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Güdemann LM, Young KG, Thomas NJM, Hopkins R, Challen R, Jones AG, Hattersley AT, Pearson ER, Shields BM, Bowden J, Dennis JM, McGovern AP. Safety and effectiveness of SGLT2 inhibitors in a UK population with type 2 diabetes and aged over 70 years: an instrumental variable approach. Diabetologia 2024:10.1007/s00125-024-06190-9. [PMID: 38836934 DOI: 10.1007/s00125-024-06190-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/11/2024] [Indexed: 06/06/2024]
Abstract
AIMS/HYPOTHESIS Older adults are under-represented in trials, meaning the benefits and risks of glucose-lowering agents in this age group are unclear. The aim of this study was to assess the safety and effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in people with type 2 diabetes aged over 70 years using causal analysis. METHODS Hospital-linked UK primary care data (Clinical Practice Research Datalink, 2013-2020) were used to compare adverse events and effectiveness in individuals initiating SGLT2i compared with dipeptidyl peptidase-4 inhibitors (DPP4i). Analysis was age-stratified: <70 years (SGLT2i n=66,810, DPP4i n=76,172), ≥70 years (SGLT2i n=10,419, DPP4i n=33,434). Outcomes were assessed using the instrumental variable causal inference method and prescriber preference as the instrument. RESULTS Risk of diabetic ketoacidosis was increased with SGLT2i in those aged ≥70 (incidence rate ratio compared with DPP4i: 3.82 [95% CI 1.12, 13.03]), but not in those aged <70 (1.12 [0.41, 3.04]). However, incidence rates with SGLT2i in those ≥70 was low (29.6 [29.5, 29.7]) per 10,000 person-years. SGLT2i were associated with similarly increased risk of genital infection in both age groups (incidence rate ratio in those <70: 2.27 [2.03, 2.53]; ≥70: 2.16 [1.77, 2.63]). There was no evidence of an increased risk of volume depletion, poor micturition control, urinary frequency, falls or amputation with SGLT2i in either age group. In those ≥70, HbA1c reduction was similar between SGLT2i and DPP4i (-0.3 mmol/mol [-1.6, 1.1], -0.02% [0.1, 0.1]), but in those <70, SGLT2i were more effective (-4 mmol/mol [4.8, -3.1], -0.4% [-0.4, -0.3]). CONCLUSIONS/INTERPRETATION Causal analysis suggests SGLT2i are effective in adults aged ≥70 years, but increase risk for genital infections and diabetic ketoacidosis. Our study extends RCT evidence to older adults with type 2 diabetes.
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Affiliation(s)
- Laura M Güdemann
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK.
| | - Katie G Young
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Nicholas J M Thomas
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Rhian Hopkins
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Robert Challen
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Angus G Jones
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Andrew T Hattersley
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Ewan R Pearson
- Division of Molecular & Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Beverley M Shields
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Jack Bowden
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK
| | - John M Dennis
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Andrew P McGovern
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, UK
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Pérez-Belmonte LM, Osuna-Sánchez J, Ricci M, Millán-Gómez M, López-Carmona MD, Barbancho MA, Bernal-López MR, Jansen-Chaparro S, Lara JP, Gómez-Huelgas R. Management of older hospitalized patients with type 2 diabetes using linagliptin: Lina-Older study. Panminerva Med 2023; 65:13-19. [PMID: 33880897 DOI: 10.23736/s0031-0808.21.04085-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Older patients managed with intensive antidiabetic therapy are more likely to be harmed. Our study's primary endpoint was to analyze the safety and efficacy of linagliptin in combination with basal insulin versus basal-bolus insulin in patients with 75 years of age or older hospitalized in medicine and surgery departments in real-world clinical practice. METHODS We retrospectively enrolled non-critically patients ≥75 years with type 2 diabetes admitted to medicine and non-cardiac surgery departments with admission glycated hemoglobin <8%, admission blood glucose <240 mg/dL, and without at-home injectable therapies managed with our hospital's antihyperglycemic protocol (basal-bolus or linagliptin-basal regimens) between January 2016 and December 2018. To match each patient who started on the basal-bolus regimen with a patient who started on the linagliptin-basal regimen, a propensity matching analysis was used. RESULTS Postmatching, 198 patients were included in each group. There were no significant differences in mean daily blood glucose levels after admission (P=0.203); patients with mean blood glucose 100-140mg/dL (P=0.134), 140-180mg/dL (P=0.109), or >200mg/dL (P=0.299); and number and day of treatment failure (P=0.159 and P=0.175, respectively). The total insulin dose and the number of daily injections were significantly lower in the linagliptin-basal group (both, P<0.001). Patients on the basal-bolus insulin regimen had more total hypoglycemic events than patients on the linagliptin-basal insulin regimen (P<0.001). CONCLUSIONS The linagliptin-basal insulin regimen was an effective alternative with fewer hypoglycemic events and daily insulin injections than intensive basal-bolus insulin in very old patients with type 2 diabetes with mild-to-moderate hyperglycemia treated at home without injectable therapies.
