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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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Bayón Cabeza M, Pérez Rivas FJ, Zamora Sarabia AL, de Las Heras Mosteiro J, Becerril Rojas B, Rodriguez Barrientos R. [Diabetic patient control in Primary Care: Influence of service portfolio and other factors]. Aten Primaria 2020; 52:617-626. [PMID: 32576384 PMCID: PMC7713397 DOI: 10.1016/j.aprim.2020.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/30/2019] [Accepted: 02/13/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To study the effect of the type of follow-up according to Service Portfolio and other associated factors, in the reduction of HbA1c levels in people with a new diagnosis of type 2 diabetes and poor initial control. DESIGN Analytical observational study of a cohort under routine clinical practice conditions. LOCATION 262 Primary Health Care Centres in Madrid. PARTICIPANTS 1,838 individuals older than 18 years with a new diagnosis of type 2 DM and initial HbA1c levels ≥ 7%, or ≥ 8.5% if older than 75 years. INTERVENTIONS The exposure variable was the type of follow-up according to Portfolio, categorised as minimum, medium, and optimal, according to the number of interventions performed and periodicity of type of therapeutic-pharmacological plan. MAIN MEASUREMENTS A study was made of the comorbidity, therapeutic-pharmacological plan, diet - exercise advice and deprivation index. The main outcome was the difference between the final and initial HbA1c. RESULTS After 2 years of follow-up there was a mean decrease in HbA1c by -1.7 percentage points (95% CI: -1.6;-1.8), which was 0.36 points higher in patients with optimal follow-up: -2.1 (95% CI: -1.7;-2.4). The factors associated with a decrease in HbA1c were the optimal follow-up -0.29 (95% CI: -0.5;-0.1), the medium follow-up -0.26 (95% CI: -0.5; -0.0), and the initial HbA1c value -0.9 (95% CI: -0.9; -0.9. The factors associated with the increase were insulin treatment and living in socially disadvantaged areas. CONCLUSIONS Glycaemic control was improved in patients with a new diagnosis of diabetes in which optimal follow-up is performed as proposed in the Service Portfolio.
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Affiliation(s)
- Marianela Bayón Cabeza
- Dirección Técnica de Procesos y Calidad, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Comunidad de Madrid, Madrid, España.
| | - Francisco Javier Pérez Rivas
- Dirección Técnica de Procesos y Calidad, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Comunidad de Madrid, Madrid, España; Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | | | - Julio de Las Heras Mosteiro
- Departamento de Medicina Preventiva, Salud Pública, e Inmunología y Microbiología, Universidad Rey Juan Carlos, Madrid, España
| | - Beatriz Becerril Rojas
- Unidad de Apoyo Técnico, Gerencia Adjunta de Procesos Asistenciales, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Comunidad de Madrid, Madrid, España
| | - Ricardo Rodriguez Barrientos
- Unidad de apoyo a la investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Comunidad de Madrid, Madrid, España; Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC), Madrid, España
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Gómez García MC, Millaruelo Trillo JM, Avila Lachica L, Cos-Claramunt FX, Franch-Nadal J, Cortés Gil X. [ESCRYTO study. Diabetes without cardiovascular disease and level of control]. Semergen 2020; 46:261-269. [PMID: 31874786 DOI: 10.1016/j.semerg.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/17/2019] [Accepted: 11/20/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Diabetes is a significant risk factor for the development of cardiovascular disease, which is the main cause of death. The purpose of this study was to determine the level of glycaemic control in patients with type 2 diabetes without cardiovascular disease in Spain. The data used includes the most recent determination of glycosylated haemoglobin, as well as the pattern of antidiabetic treatment, the incidence of episodes of severe hypoglycaemia in the last 6 months, and the level of control of cardiovascular risk factors, and gender. PATIENTS AND METHODS A national, multicentre, and cross-sectional epidemiological study in which 800 doctors associated with the GDPS network participated. RESULTS Of the total of 1,059 patients, 57% male, with a mean age of 62.7 years in men vs. 65.2 in women (P<.001). The mean onset of diabetes was 9.4±7.5 years. The mean HbA1C was 7.0% in men vs. 7.1% in women (P=.039), with the control objective of <7% being observed in 47.2%. There were 65% patients on treatment with metformin, and 62.4% on DPP-4 inhibitors, and basal insulin: 14.2%. Incidence of severe hypoglycemias in the last 6 months was 1.9%. The women had worse glycaemic control, total cholesterol, LDL cholesterol, abdominal obesity, and glomerular filtration levels. CONCLUSIONS The glycaemic control is worse in women even if adjusted for age and time of onset of diabetes (P=.043), and for the number of hypoglycaemic agents (P=.015). The level of control is also worse in women for dyslipidaemia, abdominal obesity, and glomerular filtration. A preventive strategy promoted from Primary care on healthy lifestyles and controlling all vascular risk factors is essential.
