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Sarria-Santamera A, Alexeyeva Z, Yen Chan M, Ortega MA, Asunsolo-del-Barco A, Navarro-García C. Direct and Indirect Costs Related to Physical Activity Levels in Patients with Diabetes Mellitus in Spain: A Cross-Sectional Study. Healthcare (Basel) 2022; 10:healthcare10040752. [PMID: 35455929 PMCID: PMC9027157 DOI: 10.3390/healthcare10040752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023] Open
Abstract
Diabetes mellitus (DM) is a global public health concern. DM is importantly linked to the modern lifestyle. Lifestyle-based interventions currently represent a critical preventive and therapeutic approach for patients with DM. Increasing physical activity has proven multiple benefits to prevent this condition; however, there is still room for further progress in this field, especially in terms of the effect of exercise in patients with already established DM. This study intends to examine the economic relationship between physical activity and direct/indirect costs in patients with DM. We analyze a national representative sample (n = 1496) of the general population of Spain, using available data from the National Health Survey of 2017 (NHS 2017). Our results show that 63.7% of the sample engaged in some degree of physical activity, being more frequent in men (67.5%), younger individuals (80.0%), and those with higher educational levels (69.7%). Conversely, lower levels of physical activity were associated with female sex, older subjects, and various comorbidities. Our study estimates that 2151 € per (51% in direct costs) patient may be saved if a minimum level of physical activity is implemented, primarily, due to a decrease in indirect costs (absenteeism and presenteeism). This study shows that physical activity will bring notable savings in terms of direct and indirect costs in patients with DM, particularly in some vulnerable groups.
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Affiliation(s)
- Antonio Sarria-Santamera
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan; (Z.A.); (M.Y.C.)
- Correspondence:
| | - Zhanna Alexeyeva
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan; (Z.A.); (M.Y.C.)
| | - Mei Yen Chan
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan; (Z.A.); (M.Y.C.)
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain;
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Angel Asunsolo-del-Barco
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain
| | - Carlos Navarro-García
- Faculty of Health and Sports Sciences, Universidad Alfonso X, Villanueva de la Cañada, 28691 Madrid, Spain;
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González-Touya M, Carmona R, Sarría-Santamera A. Evaluating the Impact of the Diabetes Mellitus Strategy for the National Health System: An Interrupted Time Series Analysis. Healthcare (Basel) 2021; 9:873. [PMID: 34356251 PMCID: PMC8306122 DOI: 10.3390/healthcare9070873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/24/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Diabetes mellitus is a significant public health problem. Macrovascular complications (stroke, acute myocardial infarction (AMI) and lower limb amputations (LLAs) represent the leading cause of morbi-mortality in DM. This work aims to evaluate the impact of the approval of the Diabetes Mellitus Strategy of the National Health System (SDM-NHS) on hospitalizations for those macrovascular complications related to DM; (2) Methods: Interrupted time series applying segmented regression models (Negative Binomial) adjusted for seasonality to data from hospital discharge records with a primary or secondary diagnosis of DM (code 250 ICD9MC); (3) Results: Between 2001 and 2015, there have been 7,302,750 hospital discharges with a primary or secondary diagnosis of DM. After the approval of the SDM-NHS, all the indicators showed a downward trend, modifying the previous trend in the indicators of AMI and LLA. The indicators of stroke and AMI also showed an immediate reduction in their rates; (4) Conclusions: After the approval of the SDM-NHS, an improvement has been observed in all the indicators of macrovascular complications of DM evaluated, although it is difficult to establish a causal relationship between the strategy and the effects observed. Interrupted time series is applicable for evaluating the impact of interventions in public health when experimental designs are not possible.
