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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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Artime E, Romera I, Díaz-Cerezo S, Delgado E. Epidemiology and Economic Burden of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus in Spain: A Systematic Review. Diabetes Ther 2021; 12:1631-1659. [PMID: 33942247 PMCID: PMC8179862 DOI: 10.1007/s13300-021-01060-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in people with type 2 diabetes mellitus (T2DM). The objectives of this systematic literature review were to identify and synthesize published data describing the epidemiology and mortality of CVD in the T2DM population and the associated economic burden. METHODS We conducted a systematic review searching the PubMed and MEDES databases from 2009 to 2019 using predefined selection criteria. Peer-reviewed observational studies reporting primary or secondary data on CVD prevalence, incidence, mortality, resource use and costs in patients with T2DM in Spain, written in English and Spanish, were included. Data were tabulated and summarized descriptively. RESULTS Of 706 articles identified, 52 were included in the review. Most studies were based on data from hospital discharge databases and registries. The reported prevalence of CVD among patients with T2DM ranged from 6.9 to 40.8%. The prevalence of coronary heart disease ranged from 4.7 to 37%, stroke from 3.5 to 19.6%, peripheral artery disease from 2.5 to 13.0%, and heart failure from 4.3 to 20.1%. In-hospital CVD mortality rates ranged from 5.6 to 10.8%. Direct costs due to CVD in hospitalized patients with T2DM were increased (> 50%) compared with patients without CVD. No studies analysed indirect costs of CVD in patients with T2DM. CONCLUSIONS The burden of CVD among patients with T2DM, combined with the elevated costs of care, highlights the importance of early prevention as part of integrated management of the disease to improve clinical and economic outcomes.
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Affiliation(s)
- Esther Artime
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain.
| | - Irene Romera
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Silvia Díaz-Cerezo
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Elías Delgado
- Department of Endocrinology and Nutrition, University of Oviedo, Oviedo, Spain
- Central University Hospital of Asturias, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Spanish Biomedical Research Network in Rare Diseases, Madrid, Spain
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Role of ultrafast-acting insulin analogues in the management of diabetes. J Am Assoc Nurse Pract 2019; 31:537-548. [DOI: 10.1097/jxx.0000000000000261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rashid F, Abdelgadir E, Alsaeed M, Alemadi B, Khalifa A, Farooqi MH, Alawadi F, Bashier A. Glycemic and lipids control in patients with diabetes and cardiovascular or renal diseases across all the government health sectors in the Emirate of Dubai, United Arab Emirates. Diabetes Metab Syndr 2019; 13:590-594. [PMID: 30641771 DOI: 10.1016/j.dsx.2018.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/02/2018] [Indexed: 12/17/2022]
Abstract
UNLABELLED The guidelines suggest setting the glycemic and lipid targets according to the stage of the disease and other co -existing complications in the patients with diabetes. AIMS We aimed to evaluate the HbA1c and lipids level in patients with high risk diabetes from 2012-2016, attending different level of care in Dubai health authority. MATERIALS AND METHODS This is a retrospective analysis of the electronic medical records of all patients who attended the Dubai Health authority between 2012-2016. All patients with an ICD code of any type of diabetes in addition to cardiovascular or renal diseases were. Patients were categorized based on their HbA1c into control of<7.5, 7.5 - 8, and >8%. While lipids were categorized as f LDL < 70 mg/dl, and the Non-HDL <100 mg/dl. RESULTS Out of total number of 26647 patients diagnosed with diabetes, 2015 patients did fit the criteria of this study. The desired mean of HbA1c of <7.5% achieved by 21.76% and 28.94% in T1DM and T2DM, respectively. The LDL of < 70 mg/dl was achieved by 27.8% of the patients. CONCLUSION In patients with diabetes and multiple complications, the glycemic and lipids control is suboptimal. However, the pattern showed numerical improvement over the years.
