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Llisterri-Caro JL, Turégano-Yedro M, Cinza-Sanjurjo S, Segura-Fragoso A, Sánchez-Sánchez B, Cubelos-Fernández N, Velilla-Zancada S, Micó-Pérez RM, Martín-Sánchez V. [Factors associated with the optimum simultaneous control of diabetes, arterial hypertension and hypercholesterolemia in the diabetic population. BPC Diabetes study]. Semergen 2021; 48:225-234. [PMID: 34479796 DOI: 10.1016/j.semerg.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To know the degree of simultaneous optimal control of diabetes (DM), high blood pressure (BP) and hypercholesterolemia and determine the associated factors. MATERIAL AND METHOD Cross-sectional descriptive study in diabetic patients 18 years aged or older selected consecutively in primary care centers (PC). Patient data were obtained through access to electronical clinical history. Clinical and analytical variables of interest were registered. Good metabolic control was considered as HbA1c < 7%, good blood pressure control (PA) as values < 140/80 mmHg and good LDL cholesterol control (c-LDL) as values < 100 mg/dL. Bivariate analysis was performed and odds ratio were calculated in a logistic regression model. The study was approved by the San Carlos Clinical Hospital's Clinical Research Ethics Committee (CREC), in Madrid. RESULTS 1420 patients (55.8% male), with an average (SD) age of 70.6 (10.8) years were included. 75.9% were hypertensive patients, and 69.1% dyslipemic. HbA1c values were 6.9 (1.2) %, sistolic BP 135.0 (16.8) mmHg, diastolic BP 75.9 (10.6) mmHg and LDL-cholesterol 93.7 (32.8) mg/dL. Good metabolic control of DM was achieved at 63.0% (95% CI: 60.4-65.5), good control of HTA at 42.6% (95% CI: 40.0-45.2) and good LDL cholesterol control in 61.1% (95% IC: 58.4-63.7) of patients. Good simultaneous control of the three cardiovascular risk factors (CVRF) was reached at 16.1% (95% CI: 14.2-18.1). A positive and independent association (p<0.05) was observed between good simultaneous control of CVRF with age (OR: 1.017) and with personal history of cardiovascular disease (OR: 1.596). CONCLUSIONS The results of our study indicate that a small proportion, less than two out of 10 patients, meet the good control goals recommended by clinical practice guidelines. We found important differences between patients with and without cardiovascular disease.
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Affiliation(s)
| | | | - S Cinza-Sanjurjo
- Centro de Salud Porto do Son, Área Sanitaria de Santiago de Compostela, A Coruña, España
| | - A Segura-Fragoso
- Universidad de Castilla-La Mancha, Facultad de Ciencias de la Salud, Talavera de la Reina, Toledo, España
| | | | | | | | - R M Micó-Pérez
- Consultorio Fontanars dels Alforins, Departamento de Salud de Xàtiva-Ontinyent, Valencia, España
| | - V Martín-Sánchez
- Instituto de Biomedicina (IBIOMED), Universidad de León, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), León, España
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Chawla S, Trehan S, Chawla A, Jaggi S, Chawla R, Kumar V, Singh D. Relationship between diabetic retinopathy microalbuminuria and other modifiable risk factors. Prim Care Diabetes 2021; 15:567-570. [PMID: 33551334 DOI: 10.1016/j.pcd.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diabetic Retinopathy (DR) is an important microvascular complication of diabetes that can lead to irreversible blindness. Microalbuminuria is strongly associated with diabetic retinopathy and can be used as a reliable marker of diabetic retinopathy. AIM To assess the association between DR, microalbuminuria, and other modifiable risk factors in patients with type 2 diabetes. METHODOLOGY 3090 patients with T2DM visiting North Delhi Diabetes Centre, New Delhi between July 2016 to October 2019 were evaluated for the clinical and biochemical parameters that included urinary albumin, HbA1C, lipid profiles, serum creatinine estimation and underwent biothesiometry. RESULTS 3090 patients (1350 females and 1740 males), with mean age of 52.7 ± 9.2 years and diabetes duration ranging from 1 to 19 years (mean 9.4 ± 6), duration of less than 5 years, 6-10 years and more than 10 years in 52%, 26% and in 22%, respectively. Duration of diabetes was strong predictor of retinopathy (p = 0.001). The HbA1c and BMI in patients with DR was significantly higher than in those without DR. 18.2% patients were diagnosed to have retinopathy. Peripheral neuropathy was observed in 24.2% and was positively associated with DR (p = 0.002). 33.9% and 4.5% patients had microalbuminuria macroalbuminuria, respectively and 9.7% patients had creatinine >1.3 mg/dL. There was significant positive relationship between different grades of retinopathy and albuminuria. CONCLUSIONS Our study is a large real-world study that demonstrates that HbA1c, BMI, duration of diabetes, microalbuminuria and peripheral neuropathy are relatively, yet cohesively contributing factors towards varying grade of retinopathy.
