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Molist-Brunet N, Sevilla-Sánchez D, Puigoriol-Juvanteny E, González-Bueno J, Solà-Bonada N, Cruz-Grullón M, Espaulella-Panicot J. Optimizing drug therapy in frail patients with type 2 diabetes mellitus. Aging Clin Exp Res 2020; 32:1551-1559. [PMID: 31494916 DOI: 10.1007/s40520-019-01342-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/27/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is closely linked with ageing. In frail diabetic patients, the risks of intensive antidiabetic therapy outweigh the potential benefits. AIMS To study the prevalence of T2DM in frail elderly patients, to identify inappropriate prescription (IP) of antidiabetic drugs and to study the relationship between patients' frailty index (FI) with polypharmacy and IP. METHODS This was a prospective, descriptive, observational study of elderly patients. Each patient's antidiabetic treatment was analysed by applying the patient-centred prescription model (PCP), which centres therapeutic decisions on the patient's global assessment and individual therapeutic goal. RESULTS 210 patients with T2DM were included (25.15% prevalence). They were characterised by high multimorbidity and frailty. 93.3% presented polypharmacy and 51% excessive polypharmacy. IP was identified in 66.2% of patients. A statistically significant relationship was found between the progression in FI degree and IP prevalence (p < 0.05. During the admission, drug therapy regimens were modified in 97.1% of cases with IP (n = 136). DISCUSSION These results suggest that in clinical practice T2DM treatment is not individualised, but rather is based on the same general recommendations for the population as a whole. CONCLUSIONS There is a high prevalence of T2DM in the elderly. As the frailty of patients increases, so does the prevalence of IP. The application of PCP model enables drug therapy optimization in frail patients according to their main therapeutic goal, and contributes to provide clinical evidences on the applicability of a set of knowledge areas from the theoretical framework to the daily clinical practice.
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Affiliation(s)
- N Molist-Brunet
- Hospital Universitari de la Santa Creu de Vic, Rambla Hospital, 52, 08500, 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, C/Francesc Pla "El Vigatà", 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, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain
- Hospital Universitari de Vic, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Barcelona, Spain
| | - E Puigoriol-Juvanteny
- 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, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain
- Hospital Universitari de Vic, C/Francesc Pla "El Vigatà", 1, 08500, 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, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain
- Hospital Universitari de Vic, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Barcelona, Spain
| | - N Solà-Bonada
- Hospital Universitari de Vic, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Barcelona, Spain
| | - M Cruz-Grullón
- Hospital Universitari de la Santa Creu de Vic, Rambla Hospital, 52, 08500, Vic, Barcelona, Spain
| | - J Espaulella-Panicot
- Hospital Universitari de la Santa Creu de Vic, Rambla Hospital, 52, 08500, 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, C/Francesc Pla "El Vigatà", 1, 08500, Vic, Spain
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Núñez M, Díaz S, Dilla T, Reviriego J, Pérez A. Epidemiology, Quality of Life, and Costs Associated with Hypoglycemia in Patients with Diabetes in Spain: A Systematic Literature Review. Diabetes Ther 2019; 10:375-392. [PMID: 30661221 PMCID: PMC6437233 DOI: 10.1007/s13300-019-0563-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To assess the burden of hypoglycemia in patients with diabetes mellitus (DM) in Spain, including epidemiological data and information relating to healthcare resource utilization (HRU) and costs, and patients' quality of life (QoL). METHODS A systematic literature review (SLR) was conducted to identify studies that included original information on epidemiology, HRU and costs, and/or QoL associated with hypoglycemia in patients with DM in Spain, published in either Spanish or English, between January 2007 and April 2017. RESULTS Fifteen articles, involving 14 studies, were identified in the SLR and included in the analysis. The estimated rate of severe hypoglycemia (SH) events per patient per year ranged from 0.90 to 1.50 in patients with type 1 DM (T1DM) and from 0.30 to 0.63 in patients with type 2 DM (T2DM). The data on HRU differed extensively between studies, making it difficult to draw a conclusion. Total costs per SH event ranged from €409.97 in patients with T1DM to €713.10 in patients with DM. Work absence was reported in 11.80-18% of the working patients. Further, patients who experienced hypoglycemic events expressed a higher fear and had a poorer QoL than those who did not report these events. CONCLUSION Although the data included in the SLR were difficult to synthesize due to heterogeneity of the study designs and patient characteristics in the 14 studies, our search identified a high burden associated with hypoglycemic events in terms of HRU and costs, and patients' QoL. Further research is recommended to reach a consensus on hypoglycemia definition and study design to provide robust evidence on the burden of hypoglycemia and to accurately weigh the impact of this acute complication in Spain. FUNDING Eli Lilly and Company.