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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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Miñambres I, Mediavilla JJ, Sarroca J, Pérez A. Meeting individualized glycemic targets in primary care patients with type 2 diabetes in Spain. BMC Endocr Disord 2016; 16:10. [PMID: 26887662 PMCID: PMC4756540 DOI: 10.1186/s12902-016-0090-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/09/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Information about the achievement of glycemic targets in patients with type 2 diabetes according to different individualization strategies is scarce. Our aim was to analyze the allocation of type 2 diabetic patients into individualized glycemic targets according to different strategies of individualization and to assess the degree of achievement of adequate control. METHODS Cross-sectional analysis on 5382 type 2 diabetic patients in primary care setting in Spain between 2011 and 2012. Targets of HbA1c were assigned based on different strategies of individualization of glycemic targets: 1) the ADA/EASD consensus 2) The Spanish Diabetes Society (SED) consensus 3) a strategy that accounts for the risk of hypoglycemia (HYPO) considering the presence of a hypoglycemia during the last year and type of hypoglycemic treatment. Concordance between the different strategies was analyzed. RESULTS A total of 15.9, 17.1 and 67 % applied to ADA/EASD recommendation of HbA1c target of <6.5, < 7 and <8 % (48, 53 and 64 mmol/mol), and 31.9 and 67.4 % applied to the SED glycemic target of <6.5 and <7.5 % (<48 and 58 mmol/mol). Using the HYPO strategy, 53.5 % had a recommended HbA1c target <7 % (53 mmol/mol). There is a 94 % concordance between the ADA/EASD and SED strategies, and a concordance of 41-42 % between these strategies and HYPO strategy. Using the three different strategies, the overall proportion of patients achieving glycemic targets was 56-68 %. CONCLUSIONS Individualization of glycemic targets increases the number of patients who are considered adequately controlled. The proposed HYPO strategy identifies a similar proportion of patients that achieve adequate glycemic control than ADA/EASD or SED strategies, but its concordance with these strategies in terms of patient classification is bad.
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Affiliation(s)
- I Miñambres
- Department of Endocrinology and Nutrition Services, Hospital de la Santa Creu i Sant Pau, C/ Sant Quintí, 89, 08026, Barcelona, Spain
- Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - A Pérez
- Department of Endocrinology and Nutrition Services, Hospital de la Santa Creu i Sant Pau, C/ Sant Quintí, 89, 08026, Barcelona, Spain.
- Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
- Diabetes and Metabolic Diseases CIBER (CIBERDEM), Barcelona, Spain.
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Alonso-Fernández M, Mancera-Romero J, Mediavilla-Bravo JJ, Comas-Samper JM, López-Simarro F, Pérez-Unanua MP, Iturralde-Iriso J. Glycemic control and use of A1c in primary care patients with type 2 diabetes mellitus. Prim Care Diabetes 2015; 9:385-391. [PMID: 25686480 DOI: 10.1016/j.pcd.2015.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 12/28/2014] [Accepted: 01/22/2015] [Indexed: 11/24/2022]
Abstract
AIMS To evaluate the degree of glycemic control and its relationship with disease characteristics and antidiabetic treatment in patients with type 2 diabetes mellitus (DM), as well as the frequency of A1c use. METHODS For this purpose, an observational, cross-sectorial, and multicenter study was performed. A total of 443 patients were monitored in 17 Spanish primary healthcare centers. Demographic and clinical variables were recorded from the clinical history of patients. RESULTS Mean age was 68.9±12.0 years. Time of evolution of DM was 9.2±6.4 years. Mean A1c was 7.38±1.34% and 45% of patients achieved A1c <7%. There was a no significant relationship between the degree of control and time of evolution of DM. In 16% of patients no A1c determination was performed in the previous twelve months. In those patients in whom A1c was determined, 95% received pharmacologic treatment, and 31% insulin therapy. 66% of patients on monotherapy attained A1C <7%, compared with 39% and 23% of those receiving double- and triple-oral therapy, respectively (p<0.001). Only 21% of patients on insulin therapy achieved A1c <7%. The worst-controlled patients were those receiving oral antidiabetic agents and insulin (24% had A1c levels ≥9%). CONCLUSIONS A large proportion of patients are poorly controlled. Poor control increases according to complexity of treatment. A1c is underdetermined in many patients, likely related to clinical inertia.
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Affiliation(s)
- Margarita Alonso-Fernández
- Centro de Salud La Ería, Asturias, Spain; Departamento de Medicina Preventiva y Salud Publica, Universidad de Oviedo, Asturias, Spain.
