Are There Different Viewpoints About the Management of Type 2 Diabetes Mellitus and Comorbidities? A Multidisciplinary Spanish Qualitative Research

Abstract

Introduction:The aim of this study was to explore the vision of a large multidisciplinary group of physicians treating type 2 diabetes mellitus (T2DM) in Spain, with a special focus on controversial management aspects. The perceptions of primary care (PC) physicians and hospital care (HC) specialists were compared. Methods: This was a mixed survey that included Delphi-like statements and opinion, attitude and behaviour (OAB) questions. The Delphi-like statements were assessed on the basis of the degree of agreement among respondents, and a descriptive analysis was performed on the answers to the OAB questions. Results: A total of 296 participants responded to the first wave of the survey, of whom 293 responded to the second wave (211 from PC and 80 from HC, with two respondents for whom there were no data on specialty). A high degree of consensus (CNS C 0.8) was obtained in all the statements. A proactive approach to detect prediabetes or T2DM in asymptomatic people was highly supported (80.4% of agreement). Introducing early treatment intensification was considered to favour the durability of glycaemic control and to delay the progression of the disease (80.4%). There was agreement on the statement that glycaemic variability constitutes a risk factor for chronic complications, although differences in the perceptions of HC physicians and PC specialists were identified (86.3 vs. 80.1%, respectively). More HC physicans than PC specialists considered comorbidities to affect the ability to self-care (95 vs. 82.9%, respectively). Conclusions: The survey revealed that there was a high, albeit not universal, degree of agreement amongst PC physicians and HC specialists in relation to prevention, screening and diagnosis of T2DM; early treatment intensification; dysglycaemias; and the management of patients with comorbidities. The statement on the management of patients with comorbidities elicited the highest difference between PC physicans and HC specialists. The results of this survey indicate that there is room for

Epidemiological Situation of High-Prevalence Non-Communicable Diseases in Spain: A Systematic Review

“…In addition, two studies demonstrated the benefits of the Mediterranean diet for diabetic patients [56,63]. Another point of interest is the patient-doctor relationship, and accordingly, a qualitative study by a group of doctors in Spain demonstrated the importance of early screening in patients with T2DM, in tandem with good practices, disease control and dietary habits [60]. Conversely, poor diabetes control and poor healthy lifestyle practices lead to complications of the disease [54,63].…”

“…Another qualitative study of a multidisciplinary group of physicians in Spain expressed the importance of early screening in patients with type 2 DM, healthy lifestyle interventions, glycosylated blood glucose testing and glycaemic control as key strategies for reducing the prevalence of the disease [60].…”

Abordaje holístico: la clave en el paciente con diabetes mellitus

“…Lleva razón la OMS con esta estrategia porque los profesionales de medicina de familia estamos en una posición privilegiada para realizar un abordaje holístico y lineal de nuestros pacientes gracias a la accesibilidad, proximidad y continuidad asistencial inherente al trabajo en atención primaria. Este abordaje es un continuum que acompaña al paciente en sus diferentes momentos vitales 2 . Como en muchas otras enfermedades, la Abordaje holístico: La clave en el paciente con diabetes mellitus la glucemia, la tensión arterial y los lípidos en pacientes con DM2 evolucionada aumentó la esperanza de vida, se redujeron los eventos cardiovasculares (EvCV) y los eventos microvasculares en torno al 50 % en el grupo intervención y se constató una ganancia de vida media de 7,9 años, debido fundamentalmente a la reducción o demora en la aparición de los EvCV 5 .…”

“…Palabras clave: prevención, protección, iSGLT-2, dapagliflozina. evolución natural de la diabetes mellitus (DM) se desarrolla en diferentes fases, desde la exposición al factor desencadenante, la instauración de la enfermedad hasta las fases más avanzadas donde aparecen las complicaciones 2 .…”

Factors Related to the Continuity of Care and Self-Management of Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Taiwan

“…Related studies have pointed out that various complications are caused by improper blood glucose control, including retinal-related complications (accounting for 72.6% of the patients), peripheral neuropathy (68.2%), and foot ulcers (12.7%) [ 7 ]. Related research has found that more chronic diseases of diabetic patients and longer time of the illness affect their self-management status [ 7 , 8 ], while their suffering from comorbidities is twice as higher as non-diabetic patients [ 9 ].…”