Sobretratamiento en personas con enfermedad cardiovascular establecida y diabetes tipo 2

Abstract

Introduction and objectivesTo estimate the prevalence of patients with established cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2) who are overtreated. MethodsCross-sectional study, which included a consecutive sample of adults, with CVD (defined as a history of acute myocardial infarction, cerebrovascular accident and/or peripheral arterial disease) and DM2, active affiliates to institutional prepaid of a high complexity hospital in Argentina. Overtreatment was defined as those who had at least one glycosylated hemoglobin (HbA1c) value <7% in the last year and had been prescribed at least one drug with a high risk of hypoglycemia (insulin and/or sulfonylureas and/or glinides) as part of their therapeutic scheme. ResultsA total of 1153 persons with established CVD and DM2 were included, 68.08% male, with a mean age of 75.38 years (SD=10.07), 89.59% had arterial hypertension, 52.82% were active smokers, and the average body mass index was 29.80kg/m2 (SD=5.03). As established CVD, 63.23% had a history of coronary disease, 38.86% of stroke, and 13.44% of peripheral vascular disease. The prevalence of overtreatment was 13.87% (95%CI: 11.93-16.01). Among the 160 overtreated patients, 88.13% were prescribed insulin, 12.5% sulfonylureas, and 4.38% glinides. ConclusionsThe prevalence of overtreatment among individuals with CVD and DM2 (14%) is comparatively lower than the rates reported in other studies. However, the clinical implications of these findings remain significant: the potential escalation of adverse side effects, such as hypoglycemia; the subsequent elevation in healthcare expenses due to superfluous treatments; and the possible strain on the healthcare system's capabilities, including the diversion of crucial medical resources —such as physician hours, essential equipment, and hospital beds— from those who are genuinely in need.