Manejo de perfiles de pacientes con diabetes mellitus tipo 2 en la práctica clínica de la atención primaria en EspañaPrograma CONTROVERTI2

  1. J.C. Obaya Rebollar 1
  2. S. Miravet Jiménez 2
  3. I. Aranbarri Osoro 3
  4. F.C. Carramiñana Barrera 4
  5. F.J. García Soidán 5
  6. A.M. Cebrián Cuenca 6
  1. 1 Centro de Salud La Chopera, Alcobendas, Madrid, España
  2. 2 Centro de Atención Primaria Martorell, Martorell, Barcelona, España
  3. 3 Centro de Salud Arrasate, Arrasate, Gipuzkoa, España
  4. 4 Centro de Salud San Roque, Badajoz, España
  5. 5 Centro de Salud O Porriño, O Porriño, Pontevedra, España
  6. 6 Centro de Salud Cartagena Casco Antiguo, Cartagena, Murcia, España
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Journal:
Semergen: revista española de medicina de familia

ISSN: 1138-3593

Year of publication: 2022

Issue: 1

Pages: 23-37

Type: Article

DOI: 10.1016/J.SEMERG.2021.07.009 DIALNET GOOGLE SCHOLAR

More publications in: Semergen: revista española de medicina de familia

Sustainable development goals

Abstract

Aim To identify existing controversies in the routine management of patients with T2D and to contrast them with the latest scientific evidence and clinical guidelines, in order to help optimize and homogenize the treatment of patients with T2D in Primary Care (PC) in Spain. Material and methods 240 family doctors responded to an online questionnaire about the management of 6 patient profiles with T2D of increasing complexity. Results The main drivers for the antihyperglycemic treatment choice are an HbA1c > 10% and the presence of cardiovascular disease (CVD), although in evolved patients, the estimated glomerular filtration rate and the risk of hypoglycemia become more relevant. In newly diagnosed patients with an HbA1c > 9%, treatment is still initiated with monotherapy (24%). In patients not controlled with metformin, dipeptidyl peptidase 4 inhibitors (DPP4-I, 54%) or sodium-glucose cotransporter 2 inhibitors (SGLT2-I, 39%) are usually added. On the other hand, type 1 glucagon-like peptide receptor agonists (GLP1-RA) are mainly associated with obese patients with T2D. In patients not controlled with metformin + sulfonylurea (SU), SU replacement is preferred to adding a third antihyperglycemic agent to background therapy (77% vs. 23%). Conclusions T2D treatment in PC is still focused on HbA1c reduction and treatment safety. Thus, DPP4-I are widely used. SGLT2-I are usually preferred for patients with T2D and CVD and GLP1-RA for patients with T2D and obesity, although their use in PC is low.

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Data source: Dialnet