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ISSN 0016-3813 (Impreso)

2016, Número 3

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Gac Med Mex 2016; 152 (3)


Causas de descontrol metabólico en atención primaria

Wacher NH, Silva M, Valdez L, Cruz M, Gómez-Díaz RA

Idioma: Español
Referencias bibliográficas: 55
Paginas: 350-356
Archivo PDF: 91.61 Kb.


RESUMEN

El descontrol metabólico es una constante de los pacientes con diabetes, a pesar de que existen recursos que han demostrado el logro de metas terapéuticas. Identificamos las causas de descontrol metabólico en pacientes con diabetes atendidos en Unidades de Medicina Familiar (UMF) de la Ciudad de México en el IMSS. Se analizaron 638 de 1,170 pacientes estudiados entre 2000 y 2006. Se registraron variables antropométricas, ocurrencia de infecciones, apego al tratamiento, prescripción de medicamentos, dieta, ejercicio y perfil bioquímico. La proporción de pacientes con A1c ‹ 7% empeoró con el tiempo: de 38.9% al inicio bajó a 21.4% (p ‹ 0.001); colesterol-LDL, de 51.9 a 12.2% (p ‹ 0.001), y presión arterial (TA) controlada, de 35.6 a 23.3% (p ‹ 0.001). Una dieta alta en calorías se asoció con descontrol metabólico (OR: 2.36; IC 95%: 1.34-4.13) y la intensificación del tratamiento, con A1c elevada (OR: 2.1; IC 95%: 1.14-4.14). De los pacientes fuera de meta, no se intensificó el tratamiento en 90%. Infecciones, incumplimiento y medicamentos que interfieren con antihiperglicemiantes no se asociaron con A1c › 7%. Las principales causas de descontrol fueron: la progresión de la enfermedad, alimentación inadecuada y no intensificar el tratamiento con oportunidad. Los programas de atención de la diabetes deberán considerar estos hallazgos para resolver estos problemas.


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