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Affiliation(s)
- Luis M Pérez-Belmonte
- Service of Internal Medicine, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, University of Malaga (UMA), Malaga, Spain - .,Service of Internal Medicine, Helicópteros Sanitarios Hospital, Marbella, Spain - .,Center for Biomedical Research in the Cardiovascular Diseases Network (CIBERCV), Carlos III Health Institute, Madrid, Spain - .,Unit of Cognitive Neurophysiology, Faculty of Medicine, Center for Medical Health Research (CIMES), Institute of Biomedical Research of Malaga (IBIMA), University of Malaga (UMA), Malaga, Spain -
| | - Julio Osuna-Sánchez
- Unit of Cognitive Neurophysiology, Faculty of Medicine, Center for Medical Health Research (CIMES), Institute of Biomedical Research of Malaga (IBIMA), University of Malaga (UMA), Malaga, Spain.,Service of Internal Medicine, Hospital Comarcal de La Axarquía, Málaga, Spain
| | - Michele Ricci
- Service of Internal Medicine, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, University of Malaga (UMA), Malaga, Spain
| | - Mercedes Millán-Gómez
- Center for Biomedical Research in the Cardiovascular Diseases Network (CIBERCV), Carlos III Health Institute, Madrid, Spain
| | - María D López-Carmona
- Service of Internal Medicine, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, University of Malaga (UMA), Malaga, Spain
| | - Miguel A Barbancho
- Unit of Cognitive Neurophysiology, Faculty of Medicine, Center for Medical Health Research (CIMES), Institute of Biomedical Research of Malaga (IBIMA), University of Malaga (UMA), Malaga, Spain
| | - Maria R Bernal-López
- Service of Internal Medicine, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, University of Malaga (UMA), Malaga, Spain.,Center for Biomedical Research in Network Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Health Institute, Madrid, Spain
| | - Sergio Jansen-Chaparro
- Service of Internal Medicine, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, University of Malaga (UMA), Malaga, Spain
| | - José P Lara
- Unit of Cognitive Neurophysiology, Faculty of Medicine, Center for Medical Health Research (CIMES), Institute of Biomedical Research of Malaga (IBIMA), University of Malaga (UMA), Malaga, Spain
| | - Ricardo Gómez-Huelgas
- Service of Internal Medicine, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, University of Malaga (UMA), Malaga, Spain.,Center for Biomedical Research in Network Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Health Institute, Madrid, Spain
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Pradhan T, Gupta O, Kumar V, Sristi, Chawla G. A comprehensive review on the antidiabetic attributes of thiazolidine-4-ones: Synthetic strategies and structure-activity relationships. Arch Pharm (Weinheim) 2023; 356:e2200452. [PMID: 36378997 DOI: 10.1002/ardp.202200452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022]
Abstract
The thiazolidine-4-one scaffold has recently emerged as a potential pharmacophore having clinical significance for medicinal chemists. This heterocyclic ring has been reported to possess a plethora of biological activities, including antidiabetic activity that has inspired researchers to integrate this core with different pharmacophoric fragments to design novel and effective antidiabetic leads. The antidiabetic activity has been observed due to the ability of the thiazolidine-4-one nucleus to interact with different biological targets, including peroxisome proliferator-activated receptor γ, protein tyrosine phosphatase 1B, aldose reductase, α-glucosidase, and α-amylase. The present review discusses the mode of action of thiazolidine-4-ones through these antidiabetic drug targets. This review attempts to summarize and analyze the recent developments with regard to the antidiabetic potential of thiazolidine-4-ones covering different synthetic strategies, structure-activity relationships, and docking studies reported in the literature. The significance of various structural modifications at C-2, N-3, and C-5 of the thiazolidine-4-one ring has also been discussed in this manuscript. This comprehensive compilation will provide an inevitable scope for the design and development of potential antidiabetic drug candidates having a thiazolidine-4-one core.