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Affiliation(s)
- Shubhaa Chawla
- Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Siddhant Trehan
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India
| | | | | | | | - Vinay Kumar
- North Delhi Diabetes Centre, New Delhi, India
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Gallart-Aragón T, Fernández-Lao C, Cózar-Ibañez A, Cantarero-Villanueva I, Cambil-Martín J, Jiménez Ríos JA, Arroyo-Morales M. Relationship between changes in hemoglobin glycosilated and improvement of body composition in patients with morbid obesity after tubular laparoscopic gastrectomy. Med Clin (Barc) 2018; 151:131-135. [PMID: 29292099 DOI: 10.1016/j.medcli.2017.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/09/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of our study is to analyze the possible relationship between changes in glycemic profile and body composition parameters in morbid obesity patients after tubular laparoscopic gastrectomy. MATERIAL AND METHODS A prospective observational cohort study with 69 patients was performed. The variables analyzed were body weight, blood glucose, hemoglobin, glycosylated, high density lipoprotein, low density lipoprotein, triglycerides, and waist and hip circumference. An analysis of variance of repeated measurements (ANOVA) and a correlation analysis through the Pearson test were carried out. RESULTS A significant reduction in weight (p<.001 after surgery) and in glycosylated hemoglobin (p<.036) and waist hip (p<.001) were found at 6 months after surgery. There was no significant difference in the rest of the variables studied. In correlation analysis, a significant positive correlation was found between the change in concentration of hemoglobin glycosylated and hip circumference (p=.047; r=0.237), the smaller the hip circumference, the lower the concentration of glycosylated hemoglobin. CONCLUSIONS Tubular laparoscopic gastrectomy is an effective technique for the treatment of morbidly obese patients with type 2 diabetes mellitus. The reduction in the perimeter of hip is related to glycosylated hemoglobin reduction 6 months after intervention.
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Evolución clínica de una cohorte de pacientes con diabetes mellitus tipo 2 tras su valoración en endocrinología. Estudio a 26 semanas. ENDOCRINOL DIAB NUTR 2018; 65:220-228. [DOI: 10.1016/j.endinu.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/02/2017] [Accepted: 11/08/2017] [Indexed: 01/17/2023]
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Modification of cardiometabolic profile in obese diabetic patients after bariatric surgery: changes in cardiovascular risk. ACTA ACUST UNITED AC 2014; 66:812-8. [PMID: 24773862 DOI: 10.1016/j.rec.2013.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 05/16/2013] [Indexed: 01/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES Bariatric surgery is a valuable tool for metabolic control in obese diabetic patients. The aim of this study was to determine changes in weight and carbohydrate and lipid metabolism in obese diabetic patients during the first 4 years after bariatric surgery. METHODS A retrospective study was performed in 104 patients (71 women; mean age, 53.0 [0.9] years; mean body mass index, 46.8 [0.7]) with type 2 diabetes mellitus (median duration, 3 years) who underwent laparoscopic proximal gastric bypass. RESULTS Blood glucose levels and glycated hemoglobin concentrations decreased during the first 1-3 postoperative months. Values stabilized for the rest of the study period, allowing hypoglycemic treatment to be discontinued in 80% of the patients. No significant differences were observed as a function of the body mass index, diabetes mellitus duration, or previous antidiabetic treatment. Weight decreased during the first 15-24 months and slightly increased afterward. Levels of total cholesterol, triglycerides, and low-density lipoprotein significantly decreased, and target values were reached after 12 months in 80% of the patients. No correlation was found between these reductions and weight loss. Similarly, high-density lipoprotein concentrations decreased until 12 months after surgery. Although concentrations showed a subsequent slight increase, target or lower high-density lipoprotein values were achieved at 24 months postintervention in 85% of the patients. CONCLUSIONS Bariatric surgery is effective for the treatment of obese diabetic patients, contributing to their metabolic control and reducing their cardiovascular risk.
