Tip 2 Diabetes Mellituslu Hastalar Tarafından Başvurulan Hekim Sayısının Hedef Değerlere Ulaşma ve Tedaviye Uyum Oranları Üzerine Etkileri

Abstract

Amaç: Bu çalışmanın amacı, tip 2 diabetes mellitus (DM) hastalarının antidiyabetik ve antihiperlipidemik ilaçlarına uyumunu ve diyabetin kontrolü ve tedavisi için farklı sağlık merkezlerinde ziyaret ettikleri toplam hekim sayısını belirlemek, glisemik ve lipid hedeflerine ulaşma oranları ile bu değişkenler arasındaki ilişkiyi araştırmaktır.

Gereç ve Yöntem: Tip 2 DM hastalarında; lipid ve HbA1C hedef değerlerine  ulaşma oranını ve tedaviye uyumu etkileyen faktörleri (yani üniversite hastanesine gelmeden önce ki diyabet için ziyaret edilen sağlık merkezlerinin sayısı ve tipi ve hekimlerin sayısı) belirlemek için bir anket uygulandı.

Bulgular: Toplam 400 DM hastası, yani 51-65 yaş arasındaki 226 (% 56.5) kadın ve 52-67 yaşları arasında ki 174 (% 43.5) erkek hasta çalışmaya dahil edildi. Hastaların en az 1 ve en fazla 4 hekimi ziyaret ettikleri tespit edildi. Hastalar; ziyaret ettikleri hekim sayısına göre karşılaştırıldığında, 2 veya daha az hekim ziyaret eden hastalarda; açlık, glikoz, HbA1C, trigliserid, düşük yoğunluklu lipoprotien ve total kolestrol değerleri istatistiksel olarak daha düşük ve yüksek yoğunluklu lipoprotein düzeyleri ise daha yüksekti .

Tartışma: Hastalar DM takibi için iki doktordan fazlasından  yardım aldıklarında hedef değerleri yakalamak ve tedaviye uyumu sağlamak daha zor hale gelmektedir.

Keywords

• Tip 2 Diabetes Mellitus,Doktor sayısı,metabolik kontrol

The Effects of the Number of Physicians Visited byType 2 Diabetes Mellitus Patients on the Rate of Achieving Target Values and Adherence to Medication

Abstract

Aim: The aim of this study is to identify the adherence to antidiabetic and antihyperlipidemic medications of type 2 diabetes mellitus (DM) patients, and to determine the total number physicians they visited in different healthcare centers for the control and treatment of diabetes, the rate of achieving glycemic and lipid targets and the relationship between these variables. 

Material and Methods: A survey was administered to find out the rate of achieving target levels of lipid and HbA1C intype 2 DM patients and the factors that affect adherence to treatment (i.e. the number and type of healthcare centers visited for diabetes and the number of physicians visited before and in the university hospital) as well as the rate of resort to complementary medicine and the methods used.

Results: A total of 400 DM patients – i.e. 226 (56.5%) women aged between 51 and 65 and 174 (43.5%) men aged between 52 and 67 – were included in this study. We found that patients visited minimum 1 and maximum 4 physicians. The comparison of patients by the number of physicians they visited suggests that the values of fasting glucose,  HbA1C, triglyceride, low-density lipoprotien and total cholesterol were statistically lower and the level of high-density  was higher in patients that visited 2 or fewer physicians.

Discussion: It becomes more difficult to achieve target values and ensure adherence to treatment when patients seek help from more than one or two physicians for the follow-up of DM.

Keywords

• Type 2 Diabetes Mellitus,Number of phycisian,metabolic control

References

1. 1-American Diabetes Association.Standards of medical care in diabetes-2015 abridged for primary care providers.Clin Diabetes. 2015 Apr;33(2):97-111. doi: 10.2337/diaclin.33.2.97.
2. 2-Delamater AM. Improving patient adherence. Clinical diabetes, 2006:24(2), 71-77.
3. 3-National Cholesterol Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health, NIH Publication No. 02-5215, September 2002
4. 4-S.M. Grundy, J.I. Cleeman, C.N. Bairey Merz, for the Coordinating Committee of the National Cholesterol Education Program Endorsed by the National Heart, Lung, and Blood Institute, American College of Cardiology Foundation, and American Heart Association, et al.Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III GuidelinesCirculation, 110 (2004), pp. 227–239
5. 5-McDonald HP1, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review.JAMA. 2002 Dec 11;288(22):2868-79.
6. 6-Brown MT1, Bussell JK. Medication adherence: WHO cares?Mayo Clin Proc. 2011 Apr;86(4):304-14. doi: 10.4065/mcp.2010.0575. Epub 2011 Mar 9.
7. 7-.Ho PM1, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes.Circulation. 2009 Jun 16;119(23):3028-35. doi: 10.1161/CIRCULATIONAHA.108.768986
8. 8-Guilliford MC, Mahabir D. Relationship of health- related guality of life to symptom severity in diabetes mellitus: a study in Trinidal and Tobago. J Clin Epidemiol 1993; 329: 977-86.

