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Pablo L, Garay-Aramburu G, García Layana A, Fernandez A, Vázquez I, Acebes X, Zulueta J, Balonga D, Salinas-Ortega L, Muñoz Á, Casado Gómez A, Casado MÁ, Salvador J, Bañón-Rodriguez I, Ruíz-Moreno JM. Assessing the economic burden of vision loss and irreversible legal blindness in Spain (2021-2030): a societal perspective. HEALTH ECONOMICS REVIEW 2024; 14:70. [PMID: 39225974 PMCID: PMC11370269 DOI: 10.1186/s13561-024-00546-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/07/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To estimate the economic impact for the society, generated as a consequence of the onset of loss of vision and irreversible legal blindness, for the main ophthalmologic diseases in Spain: glaucoma, diabetic retinopathy (DR), diabetic macular edema (DME), age-related macular degeneration (AMD) and high myopia (HM). METHODS A cost analysis model was developed to estimate the economic burden of glaucoma, DR, DME, AMD and HM over a 10-year time horizon (2021-2030), from a societal perspective in Spain. The epidemiological and economic parameters used in the model were obtained through a literature review. Prevalence, incidence, and progression stages were used to establish the epidemiological flows. Annual costs per patient from publications were included and classified into direct healthcare, direct non-healthcare and indirect costs. Costs from other countries were converted based on purchasing-power-parity (€EUR, PPP). Epidemiological parameters about population and cost results were validated by a panel of experts. All costs were adjusted to euros, 2021 (€, 2021), and using the Consumer Price Index (CPI) of the last 10 years, extrapolated to 2030 euros (€, 2030). RESULTS It was estimated that the total population of patients with the main diseases pathologies (glaucoma, DR, DME, AMD and HM) will increase to 7.99 million patients by 2030, representing an increase of 103%. The total cost by 2030 of all pathologies would amount to 99.8 billion euros. Direct non-healthcare costs account for the largest item (44%), followed by loss of productivity costs (38%), and direct healthcare costs (18%). The pathologies with the highest cumulative costs will be glaucoma (€33.6 billion) and DME (€19.8 billion).The greatest increment costs compared to 2021 will likely be generated by pathologies related to diabetes mellitus, such as DR (703%) and DME (317%). CONCLUSIONS Knowing the costs associated with the pathologies that generate loss of vision and irreversible legal blindness is essential to understand the socioeconomic impact associated with these pathologies. Furthermore, the high cost of treating these diseases makes necessary to coordinate efforts between administrations, together with the support of patient associations, to meet their needs.
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Affiliation(s)
- Luis Pablo
- Ophthalmology Department, University Hospital Miguel Servet, Zaragoza, Spain
| | | | | | - Anxo Fernandez
- Pharmacy Department, SERGAS) and Pharmacology Group, University Clinical Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), 15706, Santiago de Compostela, Spain
| | | | - Xenia Acebes
- Ophthalmology Department. Assistance Services Area, CATSALUT, Barcelona, Spain
| | | | - Delfina Balonga
- Glaucoma Association of Sufferers and relatives, Madrid, Spain
| | - Laura Salinas-Ortega
- Pharmacoeconomics & Outcomes Research Iberia S. L, Paseo Joaquín Rodrigo 4- letra I, Pozuelo de Alarcón, 28224, Madrid, Spain.
| | - Álvaro Muñoz
- Pharmacoeconomics & Outcomes Research Iberia S. L, Paseo Joaquín Rodrigo 4- letra I, Pozuelo de Alarcón, 28224, Madrid, Spain
| | - Araceli Casado Gómez
- Pharmacoeconomics & Outcomes Research Iberia S. L, Paseo Joaquín Rodrigo 4- letra I, Pozuelo de Alarcón, 28224, Madrid, Spain
| | - Miguel Ángel Casado
- Pharmacoeconomics & Outcomes Research Iberia S. L, Paseo Joaquín Rodrigo 4- letra I, Pozuelo de Alarcón, 28224, Madrid, Spain
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Romero-Aroca P, Garcia-Curto E, Pascual-Fontanilles J, Valls A, Moreno A, Baget-Bernaldiz M. Distribution of Microaneurysms and Hemorrhages in Accordance with the Grading of Diabetic Retinopathy in Type Diabetes Patients. Diagnostics (Basel) 2024; 14:1547. [PMID: 39061684 PMCID: PMC11275489 DOI: 10.3390/diagnostics14141547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/13/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Underlying Diabetic Retinopathy (DR) is the primary cause of poor vision in young adults. There are automatic image reading systems that can aid screening for DR. (2) Methods: Using our automatic reading system we have counted the number of microaneurysms and hemorrhages in the four quadrants of the ETDRS grid and evaluated the differences between them according to the type of DR. The study was carried out using data from two different databases, MESSIDOR and MIRADATASET. (3) Results: The majority of microaneurysms and hemorrhages are found in the temporal and inferior quadrants of the ETDRS grid. Differences are significant with respect to the other two quadrants at p < 0.001. Differences between the type of DR show that severe-DR has a greater number of microaneurysms and hemorrhages in the temporal and inferior quadrant, being significant at p < 0.001. (4) Conclusions: The count of microaneurysms and hemorrhages is higher in the temporal and inferior quadrants in all types of DR, and those differences are more important in the case of severe-DR.
