958068077831pt_BR
dc.contributor.authorAlvarenga, Marcelo Alves [UNIFESP]
dc.contributor.authorLatteshttp://lattes.cnpq.br/7530162939829529pt_BR
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)pt_BR
dc.coverage.spatialSão Paulopt_BR
dc.date.accessioned2021-01-19T16:32:00Z
dc.date.available2021-01-19T16:32:00Z
dc.date.issued2019-02-28
dc.description.abstractBackground: Clinical inertia is related to the difficulty of achieving and maintaining optimal glycemic control. It has been extensively studied the delay of the period to insulin introduction in type 2 diabetes mellitus (T2DM) patients. This study aims to evaluate clinical inertia of insulin treatment intensification in a group of T2DM patients followed at a tertiary public Diabetes Center with limited pharmacologic armamentarium (Metformin, Sulphonylurea and Human Insulin). Methods: This is a real life retrospective record based study with T2DM patients. Demographic, clinical and laboratory characteristics were reviewed. Clinical inertia was considered when the patients did not achieve the individualized glycemic goals and there were no changes on insulin daily dose in the period. Results: We studied 323 T2DM patients on insulin therapy (plus Metformin and or Sulphonylurea) for a period of 2 years. The insulin daily dose did not change in the period and the glycated hemoglobin (A1c) ranged from 8.8 + 1.8% to 8.7 + 1.7% (basal vs 1st year; ns) and to 8.5 + 1.8% (basal vs 2nd year; p = 0.035). The clinical inertia prevalence was 65.8% (basal), 61.9% (after 1 year) and 58.2% (after 2 years; basal vs 1st year vs 2nd year; ns). In a subgroup of 100 patients, we also studied the first 2 years after insulin introduction. The insulin daily dose ranged from 0.22 + 0.12 to 0.32 + 0.24 IU/kg of body weight/day (basal vs 1st year; p < 0.001) and to 0.39 + 0.26 IU/kg of body weight/day (basal vs 2nd year; p < 0.05). The A1c ranged from 9.6 + 2.1% to 8.6 + 2% (basal vs 1st year; p < 0.001) and to 8.7 + 1.7% (1st year vs 2nd year; ns). The clinical inertia prevalence was 78.5% (at the moment of insulin therapy introduction), 56.2% (after 1 year; p = 0.001) and 62.2% (after 2 years; ns). Conclusion: Clinical inertia prevalence ranged from 56.2% to 78.5% at different moments of the insulin therapy (first 2 years and long term) of T2DM patients followed at a tertiary public Diabetes Center from an upper-middle income country with limited pharmacologic armamentarium.en
dc.description.sourceDados abertos - Sucupira - Teses e dissertações (2019)
dc.format.extent170 f.
dc.identifierhttps://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7610354pt_BR
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/59242
dc.language.isopor
dc.publisherUniversidade Federal de São Paulo (UNIFESP)
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectType 2 diabetes mellitusen
dc.subjectDiabetes complicationsen
dc.subjectGlycosylated hemoglobin (HbA1c)en
dc.subjectInsulin therapyen
dc.subjectDiabetes mellitus Tipo 2pt_BR
dc.subjectComplicações do diabetespt_BR
dc.subjectHemoglobina glicosilada (HbA1c)pt_BR
dc.subjectTerapia com Insulinapt_BR
dc.titleInércia clínica na intensificação da terapia com insulina em pacientes com Diabetes mellitus tipo 2 de um centro de diabetes público, terciário e com limitações no arsenal terapêutico farmacológicopt_BR
dc.title.alternativeClinical inertia on insulin treatment intensification in type 2 diabetes mellitus patients of a tertiary public diabetes center with limited pharmacologic armamentarium from na uppermiddle income countryen
dc.typeinfo:eu-repo/semantics/masterThesis
unifesp.campusSão Paulo, Escola Paulista de Medicinapt_BR
unifesp.graduateProgramMedicina (Endocrinologia e Metabologia)pt_BR
unifesp.knowledgeAreaEndocrinologia e Metabologiapt_BR
unifesp.researchAreaDiagnóstico e Terapêuticapt_BR
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