The high care pressure makes it difficult to handle patients with diabetes 2. One of the big problems in the daily care task is the lack of time.Actually, with the assigned time to make a consultation, five minutes, quality assistance can hardly be carried out.Keep in mind that the high number of visits generated by DM and nursing care overload also suppose a high sanitary cost.

Thus, one of the aspects that can help improve this situation is the development of programs in which nursing has an important role in monitoring patients with DM2.These care programs are carried out, although they have to improve and be extensive to all patients with DM2.

However, nursing professionals make a great effort informing the diabetic about their illness and treatment, but educational programs are not standardized and, together with the great care demand, decreases the effectiveness of these interventions.

Request for evidence

Regarding the request for evidence to study the diabetic, specialists comment that they can be requested without problems, although the most specific ones must be processed by giving some type of justification.But in this aspect there are no problems to request for example glycosylated hemoglobin or other tests that are part of the monitoring of diabetic disease.

As a general rule, the valuation of the organization and the involvement of nursing in the control of patients with DM2 is positive, although there are some improvement points.The time available to these patients is limited, which makes the problem similar to the one that occurs with doctors.Nursing has more and more work at home and that makes it difficult to have efficient programs not only for DM2, but for other chronic pathologies.

Problems to individualize treatment

On the other hand, the cost and/or administrative pressure on the prescription of antidiabetic therapy hinders the individualization of treatment.The cost of drugs and, above all, of the therapeutic news and administrative pressure, through protocols, drug visa ... constitute a difficulty when performing an individualized treatment.

In any case, there are currently a lot of therapeutic alternatives that, if you know how to choose the type of patient well and the moment of use, you can treat type 2 diabetics with controlled costs.

However, the obstacles that the administration puts for greater savings in pharmacological expense makes it difficult to use more intensively of therapies that can mean a better treatment for the patient.You have to be more selective when making use of them.

Therapeutic inertia

In this context, another problem must be added: the therapeutic inertia, which makes the beginning of pharmacological treatment or its increase unnecessarily.The general objective of achieving an Hbalc & Lt;7% is reasonable as long as the treatment does not entail an unacceptable risk of serious hypoglycemia or other adverse effects.

Thus, intensive treatment (Hbalc & LT; 6.5%) could be more beneficial in younger patients, at the beginning of the disease and without comorbidities.This, by inertia, would be extensible to elderly patients.

Therefore, in elderly patients, long evolution and presence of comorbidities or complications or with a history of severe hypoglycemia, an objective of Hbalc & LT; 7.5% or even 8%, would be more prudent.When evaluating inertia, if all these conditions cannot be taken into account, an 8% value would be more appropriate.

What is clear is that theAchievement of good metabolic control can avoid or delay the appearance of microvascular and macrovascular complications, as various studies with long -term monitoring have been demonstrated such as the UKPDS study for type 2 diabetes.

Thus, once the changes in the lifestyle are established, the objective of the pharmacological treatment of type 2 diabetes will be to obtain an optimized metabolic control with the maximum possible safety.

key guidelines

The beginning of the pharmacological treatment must begin at three or six months after initiating non -pharmacological measures, such as the change of lifestyle aimed at weight, increase the level of daily physical exercise and reduce food consumption thatThey can increase glycemic levels.

If these measures alone are not enough to have good control, the pharmacological treatment must be immediately started.The early beginning will result in long -term benefits to control the evolution of the disease.Thus, in young patients you have to be ambitious in achieving good glycemic control, so it is recommended to use drugs that do not cause hypoglycemia.

Obesity and hypoglycemia are the main challenges of diabetes treatment since the first increases the risk of cardiovascular problems and the second impact on the control of the disease.One of the measures to consider when choosing a drug for diabetes are its side effects, such as weight gain/ loss, hypoglycemia ...

Currently, treatments that help in this task are available, either by its neutral effect on weight, such as IDPP4 or drugs that manage to reduce weight such as glucosuric or agonists of the LPG-1 receiver.

In addition to the effectiveness of a drug to lower glycosylated hemoglobin figures, other parameters are taken into account, among which cardiovascular safety.

For the elaboration of this article, the collaboration of the doctors specializing in Family Medicine Juan Carlos Lisbona Delgado, of the Velez Norte Health Center;Francisco Javier Rodríguez Peso, from the Lagunas Health Center, and Ignacio de Pedro Uretea, of the Periana Health Center;Jesús Serrano Rasero, from the La Velada Health Center;Juan Carlos Nieto Rivas, from the Palmones office, Juana Gutierrez Cera, of the Bajadilla office;Emilio Torres Bonilla, from the Algeciras-Centro Health Center and Félix Rodríguez Bermudez de Castro, of the Cortijo Vides office.