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Affiliation(s)
- Tathagata Pradhan
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard University, New Delhi, India
| | - Ojasvi Gupta
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard University, New Delhi, India
| | - Vivek Kumar
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard University, New Delhi, India
| | - Sristi
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard University, New Delhi, India
| | - Gita Chawla
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard University, New Delhi, India
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Molist-Brunet N, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Barneto-Soto M, González-Bueno J, Espaulella-Panicot J. Improving individualized prescription in patients with multimorbidity through medication review. BMC Geriatr 2022; 22:417. [PMID: 35549672 PMCID: PMC9096338 DOI: 10.1186/s12877-022-03107-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/02/2022] [Indexed: 02/07/2023] Open
Abstract
Background Older patients tend to have multimorbidity, represented by multiple chronic diseases or geriatric conditions, which leads to a growing number of prescribed medications. As a result, pharmacological prescription has become a major concern because of the increased difficulties to ensure appropriate prescription in older adults. The study’s main objectives were to characterize a cohort of older adults with multimorbidity, carry out a medication review and compare the pharmacological data before and after the medication review globally and according to the frailty index. Methods This was a quasi-experimental (uncontrolled pre-post) study with a cohort of patients ≥ 65 years old with multimorbidity. Data were collected from June 2019 to October 2020. Variables assessed included demographic, clinical, and pharmacological data, degree of frailty (Frail-VIG index), medication regimen complexity index, anticholinergic and or sedative burden index, and monthly drug expenditure. Finally, a medication review was carried out by an interdisciplinary team (primary care team and a consultant team with a geriatrician and a clinical pharmacist) by applying the Patient-Centered Prescription model to align the treatment with care goals. Results Four hundred twenty-eight patients were recruited [66.6% women; mean age 85.5 (SD 7.67)]. The mean frail index was 0.39 (SD 0.13), corresponding with moderate frailty. Up to 90% of patients presented at least one inappropriate prescription, and the mean of inappropriate prescriptions per patient was 3.14 (SD 2.27). At the three-month follow-up [mortality of 17.7% (n = 76)], the mean chronic medications per patient decreased by 17.96%, varying from 8.13 (SD 3.87) to 6.67 (SD 3.72) (p < 0.001). The medication regimen complexity index decreased by 19.03%, from 31.0 (SD 16.2) to 25.1 (SD 15.1), and the drug burden index mean decreased by 8.40%, from 1.19 (SD 0.82) to 1.09 (SD 0.82) (p < 0.001). A decrease in polypharmacy, medication regimen complexity index, and drug burden index was more frequent among frail patients, especially those with severe frailty (p < 0.001). Conclusions An individualized medication review in frail older patients, applying the Patient-Centered Prescription model, decreases pharmacological parameters related to adverse drug effects, such as polypharmacy, therapeutical complexity, and anticholinergic and, or sedative burden. The benefits are for patients with frailty.
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Affiliation(s)
- Núria Molist-Brunet
- Department of Geriatrics, Hospital Universitari de La Santa Creu de Vic, Vic, Spain. .,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.
| | - Daniel Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Pharmacy, Parc Sanitari Pere Virgili, Vic, Barcelona, Spain
| | - Emma Puigoriol-Juvanteny
- Department of Geriatrics, Hospital Universitari de La Santa Creu de Vic, Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Epidemiology, Hospital Universitari de Vic, Vic, Barcelona, Spain.,Laboratory of Tissue Repair and Regeneration (TR2Lab), University of Vic - Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de La Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain
| | - Matilde Barneto-Soto
- Department of Geriatrics, Hospital Universitari de La Santa Creu de Vic, Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
| | - Javier González-Bueno
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.,Department of Pharmacy, Consorci Hospitalari de Vic, Vic, Barcelona, Spain
| | - Joan Espaulella-Panicot
- Department of Geriatrics, Hospital Universitari de La Santa Creu de Vic, Vic, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
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Molist-Brunet N, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Bajo-Peñas L, Cantizano-Baldo I, Cabanas-Collell L, Espaulella-Panicot J. Individualized Medication Review in Older People with Multimorbidity: A Comparative Analysis between Patients Living at Home and in a Nursing Home. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063423. [PMID: 35329110 PMCID: PMC8955931 DOI: 10.3390/ijerph19063423] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 01/27/2023]
Abstract
(1) Background: aging is associated with complex and dynamic changes leading to multimorbidity and, therefore, polypharmacy. A periodic medication review (MR) in frail older people leads to optimizing medication use. The aims of the study were to perform a comparative analysis of the impact of place of residence (own home versus nursing home) in a cohort of older patients on the characteristics of the baseline therapeutic plan and characteristics of the therapeutic plan after an MR; (2) Methods: Study with paired pre- and post-MR data based on person-centred prescription, with a follow-up assessment at three months. Patients who lived either in their own home or in a nursing home were recruited. We selected patients of 65 years or more with multimorbidity whose General Practitioner identified difficulties with the prescription management and the need for an MR. Each patient’s treatment was analysed by applying the Patient-Centred Prescription (PCP) model; (3) Results: 428 patients. 90% presented at least one inappropriate prescription (IP) in both settings. In nursing homes, a higher number of implemented optimization proposals was detected (81.6% versus 65.7% (p < 0.001)). After the MR, nursing-home patients had a greater decrease in their mean number of medications, polypharmacy prevalence, therapeutic complexity, and monthly drug expenditure (p < 0.001); (4) Conclusions: PCP model detected a high number of IP in both settings. However, after an individualized MR, nursing-home patients presented a greater decrease in some pharmacological parameters related to adverse events, such as polypharmacy and therapeutic complexity, compared to those living at home. Nursing homes may be regarded as a highly suitable scenario to carry out a periodic MR, due to its high prevalence of frail people and its feasibility to apply the recommendations of an MR. Prospective studies with a robust design should be performed to demonstrate this quasi-experimental study along with a longitudinal follow-up on clinical outcomes.