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[Therapeutic inertia in the management of type 2 diabetic patients in Primary Health Care]. Semergen 2015; 42:152-7. [PMID: 25910605 DOI: 10.1016/j.semerg.2015.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/16/2015] [Accepted: 02/21/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess therapeutic inertia (TI) in the management of type 2 diabetic patients (DM2), as regards glycemic and lipid control. MATERIALS AND METHODS Two groups of patients were studied. Group 1: All the patients were older than 14 years, diagnosed with DM2 up to 28th February 2013, and their last determination of HbA1c was ≥ 8.5%. Group 2: All patients, under 60 years old, diagnosed with DM2 between the 1st January 2011 and the 31st December 2012, with no chronic complications and their last determination of HbA1c was ≥ 6.5%. RESULTS Group 1: 253 patients were included (13% of DM2 diagnosed). TI was 43% for DM2, 83% for LDL cholesterol, and 80% for triglycerides. TI was lower (P=.037) in patients with HbA1c ≥ 10%. There was no difference in TI as regards the management of lipid profile depending on the HbA1c levels. Group 2: All DM2 patients (n=53) who met inclusion criteria were assessed (2.7% of DM2 diagnosed). Percentage of visits of those patients that had TI: 55% for DM2, 63% for LDL cholesterol and 64% for triglycerides. A more intense therapy was observed in patients with HbA1c>7.5% in 3 of the 5 visits made. CONCLUSIONS TI in both groups was high and there is a lack of recording the reasons for this. It is important to improve the attitude of the professionals who care for the diabetic population.
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The ABC of diabetes. How many patients are able to achieve the goal laid down by American Diabetes Association? Med J Armed Forces India 2015; 71:132-4. [PMID: 25859074 DOI: 10.1016/j.mjafi.2014.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND To study the number of patients with Type 2 Diabetes Mellitus who achieve the glycemic, blood pressure and LDL-Cholesterol targets as per American Diabetes Association, Standard of Care for Management of Diabetes. METHODS Hundred patients of Type 2 Diabetes mellitus were recruited from December 2008 to January 2009 from an Endocrinology OPD of tertiary care hospital and followed up for six months. Glycosylated hemoglobin (HbA1c), blood pressure (BP) and LDL-Cholesterol (LDL) were estimated at baseline and prevalence of those at target (HbA1c <7%, BP < 130/80 mm Hg, LDL < 100 mg/dl) was documented and repeated at three and six months to monitor improvement in the number of patients at target and trend in improvement of individual parameters. RESULTS The percentage of patients at target at baseline and six months for HbA1c was (45% vs. 55% p = 0.101), BP < 130/80 mm Hg (27% vs. 25%) and LDL <100 mg/dl (37% vs. 40% p = 0.386). All three parameters were at target in one patient and three patients at six months period. Mean values at baseline and six months of HbA1c 7.46% (95% CI 7.17-7.75) vs 7.21% (95% CI 6.9-7.52), Systolic BP 138 mm Hg (95% CI 135-141), Diastolic BP 86 mm Hg (95% CI 84-86) and LDL 114 mg/dl (95%CI 107-121) vs. 110 mg/dl (95%CI 105-116) did not show significant improvement (p for trend). CONCLUSION Standards of care for HbA1c, blood pressure and LDL remains to be achieved in majority of the diabetic patients.
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Pérez A, Mediavilla J, Miñambres I, González-Segura D. Glycemic control in patients with type 2 diabetes mellitus in Spain. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rceng.2014.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Pérez A, Mediavilla JJ, Miñambres I, González-Segura D. Glycemic control in patients with type 2 diabetes mellitus in Spain. Rev Clin Esp 2014; 214:429-36. [PMID: 25016415 DOI: 10.1016/j.rce.2014.05.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/12/2014] [Accepted: 05/25/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the degree of glycemic control in patients with type 2 diabetes in Spain and identify factors associated with glycemic control. PATIENTS AND METHODS This was a cross-sectional, multicenter, epidemiological study that used consecutive sampling and was conducted in primary care practices in Spain. A total of 5591 patients with type 2 diabetes mellitus lasting more than 1 year and who were treated with hypoglycemic agents for more than 3 months were included in the study. At a single visit, HbA1c levels were measured (A1cNow+ system) and demographic and clinical variables related to diabetes and its treatment were recorded. During the visit, CV risk factors (CVRF), the presence of target-organ damage (TOD), the presence of hypoglycemia and body weight changes within the previous year were recorded. RESULTS We analyzed data from 5382 patients (mean age 66.7 [10.8] years, mean duration of the diabetes 8.8 [6.3] years). TOD was present in 43.6% of the patients and 59.1% were taking 2 or more drugs. The patients' mean HbA1c was 7.1 (1.1)%, and 48.6% had HbA1c levels <7.0%. The patients with HbA1c levels ≥7.0% had longer-standing diabetes, a higher prevalence of TOD and CVRF, used more complex therapies, experienced more hypoglycemic episodes in the previous year and had more weight gain. In the multivariate analysis, the absence of insulin treatment, the absence of abdominal obesity and atherogenic dyslipidemia, a duration of the diabetes <10 years and an age >70 years were associated with improved glycemic control. CONCLUSIONS Patients with poorly controlled type 2 diabetes mellitus are highly prevalent in Spain. Factors associated with poorer glycemic control include the complexity of both the disease and the hypoglycemic therapy, a history of hypoglycemia and weight gain.