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Affiliation(s)
| | | | | | | | - Antonio Pérez
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
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Formiga F, Rodriguez Mañas L. Improving drug prescription in elderly diabetic patients. Rev Esp Geriatr Gerontol 2016; 51:127-9. [PMID: 27006270 DOI: 10.1016/j.regg.2015.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
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Ena J, Gómez-Huelgas R, Sánchez-Fuentes D, Camafort-Babkowsk M, Formiga F, Michán-Doña A, Casariego E. Management of patients with type 2 diabetes and multiple chronic conditions: A Delphi consensus of the Spanish Society of Internal Medicine. Eur J Intern Med 2016; 27:31-6. [PMID: 26586286 DOI: 10.1016/j.ejim.2015.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/28/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023]
Abstract
AIMS To develop consensus-based recommendations for the management of chronic complex patients with type 2 diabetes mellitus using a two round Delphi technique. METHODS Experts from the Diabetes and Obesity Working Group (DOWG) of the Spanish Society of Internal Medicine (SEMI) reviewed MEDLINE, PubMed, SCOPUS and Cochrane Library databases up to September 2014 to gather information on organization and health care management, stratification of therapeutic targets and therapeutic approach for glucose control in chronic complex patients with type 2 diabetes mellitus. A list of 6 recommendations was created and rated by a panel of 75 experts from the DOWG by email (first round) and by open discussion (second round). A written document was produced and sent back to DOWG experts for clarification purposes. RESULTS A high degree of consensus was achieved for all recommendations summarized as 1) there is a need to redesign and test new health care programs for chronic complex patients with type 2 diabetes mellitus; 2) therapeutic targets in patients with short life expectancy should be individualized in accordance to their personal, clinical and social characteristics; 3) patients with chronic complex conditions and type 2 diabetes mellitus should be stratified by hypoglycemia risk; 4) age and specific comorbidities should guide the objectives for glucose control; 5) the risk of hypoglycemia should be a key factor when choosing a treatment; and 6) basal insulin analogs compared to human insulin are cost-effective options. CONCLUSION The assessment and recommendations provided herein represent our best professional judgment based on current data and clinical experience.
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Affiliation(s)
- Javier Ena
- Internal Medicine Department, Hospital Marina Baixa, Alicante, Spain.
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Hospital Regional Universitario, FIMABIS, Málaga, Spain
| | | | - Miguel Camafort-Babkowsk
- Geriatric Unit, Internal Medicine Department, Hospital Clínic, University of Barcelona, "August Pi i Sunyer" Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - Alfredo Michán-Doña
- Internal Medicina Deparment, Hospital de Jerez de la Frontera, Universidad de Cádiz, Cádiz, Spain
| | - Emilio Casariego
- Internal Medicine Department, Hospital Lucus Augustis, Lugo, Spain
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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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Formiga F, Perez-Maraver M. La diabetes mellitus tipo 2 en el paciente anciano. Es básico saber cómo individualizar. Med Clin (Barc) 2014; 142:114-5. [DOI: 10.1016/j.medcli.2013.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 11/21/2013] [Indexed: 01/22/2023]
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Corriere M, Rooparinesingh N, Kalyani RR. Epidemiology of diabetes and diabetes complications in the elderly: an emerging public health burden. Curr Diab Rep 2013; 13:805-13. [PMID: 24018732 PMCID: PMC3856245 DOI: 10.1007/s11892-013-0425-5] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes in the elderly is a growing public health burden. Persons with diabetes are living longer and are vulnerable to the traditional microvascular and macrovascular complications of diabetes but also at increased risk for geriatric syndromes. Peripheral vascular disease, heart disease, and stroke all have a high prevalence among older adults with diabetes. Traditional microvascular complications such as retinopathy, nephropathy, and neuropathy also frequently occur. Unique to this older population is the effect of diabetes on functional status. Older adults with diabetes are also more likely to experience geriatric syndromes such as falls, dementia, depression, and incontinence. Further studies are needed to better characterize those elderly individuals who may be at the highest risk of adverse complications from diabetes.
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Affiliation(s)
- Mark Corriere
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument St, Suite 333, Baltimore, MD, 21287, USA
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[Diabetic nephropathy confirmed by renal biopsy: are there age differences?]. Rev Esp Geriatr Gerontol 2013; 48:298-9. [PMID: 24042043 DOI: 10.1016/j.regg.2013.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/22/2013] [Accepted: 05/27/2013] [Indexed: 11/20/2022]
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Formiga F, Rodriguez Mañas L. [Type 2 diabetes mellitus in the elderly, new evidence to apply the knowledge in daily clinical practice]. Rev Esp Geriatr Gerontol 2013; 48:53-54. [PMID: 23332413 DOI: 10.1016/j.regg.2012.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 11/07/2012] [Indexed: 06/01/2023]
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