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Affiliation(s)
- Núria Molist-Brunet
- Geriatric Department, Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (L.B.-P.); (I.C.-B.); (J.E.-P.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic—University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
- Correspondence: ; Tel.: +34-938-833-300
| | - Daniel Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic—University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
- Pharmacy Department, Parc Sanitari Pere Virgili, 08023 Barcelona, Spain
| | - Emma Puigoriol-Juvanteny
- Epidemiology Department, Hospital Universitari de Vic, 08500 Vic, Spain;
- Tissue Repair and Regeneration Laboratory (TR2Lab), Research Group, University of Vic, 08500 Vic, Spain
| | - Lorena Bajo-Peñas
- Geriatric Department, Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (L.B.-P.); (I.C.-B.); (J.E.-P.)
| | - Immaculada Cantizano-Baldo
- Geriatric Department, Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (L.B.-P.); (I.C.-B.); (J.E.-P.)
| | | | - Joan Espaulella-Panicot
- Geriatric Department, Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain; (L.B.-P.); (I.C.-B.); (J.E.-P.)
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic—University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
- Geriatric and Palliative Care Department, Hospital Universitari de Vic, 08500 Vic, Spain
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Molist-Brunet N, Sevilla-Sánchez D, González-Bueno J, Garcia-Sánchez V, Segura-Martín LA, Codina-Jané C, Espaulella-Panicot J. Therapeutic optimization through goal-oriented prescription in nursing homes. Int J Clin Pharm 2021; 43:990-997. [PMID: 33247821 PMCID: PMC8352828 DOI: 10.1007/s11096-020-01206-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022]
Abstract
Background People living in nursing homes are highly vulnerable and frail. Polypharmacy and inappropriate prescription (IP) are also common problems. Objectives The objectives of the study are (i) to study the baseline situation and calculate the frailty index (FI) of the residents, (ii) to assess the results of routine clinical practice to do a pharmacotherapy review (patient-centred prescription (PCP) model) (Molist Brunet et al., Eur Geriatr Med. 2015;6:565-9) and (iii) to study the relationship between IP and frailty, functional dependence, advanced dementia and end-of-life situation. Setting Two nursing homes in the same geographical area in Catalonia (Spain). Method This was a prospective, descriptive and observational study of elderly nursing home residents. Each patient's treatment was analysed by applying the PCP model, which centres therapeutic decisions on the patient's global assessment and individual therapeutic goal. Main outcome measure Prevalence of polypharmacy and IP. Results 103 patients were included. They were characterized by high multimorbidity and frailty. Up to 59.2% were totally dependent. At least one IP was identified in 92.2% of residents. Prior to the pharmacological review, the mean number of chronic medications prescribed per resident was 6.63 (SD 2.93) and after this review it was 4.97 (SD 2.88). Polypharmacy decreased from 72.55% to 52.94% and excessive polypharmacy fell from 18.62% to 5.88%.The highest prevalence of IP was detected in people with a higher FI, in those identified as end-of-life, and also in more highly dependent residents (p < 0.05). Conclusions People who live in nursing homes have an advanced frailty. Establishing individualized therapeutic objectives with the application of the PCP model enabled to detect 92.2% of IP. People who are frailer, are functionally more dependent and those who are end-of-life are prescribed with inappropriate medication more frequently.
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Affiliation(s)
- N Molist-Brunet
- Hospital Universitari de la Santa Creu de Vic, Vic, Barcelona, Spain.
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain.
| | - D Sevilla-Sánchez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain
- Pharmacy Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
| | - J González-Bueno
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain
- Pharmacy Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
| | | | | | - C Codina-Jané
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain
- Pharmacy Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
| | - J Espaulella-Panicot
- Hospital Universitari de la Santa Creu de Vic, Vic, Barcelona, Spain
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic-University of Vic-Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500, Vic, Spain
- Geriatric and Palliative Care Department, Hospital Universitari de Vic, Vic, Barcelona, Spain
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