9. 9-Garrat AM, Schmidt L, Fitzpatrick R. Patient- assessed health outcome measures for diabetes: a structured review. Diabet Med 2002; 19: 1- 11.
10. 10-Krans HMJ, Porta M, Keen H. Diabetes care and research in Europe: The Saint Vincent Declaration Action Programme İmplementation Document. Copenhagen: WHO,Regional Office for Europe, 1992. Piwernetz K, Home HD, Snoorgard O, Antsiferov N, Staehr- Joansen K, Krans M. For the DIABCARE monitoring group of the St. Vincent Declaration Steering Committee. Monitoring the targets of the St. Vincent Declaration and the implication of guality management in diabetes care: the DIABCARE initiative. Diabetic Medicine 1993; 10: 371-7.
11. 11-Stephen J. Spann, Paul A. Nutting Management of Type 2 Diabetes in the Primary Care Setting: A Practice- Based Research Network Study Annals of Family Medicine 2006; 4: 23- 31
12. 12-İlkova H, Damcı T, Siva ZO, Özyazar M, Yumuk V, Görpe EU, Esra Hatipoğlu. The Relation of Changes in Prescribing Patterns of Anti-diabetic Drugs and HbA1c Levels Among Patients with Type 2 Diabetes Mellitus: Systematic Analysis of Studies From the the Past 20 Years in Turkey. Turk Jem 2011; 15: 77-105
13. 13-Ergin E, Akın S, Efetürk E, Erdem ME, Tekçe M, Aliustaoğlu A. Which Treatment Reaches Glycemic Goals in Type-2 Diabetic Patients? J Kartal TR 2014;25(1):13-18 doi: 10.5505/jkartaltr.2014.27122
14. 14-Yiğiner O, Ozmen N, Ozçelik F, Inanç T, Kardeşoğlu E, Uz O, Işılak Z, Aparcı M, Sahin I, Arslan E, Cebeci BS.Adherence to statin therapy and LDL cholesterol goal attainment in type 2 diabetics and secondary preventionpatients: the role of education and knowledge. Turk Kardiyol Dern Ars. 2010 Dec;38(8):544-50.
15. 15-Pearson TA, Laurora I, Chu H, Kafonek S. The lipid treatment assessment project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals. Arch Intern Med 2000; 160:459-67.
16. 16-Nag S.S., Daniel GW, Bullamo MF, Kamal-Bahl S, Sajjan SG, Hu H, ET AL. LDL-C goal attainment among patients newly diagnosed with coronary heart disease or diabetes in a commercial HMO. J. Manag Care Pharm 2007; 13: 652-63.
17. 17-Ferrieres J, Gousse ET, Fabry C, Hermans MP; French Cepheus Investigators. Assessment of lipid-lowering treatment in France-the Cepheus study. Arch Cardiobasc Dis 2008; 101: 557-63
18. 18- Keskin A. Status of reaching LDL goals in Diabetic patients and freguency of statin treatment compliance. Ankara Medical Journal 2012; 12 (3): 122-3
19. 19-Kultursay H. Results of the rosuvastatin studies in Turkey. ( Article in Turkish). Türk Kardiol. Dern. Arş. 2007; 35 (Suppl 1): 24-30.
20. 20-Pringle M1, Stewart-Evans C, Coupland C, Williams I, Allison S, Sterland J. Influences on control in diabetes mellitus: patient, doctor, practice, or delivery of care? BMJ. 1993 Mar 6;306(6878):630-4.
21. 21-Morris AD1, Boyle DI, McMahon AD, Greene SA, MacDonald TM, Newton RW. Adherence to insulin treatment, glycemic control,and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit. Lancet. 1997 Nov 22;350(9090):1505-10.
22. 22-Junius-Walker U, Theile G, Hummers-Pradier E. Prevalence and predictors of polypharmacy among older primary care patients in Germany. Fam Pract. 2007 Feb;24(1):14-9. Epub 2006 Dec 11.
23. 23-O’Keefe JH, Abuannadi M, Lavie CJ, Bell DS. Strategies for optimizing glycemic control and cardiyovascular prognosis in patients with type 2 diabetes mellitus. Mayo Clin Proc 2011;86(2):128-38.