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Affiliation(s)
| | - Rocío Carmona
- Institute of Health Carlos III, 28029 Madrid, Spain;
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Alemán-Vega G, Garrido-Elustondo S, Del Cura-González I, Sarria-Santamera A. [¿Is a maintained glycemia between 110/125 mg/dl a risk factor in the development of diabetes?]. Aten Primaria 2017; 49:557-558. [PMID: 28318684 PMCID: PMC6876033 DOI: 10.1016/j.aprim.2016.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Sofía Garrido-Elustondo
- Unidad de Investigación de Atención Primaria de Madrid, Madrid, España; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas, REDISSEC, España
| | - Isabel Del Cura-González
- Unidad de Investigación de Atención Primaria de Madrid, Madrid, España; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas, REDISSEC, España; Departamento de Medicina Preventiva, Universidad Rey Juan Carlos, Madrid, España
| | - Antonio Sarria-Santamera
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas, REDISSEC, España; Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España; Facultad de Medicina, Universidad de Alcalá, Madrid, España
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Garzón G, Gil Á, Herrero AM, Jiménez F, Cerezo MJ, Domínguez C. [Achievement of cardiovascular goals in patients diagnosed with type 2 diabetes with and without cardiovascular disease]. GACETA SANITARIA 2015; 29:425-30. [PMID: 26342408 DOI: 10.1016/j.gaceta.2015.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/21/2015] [Accepted: 07/24/2015] [Indexed: 11/15/2022]
Abstract
AIMS To determine the proportion of patients with type 2 diabetes with and without cardiovascular disease achieving the main cardiovascular goals. METHODS DESIGN Cross-sectional study. SETTING A regional health district in a European country, Spain. Year: 2013. PARTICIPANTS Adult patients diagnosed with type 2 diabetes with and without cardiovascular disease. MEASUREMENTS Study using secondary data obtained from electronic records of clinical history. Haemoglobin A1c, blood pressure, LDL cholesterol, smoking and medication were covered. n=49,658 RESULTS: The proportion of patients with diabetes achieving cardiovascular goals (among those with recent measurement) was: haemoglobin A1c 68.8% (CI95%:68.2%-69.4%), blood pressure 74.3% (CI95%:73.9%-74.7%), LDL cholesterol 59.8% (CI95%:59.0%-60.6%), tobacco 80.2% (CI95%:79.6%-80.8%). Only 40%-67% of patients has recent measurement. Only 48.0% (CI95%: 46.6%-49.4%) of patients who needed statins were receiving them. Higher proportion of patients with cardiovascular disease were achiving goals. Differences were small but significant. CONCLUSIONS Cardiovascular goals were measured in around half of patients with diabetes. Proportion of patients achiving cardiovascular goals were similar to published and best in patients with cardiovascular disease but it could improve. This points to prioritising interventions in this group of patients at very high risk, improving the implementation of guidelines and patient adherence.
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Affiliation(s)
- Gerardo Garzón
- Área de Atención Primaria, Servicio Madrileño de Salud, Madrid, España.
| | - Ángel Gil
- Departamento de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, España
| | - Ana María Herrero
- Área de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - Fernando Jiménez
- Área de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - María José Cerezo
- Área de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - Cristina Domínguez
- Servicio de Urgencias, Hospital de la Princesa, Servicio Madrileño de Salud, Madrid, España
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Gil Montalbán E, Ortiz Marrón H, López-Gay Lucio-Villegas D, Zorrilla Torrás B, Arrieta Blanco F, Nogales Aguado P. Validez y concordancia de la historia clínica electrónica de atención primaria (AP-Madrid) en la vigilancia epidemiológica de la diabetes mellitus. Estudio PREDIMERC. GACETA SANITARIA 2014; 28:393-6. [DOI: 10.1016/j.gaceta.2014.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/04/2014] [Accepted: 03/06/2014] [Indexed: 10/25/2022]
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Sánchez Martínez M, Blanco A, Castell MV, Gutiérrez Misis A, González Montalvo JI, Zunzunegui MV, Otero Á. Diabetes in older people: Prevalence, incidence and its association with medium- and long-term mortality from all causes. Aten Primaria 2014; 46:376-84. [PMID: 24576691 PMCID: PMC6983613 DOI: 10.1016/j.aprim.2013.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To estimate the prevalence and incidence of self-reported diabetes and to study its association with medium- and long-term mortality from all causes in persons ≥ 65 years. DESIGN A population-based cohort study begun in 1993. SETTING "Envejecer en Leganés" cohort (Madrid). PARTICIPANTS A random sample of persons ≥ 65 years (n=1277 in the 1993 baseline sample). METHODS Participants were classified as having diabetes if they so reported and had consulted a physician for this reason within the last year. Diabetes history was categorized in <10 and ≥ 10 years in 1993. Incidence density was calculated in 2-year periods in non-diabetic individuals (1965 persons/2 years). Vital status was recorded on 31 December 2011. The association between diabetes history ≥ 10 years and mortality at 6 and 18 years follow-up was studied by the Kaplan-Meier and Cox regression analyses after adjusting for age, sex, heart disease and comorbidity. RESULTS The prevalence of self-reported diabetes rose from 10.3% in 1993 to 16.1% in 1999 (p ≤ 0.001) and was higher in women than men (p ≤ 0.05). Total incidence density was 2.6 cases/100 persons/2 years (95% CI: 2.0-3.3). Medium- and long-term mortality was higher in persons with diabetes history ≥ 10 years than in non-diabetic individuals (HR: 2.0; 95% CI: 1.2-3.3 and HR: 1.7; 95% CI: 1.1-2.5, respectively). In diabetics with history <10 years the HR was 1.3 (95% CI: 0.9-1.9) and HR: 1.5 (95% CI: 1.2-1.9, respectively). CONCLUSIONS Although diabetes is clearly associated with increased risk of mortality, it is significant only for patients with ≥ 10 years' history of diabetes.