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Affiliation(s)
- A Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) , Barcelona, España.
| | | | - I Miñambres
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
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González-Clemente JM, Font B, Lahoz R, Llauradó G, Gambús G. Inercia clínica en pacientes con diabetes mellitus tipo 2 no insulinizados en tratamiento con hipoglucemiantes orales. Estudio INERCIA. Med Clin (Barc) 2014; 142:478-84. [DOI: 10.1016/j.medcli.2013.02.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 02/19/2013] [Accepted: 02/21/2013] [Indexed: 11/26/2022]
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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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Rodríguez A, Tofe S, Reviriego J. Clinical course after five years of insulin therapy in patients with type 2 diabetes in Spain: results of the EDIN study. ACTA ACUST UNITED AC 2014; 61:369-76. [PMID: 24685227 DOI: 10.1016/j.endonu.2014.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/31/2014] [Accepted: 02/03/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The primary study objective was to assess the proportion of patients with type 2 diabetes and an HbA1c value ≤ 6.5% from the start of insulin therapy to five years later in the outpatient setting in Spain. MATERIAL AND METHODS This was an observational, multicenter, naturalistic study with retrospective collection of clinical data. Investigators were endocrinologists or internal medicine specialists from all over Spain. During standard clinical care, patients started insulin therapy, which was continued for at least 5 years. RESULTS The clinical records of 405 patients were reviewed. The final analysis set included records from 346 patients. At baseline (start of insulin therapy), 51.2% of patients were female; mean (SD) age was 64.6 (9.0) years; body mass index, 29.8 (4-5) kg/m(2); time since diagnosis, 8.8 (6.8) years; HbA1c, 9.4% (1.5); fasting glucose, 223.7 (55.9) mg/dL; and mean 2-hour postprandial glucose, 293.6 (71.0) mg/dL. When insulin therapy was started, <1.0% of patients had an HbA1c value ≤ 6.5%. At 5 years, 10.3% of patients achieved the HbA1c goal of ≤ 6.5% (mean, 7.72%). All glucose parameters (HbA1c, fasting glucose, and 2-hour postprandial glucose) improved at 5 years as compared to values at the start of insulin therapy. CONCLUSIONS Glucose parameters improved over time in patients with type 2 diabetes in this naturalistic study. However, blood glucose control exceeded the internationally recommended target values. These results therefore suggest that there is still some margin for improvement in outpatient care in Spain.
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Affiliation(s)
| | - Santiago Tofe
- Departamento de Endocrinología y Nutrición, Hospital Universitario Son Espases, Mallorca, España
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García-Mochón L, Olry de Labry Lima A, Espín Balbino J. Costes y efectividad de un detector de tendencias glucémicas en pacientes con diabetes mellitus. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.avdiab.2013.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Arrieta F, Piñera M, Iglesias P, Nogales P, Salinero-Fort MA, Abanades JC, Botella-Carretero JI, Calañas A, Balsa JA, Zamarrón I, Rovira A, Vázquez C. Metabolic control and chronic complications during a 3-year follow-up period in a cohort of type 2 diabetic patients attended in primary care in the community of Madrid (Spain). ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.endoen.2013.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Metabolic control and chronic complications during a 3-year follow-up period in a cohort of type 2 diabetic patients attended in primary care in the Community of Madrid (Spain). ACTA ACUST UNITED AC 2014; 61:11-7. [DOI: 10.1016/j.endonu.2013.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 08/09/2013] [Accepted: 09/04/2013] [Indexed: 01/17/2023]
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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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Depablos-Velasco P, Salguero-Chaves E, Mata-Poyo J, Derivas-Otero B, García-Sánchez R, Viguera-Ester P. Quality of life and satisfaction with treatment in subjects with type 2 diabetes: results in Spain of the PANORAMA study. ACTA ACUST UNITED AC 2013; 61:18-26. [PMID: 24055176 DOI: 10.1016/j.endonu.2013.05.