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
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7610354 https://repositorio.unifesp.br/handle/11600/59242 |
Resumo: | Background: 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. |
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Alvarenga, Marcelo Alves [UNIFESP]Universidade Federal de São Paulo (UNIFESP)http://lattes.cnpq.br/7530162939829529http://lattes.cnpq.br/1283958068077831http://lattes.cnpq.br/3659437526996462Chacra, Antonio Roberto [UNIFESP]Dib, Sergio Atala [UNIFESP]São Paulo2021-01-19T16:32:00Z2021-01-19T16:32:00Z2019-02-28https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7610354https://repositorio.unifesp.br/handle/11600/59242Background: 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.Dados abertos - Sucupira - Teses e dissertações (2019)170 f.porUniversidade Federal de São Paulo (UNIFESP)Diabetes mellitus Tipo 2Complicações do diabetesHemoglobina glicosilada (HbA1c)Terapia com InsulinaType 2 diabetes mellitusDiabetes complicationsGlycosylated hemoglobin (HbA1c)Insulin therapyInércia 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 farmacológicoClinical 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 countryinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisMestradoinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESPSão Paulo, Escola Paulista de MedicinaMedicina (Endocrinologia e Metabologia)Endocrinologia e MetabologiaDiagnóstico e TerapêuticaORIGINALMarcelo Alves Alvarenga - A.pdfMarcelo Alves Alvarenga - A.pdfTese de doutoradoapplication/pdf5211394${dspace.ui.url}/bitstream/11600/59242/1/Marcelo%20Alves%20Alvarenga%20-%20A.pdf0bc02eb095f4af952a2123da822f4171MD51open access11600/592422023-08-17 15:53:07.987open accessRepositório InstitucionalPUB |
dc.title.pt_BR.fl_str_mv |
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 |
dc.title.alternative.en.fl_str_mv |
Clinical 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 country |
title |
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 |
spellingShingle |
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 Alvarenga, Marcelo Alves [UNIFESP] Diabetes mellitus Tipo 2 Complicações do diabetes Hemoglobina glicosilada (HbA1c) Terapia com Insulina Type 2 diabetes mellitus Diabetes complications Glycosylated hemoglobin (HbA1c) Insulin therapy |
title_short |
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 |
title_full |
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 |
title_fullStr |
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 |
title_full_unstemmed |
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 |
title_sort |
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 |
author |
Alvarenga, Marcelo Alves [UNIFESP] |
author_facet |
Alvarenga, Marcelo Alves [UNIFESP] |
author_role |
author |
dc.contributor.institution.pt_BR.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
dc.contributor.authorLattes.pt_BR.fl_str_mv |
http://lattes.cnpq.br/7530162939829529 |
dc.contributor.advisorLattes.pt_BR.fl_str_mv |
http://lattes.cnpq.br/1283958068077831 |
dc.contributor.advisor-coLattes.pt_BR.fl_str_mv |
http://lattes.cnpq.br/3659437526996462 |
dc.contributor.author.fl_str_mv |
Alvarenga, Marcelo Alves [UNIFESP] |
dc.contributor.advisor1.fl_str_mv |
Chacra, Antonio Roberto [UNIFESP] |
dc.contributor.advisor-co1.fl_str_mv |
Dib, Sergio Atala [UNIFESP] |
contributor_str_mv |
Chacra, Antonio Roberto [UNIFESP] Dib, Sergio Atala [UNIFESP] |
dc.subject.por.fl_str_mv |
Diabetes mellitus Tipo 2 Complicações do diabetes Hemoglobina glicosilada (HbA1c) Terapia com Insulina |
topic |
Diabetes mellitus Tipo 2 Complicações do diabetes Hemoglobina glicosilada (HbA1c) Terapia com Insulina Type 2 diabetes mellitus Diabetes complications Glycosylated hemoglobin (HbA1c) Insulin therapy |
dc.subject.eng.fl_str_mv |
Type 2 diabetes mellitus Diabetes complications Glycosylated hemoglobin (HbA1c) Insulin therapy |
description |
Background: 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. |
publishDate |
2019 |
dc.date.issued.fl_str_mv |
2019-02-28 |
dc.date.accessioned.fl_str_mv |
2021-01-19T16:32:00Z |
dc.date.available.fl_str_mv |
2021-01-19T16:32:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/masterThesis |
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masterThesis |
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publishedVersion |
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https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7610354 |
dc.identifier.uri.fl_str_mv |
https://repositorio.unifesp.br/handle/11600/59242 |
url |
https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7610354 https://repositorio.unifesp.br/handle/11600/59242 |
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por |
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por |
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info:eu-repo/semantics/openAccess |
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openAccess |
dc.format.none.fl_str_mv |
170 f. |
dc.coverage.spatial.pt_BR.fl_str_mv |
São Paulo |
dc.publisher.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
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Universidade Federal de São Paulo (UNIFESP) |
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Repositório Institucional da UNIFESP |
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