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Affiliation(s)
| | | | - L Avila Lachica
- Consultorio Almachar, Unidad de Gestión Clínica Vélez-Norte, Almachar, Málaga, España
| | - F X Cos-Claramunt
- CAP Sant Martí, Atenció Primària, Institut Catalá de la Salut, Barcelona, España
| | - J Franch-Nadal
- Centro de Salud de Raval Sud, Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, España
| | - X Cortés Gil
- Departamento Médico, Almirall S.A., Barcelona, España
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Herrero Gil AM, Pinillos Robles J, Sabio Repiso P, Martín Maldonado JL, Garzón González G, Gil de Miguel Á. [Trends in the level of control of patients with type 2 diabetes from 2010 to 2015]. Aten Primaria 2018; 50:459-466. [PMID: 28838742 PMCID: PMC6836903 DOI: 10.1016/j.aprim.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Aim: To examine the trend in the level of control of glycated haemoglobin (HbA1c), blood pressure (BP), and LDL-cholesterol (LDL) in patients with type 2 diabetes mellitus between 2010 and 2015. METHODS Setting: 3 cut-offs in the years 2010, 2013, and 2015. Southeast area of Madrid. DESIGN Descriptive and cross-sectional epidemiological study. PARTICIPANTS Patients diagnosed and registered with type 2 diabetes. N=41,096 (2010), n=49,658 (2013), n=6,674 (2015) MAIN MEASUREMENTS: Measurement or not in the last year of HbA1c, BP, and LDL. Control of HbA1c (<7% individual targeting), BP (<140/90mmHg), and LDL (<100mg/dL, if cardiovascular disease <70mg/dL). Data were collected from electronic records of clinical history. The Chi-square test was used. RESULTS The percentages of patients with each parameter measured in 2010, 2013 and 2015 were: HbA1c: 36.4%, 37.0%, 62.0% (P<.001); BP: 33.2%, 43.3%, 65.0% (P<.001); LDL: 32.9%, 33.2%, 43.5% (P<.001). The percentages of patients with each parameter measured and controlled in 2010, 2013, and 2015 were: HbA1c: 59.6%, 59.1%, 79.6% (P<.001); BP: 74.9%, 67.4%, 79.2% (P<.001); LDL: 41.8%, 58.3%, 58.8% (P<.001) CONCLUSION: In the 2010-2015 period, a sustained but insufficient trend of better control of HbA1c, BP and LDL was observed in patients with diabetes. The frequency of the measurements of these parameters improved more than the control of them. It seems that efforts to improve care for the patient with diabetes pay off, but they still have to be maintained.