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/09/2013] [Accepted: 05/27/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Few studies are available on quality of life and treatment satisfaction of patients with type 2 diabetes mellitus (T2DM). Both of them were the primary objectives of the PANORAMA (NCT00916513) study. Metabolic control, treatment patterns, and management by healthcare professionals were also evaluated. MATERIAL AND METHODS This multicenter, cross-sectional, observational study randomly recruited>40 year-old patients with T2DM from Spanish healthcare centers. HbA1c was measured using the same technique in all patients, who also completed quality of life (EQ-5D and ADDQoL) and treatment satisfaction (DTSQ) questionnaires and the Hypoglycemia Fear Survey (HFS-II). RESULTS Fifty-four investigators recruited 751 patients, 60.3% of whom had HbA1c levels <7%. Approximately 25% of patients on monotherapy had HbA1c values ≥ 7%, Patients with longer disease duration and more complex treatments, especially with insulin, showed the poorer control. Despite good overall treatment satisfaction (mean 29.3±6.1, 0 to 36-point scale), patients with a poorer metabolic control, previous hypoglycemia episodes, and more complex therapies had a worse QoL and a greater fear of suffering hypoglycemia. CONCLUSIONS Despite advances in metabolic control, there are still areas to improve. Early addition of safe drugs to monotherapy would help achieve control objectives without increasing the risk of hypoglycemia, and delaying the start of insulin therapy. This would also improve QoL and treatment satisfaction.
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Affiliation(s)
- Pedro Depablos-Velasco
- Departamento de Endocrinología y Metabolismo, Hospital Dr. Negrín, Universidad de Las Palmas, Las Palmas de Gran Canaria, España
| | - Emilio Salguero-Chaves
- Servicio Extremeño de Salud, Centro de Atención primaria de Valdepasillas, Badajoz, España
| | - Julio Mata-Poyo
- Servicio Extremeño de Salud, Centro de Atención primaria de Tabara, Zamora, España
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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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Sastre J, Pinés PJ, Moreno J, Aguirre M, Blanco B, Calderón D, Herranz S, Roa C, Lopez J. Situación de control metabólico y pautas de tratamiento en pacientes con diabetes tipo 1 en Castilla-La Mancha: estudio de diabetes tipo 1 en Castilla-La Mancha. ACTA ACUST UNITED AC 2012; 59:539-46. [DOI: 10.1016/j.endonu.2012.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 07/02/2012] [Accepted: 07/11/2012] [Indexed: 12/11/2022]
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Arrieta F, Salinero M, Piñera M, Botella-Carretero JI, Iglesias P, Abanades JC, Carrillo E, Nogales P, Balsa JA, Zamarrón I, Rovira A, Vázquez C. Estudio descriptivo de la evolución clínico-asistencial de la población con diabetes tipo 2 en la Comunidad de Madrid. Estudio de seguimiento diabético tipo 2 (ESD-2). ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1134-3230(11)70009-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Grado de control metabólico en una población diabética atendida en servicios de endocrinología. ACTA ACUST UNITED AC 2010; 57:472-8. [DOI: 10.1016/j.endonu.2010.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 08/10/2010] [Accepted: 09/09/2010] [Indexed: 11/18/2022]
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Abstract
Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by absolute insulin deficiency resulting from the progressive immune-mediated destruction of pancreatic islet beta cells. It is thought to be triggered by as yet unidentified environmental factors in genetically susceptible individuals, the major genetic contribution coming from loci within the HLA complex, in particular HLA class II. The worldwide incidence of T1D varies by at least 100-fold, being highest in Finland and Sardinia (Italy) and lowest in Venezuela and China. The incidence has been increasing worldwide at an annual rate of approximately 3%. While genetic factors are thought to explain some of the geographic variability in T1D occurrence, they cannot account for its rapidly increasing frequency. Instead, the declining proportion of newly diagnosed children with high-risk genotypes suggests that environmental pressures are now able to trigger T1D in genotypes that previously would not have developed the disease during childhood. Although comparisons between countries and regions with low and high-incidence rates have suggested that higher socioeconomic status and degree of urbanization are among the environmental factors that play a role in the rising incidence of T1D, the findings are too inconsistent to allow firm conclusions. Morbidity and mortality as well as causes of death also show considerable geographic variation. While glycemic control has been identified as a major predictor of the micro- and macrovascular complications of T1D and shows considerable geographical variability, it does not appear to be the only factor involved in the regional differences in complication rates. The role of genetics in susceptibility to nephropathy, retinopathy and other diabetic complications largely remains to be explored.
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