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Arrieta F, Rubio-Terrés C, Rubio-Rodríguez D, Magaña A, Piñera M, Iglesias P, Nogales P, Calañas A, Novella B, Botella-Carretero JI, Debán C, Zamarrón I, Mora G, Balsa JA, Vázquez C. Estimation of the economic and health impact of complications of type 2 diabetes mellitus in the autonomous community of Madrid (Spain). ACTA ACUST UNITED AC 2014; 61:193-201. [PMID: 24440211 DOI: 10.1016/j.endonu.2013.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/30/2013] [Accepted: 11/06/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To estimate the economic and health impact of chronic complications (macrovascular and microvascular) of type 2 diabetes mellitus (T2DM) in the autonomous community of Madrid (Spain) (ACM). METHODS The number of expected complications was obtained from a descriptive, cross-sectional study on a cohort of 3,268 patients with T2DM from the ACM. Cost of complications (€, 2012) was assessed both at hospitals and in primary care. The number of medical visits in primary care and drug treatment for complications were collected by a panel of 21 physicians experienced in treatment of T2DM. Population and epidemiological data and healthcare costs were obtained from Spanish sources. Univariate sensitivity analyses were performed. RESULTS It is estimated that there are 390,944 patients with T2DM in the ACM, and that they experience 172,406 and 212,283 macrovascular and microvascular complications respectively during their lifetimes. Mean cost of T2DM complications per patient is estimated at € 4,121.54 (66% due to macrovascular complications). The economic impact of T2DM complications in the ACM would be € 1,611 million (1,065 and 545 millions from macrovascular and microvascular complications respectively). The economic impact would range from € 1,249 and 2.509 million euro depending on T2DM prevalence. CONCLUSIONS Complications of T2DM have a great health and economic impact in ACM.
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Affiliation(s)
- Francisco Arrieta
- Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, España; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto Ramón y Cajal de Investigación Sanitaria (IRyCIS), Madrid, España.
| | | | | | | | | | - Pedro Iglesias
- Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Alfonso Calañas
- Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - José Ignacio Botella-Carretero
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto Ramón y Cajal de Investigación Sanitaria (IRyCIS), Madrid, España
| | - Carlos Debán
- Centro de Salud El Restón, Valdemoro (Madrid), España
| | - Isabel Zamarrón
- Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, España; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto Ramón y Cajal de Investigación Sanitaria (IRyCIS), Madrid, España
| | | | - José Antonio Balsa
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto Ramón y Cajal de Investigación Sanitaria (IRyCIS), Madrid, España; Servicio de Endocrinología y Nutrición, Hospital Universitario Infanta Sofía, Madrid, España
| | - Clotilde Vázquez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, España; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto Ramón y Cajal de Investigación Sanitaria (IRyCIS), Madrid, España
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Pujante P, Hellín MD, Fornovi A, Martínez Camblor P, Ferrer M, García-Zafra V, Hernández AM, Frutos MD, Luján-Monpeán J, Tébar J. Variación del perfil cardiometabólico en pacientes diabéticos obesos intervenidos de cirugía bariátrica. Cambios en el riesgo cardiovascular. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Lavalle-González FJ, Chiquete E, de la Luz J, Ochoa-Guzmán A, Sánchez-Orozco LV, Godínez-gutiérrez SA. Achievement of therapeutic targets in Mexican patients with diabetes mellitus. ACTA ACUST UNITED AC 2012; 59:591-8. [DOI: 10.1016/j.endonu.2012.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 06/25/2012] [Accepted: 07/03/2012] [Indexed: 11/26/2022]
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Pujante Alarcón P, Hellín Gil MD, Román LM, Ferrer Gómez M, García Zafra MV, Tébar Massó J. Control metabólico y pérdida de peso en pacientes con obesidad y diabetes mellitus tipo 2 tratados con exenatida. Med Clin (Barc) 2012; 139:572-8. [DOI: 10.1016/j.medcli.2011.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 10/21/2011] [Accepted: 10/25/2011] [Indexed: 02/03/2023]
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Llamazares Iglesias O, Sastre Marcos J, Peña Cortés V, Luque Pazos A, Cánovas Gaillemin B, Vicente Delgado A, Marco Martínez A, López López J. Control metabólico y de factores de riesgo cardiovascular en una cohorte de pacientes con diabetes mellitus. Resultados a los 4 años. ACTA ACUST UNITED AC 2012; 59:117-24. [DOI: 10.1016/j.endonu.2011.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 11/15/2011] [Accepted: 11/28/2011] [Indexed: 10/14/2022]
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