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Affiliation(s)
| | | | | | | | | | - Ángel Gil de Miguel
- Departamento de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, España
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Brugos-Larumbe A, Aldaz-Herce P, Guillen-Grima F, Garjón-Parra FJ, Bartolomé-Resano FJ, Arizaleta-Beloqui MT, Pérez-Ciordia I, Fernández-Navascués AM, Lerena-Rivas MJ, Berjón-Reyero J, Jusué-Rípodas L, Aguinaga-Ontoso I. Assessing variability in compliance with recommendations given by the International Diabetes Federation (IDF) for patients with type 2 diabetes in primary care using electronic records. The APNA study. Prim Care Diabetes 2018; 12:34-44. [PMID: 28732655 DOI: 10.1016/j.pcd.2017.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 02/01/2017] [Accepted: 06/15/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Assess compliance with the IDF recommendations for patients with Diabetes Type2 (DM2), and its variability, by groups of doctors and nurses who provide primary care services in Navarre (Spain). MATERIALS AND METHODOLOGIES A cross-sectional study of a population of 462,568 inhabitants, aged ≥18 years in 2013, attended by 381 units of doctor/nurse (quota). Clinical data were collected retrospectively through electronic records. Using cluster analysis, we identified two groups of units according to the score for each indicator. We calculated the Odds Ratio, adjusted for age sex, BMI, socioeconomic status and smoking, for complying with each recommendation whether a patient was treated by one of the quota from the highest score to the lowest. 30,312 patients with DM2 were identified: prevalence: 6.39%; coefficient of variation between UDN: 22.8%; biggest cluster 7.7% and smallest 5.3%; OR=1.54 (1.50-1.58). The HbA1c control at ≤8% was 82.8% (82.2-83.3) and >9% was 7.6% (7.3-8.0), with OR 1.79 (1.69-1.89) and 2.62 (2.36-2.91) respectively. Control of BP and LDL-C show significant differences between the clusters. CONCLUSIONS An important variability was identified according to the doctor treating patients. The average HbA1c control is acceptable being limited in BP and LDL-C.
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Affiliation(s)
| | - Pablo Aldaz-Herce
- Primary Health Care, Navarra Health Service, Pamplona, Navarra, Spain.
| | - Francisco Guillen-Grima
- Dept. of Health Sciences, Public University of Navarra, Preventive Medicine University of Navarra Clinic, IdiSNA (Navarra Institute for Health Research), Pamplona, Navarra, Spain.
| | | | | | | | | | | | | | - Jesús Berjón-Reyero
- Hospital Complex of Navarra, Navarra Health Service, Pamplona, Navarra, Spain.
| | | | - Ines Aguinaga-Ontoso
- Dept. of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain.
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Herrero A, Pinillos J, Sabio P, Martín JL, Garzón G, Gil Á. [Level at which control objectives are reached in patients in different population groups with type 2 diabetes]. Semergen 2016; 43:550-556. [PMID: 27889132 DOI: 10.1016/j.semerg.2016.09.005] [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: 02/10/2016] [Revised: 05/13/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is evidence of increased macro- and micro-vascular risk in diabetic patients. The objective of this study was to determine the level of control in patients in different population groups with type 2 diabetes. MATERIAL AND METHODS DESIGN Descriptive cross-sectional study. LOCATION Primary care. Madrid Health Service. Year: 2014. SUBJECTS Patients over 14 years with type 2 diabetes. Number of patientes: n=6674. MEASUREMENTS Variables on the degree of control (HbA1c, systolic blood pressure [SBP], diastolic blood pressure [DBP], LDL-c) and variables on patient characteristics (demographic, other cardiovascular risk factors, complications). RESULTS The mean age of patients with controlled HbA1c was 67.8 years vs. 62.9 years in the uncontrolled (P<.001). Patients diagnosed with hypertension have a higher percentage of control with respect to the undiagnosed in HbA1c, SBP, DBP and LDL-c: 51 vs. 37%, 62 vs. 43%, 75 vs. 47% and 57 vs. 44% respectively; diagnosed with dyslipidaemia: 51 vs. 39%, 60 vs. 49%, 70 vs. 56% and 56 vs. 46%. With a diagnosis of macroangiopathy: 46 vs. 45%, 58 vs. 54%, 71 vs. 62% and 15 vs. 60%. All differences were statistically significant (P<.001). Over 50% of patients without a diagnosis of hypertension had an SBP> 140mmHg or DBP> 90mmHg. Over 25% of patients with hypertension or DL and uncontrolled levels were not receiving drug treatment. CONCLUSION Control was improved in all groups, especially in younger patients, with particularly high cardiovascular risk by the presence of other cardiovascular risk factors or macroangiopathy. A significant percentage of patients with uncontrolled BP and cLDL were not diagnosed or receiving drug treatment.
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Affiliation(s)
- A Herrero
- Universidad Rey Juan Carlos, Madrid, España.
| | - J Pinillos
- Servicio de neumología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - P Sabio
- Servicio de urgencias, Hospital Universitario del Henares, Madrid, España
| | - J L Martín
- Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - G Garzón
- Universidad Rey Juan Carlos, Madrid, España
| | - Á Gil
- Departamento de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, España
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