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Affiliation(s)
- Mercedes Sánchez Martínez
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, Spain; IdiPAZ, Instituto de Investigación Hospital La Paz, Madrid, Spain.
| | - Augusto Blanco
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Salud Reina Victoria, Madrid, Spain
| | - María Victoria Castell
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Salud Dr. Castroviejo, Madrid, Spain; IdiPAZ, Instituto de Investigación Hospital La Paz, Madrid, Spain
| | - Alicia Gutiérrez Misis
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan Ignacio González Montalvo
- Servicio de Geriatría, Hospital Universitario La Paz, Madrid, Spain; IdiPAZ, Instituto de Investigación Hospital La Paz, Madrid, Spain
| | | | - Ángel Otero
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, Spain; IdiPAZ, Instituto de Investigación Hospital La Paz, Madrid, Spain
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Sicras-Mainar A, Navarro-Artieda R, Ibáñez-Nolla J. Clinical and economic characteristics associated with type 2 diabetes. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Clinical and economic characteristics associated with type 2 diabetes. Rev Clin Esp 2013; 214:121-30. [PMID: 24359793 DOI: 10.1016/j.rce.2013.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 10/30/2013] [Accepted: 11/03/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Type 2 diabetes mellitus (DM2) is usually accompanied by various comorbidities that can increase the cost of treatment. We are not aware of studies that have determined the costs associated with treating DM2 patients with co-morbidities such as overweight (OW), obesity (OBE) or arterial hypertension (AHT). The aim of the study was to examine the health-related costs and the incidence of cardiovascular disease (CVD) in these patients. PATIENTS AND METHODS Multicenter, observational retrospective design. We included patients 40-99 years of age who requested medical attention in 2010 in Badalona (Barcelona, Spain). There were two study groups: those with DM2 and without DM2 (reference group/control), and six subgroups: DM2-only, DM2-AHT, DM2-OW, DM2-OBE; DM2-AHT-OW and DM2-AHT-OBE. The main outcome measures were: co-morbidity, metabolic syndrome (MS), complications (hypoglycemia, CVD) and costs (health and non-health). Follow-up was carried out for two years. RESULTS A total of 26,845 patients were recruited. The prevalence of DM2 was 14.0%. Subjects with DM2 were older (67.8 vs. 59.7 years) and more were men (51.3 vs. 43.0%), P<.001. DM2 status was associated primarily with OBE (OR=2.8, CI=2.4-3.1), AHT (OR=2.4, CI=2.2-2.6) and OW (OR=1.9, CI=1.7-2.2). The distribution by subgroups was: 6.7% of patients had only DM2, 26.1% had DM2, AHT and OW, and 34.1% had DM2, AHT, and OBE. Some 75.4% had MS and 37.5% reported an episode of hypoglycemia. The total cost/patient with DM2 was €4,458. By subgroups the costs were as follows: DM2: €3,431; DM2-AHT: €4,075; DM2-OW: €4,057; DM2-OBE: €4,915; DM2-AHT-OW: €4,203 and DM2-AHT-OBE: €5,021, P<.001. The CVD rate among patients with DM2 was 4.7 vs. 1.7% in those without DM2 P<.001. CONCLUSIONS Obesity is a comorbidity associated with DM2 that leads to greater healthcare costs than AHT. The presence of these comorbidities causes increased rates of CVD.
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Sarría Santamera A, Martín Martínez MA, Carmona Alférez R, Prado Galbarro J, Serrano Aguilar P. La utilización de servicios de salud y las medidas para la sostenibilidad de la Comunidad de Madrid. Aten Primaria 2013; 45:440-1. [PMID: 23790645 PMCID: PMC6983535 DOI: 10.1016/j.aprim.2013.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 01/16/2013] [Indexed: 11/25/2022] Open
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