L'inertie thérapeutique dans la prise en charge du diabète type 2 en médecine générale : l'exemple du passage à une bithérapie

Abstract : Objective: A major factor of poor glycaemic control in type 2 diabetic patients is linked to the therapeutic inertia(IT), it means the delay of beginning or intensification of a treatment, whereas the therapeutic objective is not reached. In particular, after therapeutic failure of metformin, an intensification by a dual therapy is recommended, by gliptins (DPP-4 inhibitors) or sulfonylureas, according to the recommendations of the Francophone Society of Diabetes or the High Authority of Health, respectively. Materials and methods: A retrospective study of 51 patients was conducted on the basis of questionnaires completed by general practitioners from the different departments of the PACA region. Results: Among diabetic patients, the average age of diabetes was 7.7 +/- 5 years. Almost all patients were on dual therapy, except 4 patients on triple therapy. The 64% had no complication at the time of switching to dual therapy. In patients with IT the average HbA1c was 9.3 +/- 0.8, while in non-IT patients it was 7.7 +/- 1 . Their clinical profile was comparable. The total IT, given by the sum of patient-related cases and physician-related cases, was observed in the 56% of the population. The therapy chosen preferably in second intention was the gliptins. Discussion and conclusion: IT in the PACA region reflects the trend of the national framework and seems even higher. The causes were mostly related to the patient and to the denial of the diabetic disease and the efforts needed to reach their therapeutic goal. The age of the patients, the age of the diabetes, the sex of the patient did not influence the IT, whereas IT was more felt by the older doctors. The probability of IT increased with the value of HbA1c, to decrease after when this one exceeds 9%. The choice of dual therapy was preferentially focused on gliptins in the usual clinical practice. At this stage, a specialist opinion for unbalanced patients was requested by only 1 in 5 doctors.
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https://dumas.ccsd.cnrs.fr/dumas-02086195
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Submitted on : Monday, April 1, 2019 - 11:08:36 AM
Last modification on : Thursday, April 18, 2019 - 11:35:27 PM
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Lucia Giangreco. L'inertie thérapeutique dans la prise en charge du diabète type 2 en médecine générale : l'exemple du passage à une bithérapie. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02086195⟩

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