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Affiliation(s)
- Pedro Romero-Aroca
- Ophthalmology Service, Hospital Universitario Sant Joan, Universitat Rovira & Virgili, Institut de Investigacio Sanitaria Pere Virgili (IISPV), 43204 Reus, Spain; (E.G.-C.); (M.B.-B.)
| | - Eugeni Garcia-Curto
- Ophthalmology Service, Hospital Universitario Sant Joan, Universitat Rovira & Virgili, Institut de Investigacio Sanitaria Pere Virgili (IISPV), 43204 Reus, Spain; (E.G.-C.); (M.B.-B.)
| | - Jordi Pascual-Fontanilles
- ITAKA Research Group, Department of Computer Science and Mathematics, Universitat Rovira & Virgili, Institut d’Investigacions Sanitaries Pere Virgili (IISPV), 43007 Tarragona, Spain; (J.P.-F.); (A.V.); (A.M.)
| | - Aida Valls
- ITAKA Research Group, Department of Computer Science and Mathematics, Universitat Rovira & Virgili, Institut d’Investigacions Sanitaries Pere Virgili (IISPV), 43007 Tarragona, Spain; (J.P.-F.); (A.V.); (A.M.)
| | - Antonio Moreno
- ITAKA Research Group, Department of Computer Science and Mathematics, Universitat Rovira & Virgili, Institut d’Investigacions Sanitaries Pere Virgili (IISPV), 43007 Tarragona, Spain; (J.P.-F.); (A.V.); (A.M.)
| | - Marc Baget-Bernaldiz
- Ophthalmology Service, Hospital Universitario Sant Joan, Universitat Rovira & Virgili, Institut de Investigacio Sanitaria Pere Virgili (IISPV), 43204 Reus, Spain; (E.G.-C.); (M.B.-B.)
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Barrio-Cortes J, Mateos-Carchenilla MP, Martínez-Cuevas M, Beca-Martínez MT, Herrera-Sancho E, López-Rodríguez MC, Jaime-Sisó MÁ, Ruiz-López M. Comorbidities and use of health services in people with diabetes mellitus according to risk levels by adjusted morbidity groups. BMC Endocr Disord 2024; 24:115. [PMID: 39010042 PMCID: PMC11251131 DOI: 10.1186/s12902-024-01634-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 06/25/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND People with diabetes mellitus frequently have other comorbidities and involve greater use of primary and hospital care services. The aim of this study was to describe the comorbidities and use of primary and hospital care services of people with diabetes according to their risk level by adjusted morbidity groups (AMG) and to analyse the factors associated with the utilisation of these services. METHODS Cross-sectional study. People with diabetes were identified within the population of patients with chronic conditions of an urban health care centre by the AMG stratification tool integrated into the primary health care electronic clinical record of the Community of Madrid. Sociodemographic, functional, clinical characteristics and annual health care services utilisation variables were collected. Univariate, bivariate and Poisson regression analyses were performed. RESULTS A total of 1,063 people with diabetes were identified, representing 10.8% of patients with chronic conditions within the health centre. A total of 51.4% were female, the mean age was 70 years, 94.4% had multimorbidity. According to their risk level, 17.8% were high-risk, 40.6% were medium-risk and 41.6% were low-risk. The most prevalent comorbidities were hypertension (70%), dyslipidaemia (67%) and obesity (32.4%). Almost 50% were polymedicated. Regarding health services utilisation, 94% were users of primary care, and 59.3% were users of hospital care. Among the main factors associated with the utilisation of both primary and hospital care services were AMG risk level and complexity index. In primary care, utilisation was also associated with the need for primary caregivers, palliative care and comorbidities such as chronic heart failure and polymedication, while in hospital care, utilisation was also associated with comorbidities such as cancer, chronic obstructive pulmonary disease or depression. CONCLUSIONS People with diabetes were older, with important needs for care, many associated comorbidities and polypharmacy that increased in parallel with the patient's risk level and complexity. The utilisation of primary and hospital care services was very high, being more frequent in primary care. Health services utilization were principally associated with functional factors related to the need of care and with clinical factors such as AMG medium and high-risk level, more complexity index, some serious comorbidities and polymedication.
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Affiliation(s)
- Jaime Barrio-Cortes
- Foundation for Biosanitary Research and Innovation in Primary Care, Madrid, Spain.
- Primary Care Investigation Unit, Gerencia Asistencial de Atención Primaria, Madrid, Spain.
- Faculty of Health, Universidad Camilo José Cela, Madrid, Spain.
| | - María Pilar Mateos-Carchenilla
- Faculty of Health, Universidad Camilo José Cela, Madrid, Spain
- V Centenario Healthcare Centre, Gerencia Asistencial de Atención Primaria, San Sebastián de los Reyes, Madrid, Spain
| | | | | | - Elvira Herrera-Sancho
- Ciudad Jardín Healthcare Centre, Gerencia Asistencial de Atención Primaria, Madrid, Spain
| | | | | | - Montserrat Ruiz-López
- Nursing School, Fundación Jiménez Diaz Hospital, Universidad Autónoma de Madrid, Madrid, Spain
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Vilafranca-Cartagena M, Bonet-Augè A, Colillas-Malet E, Puiggrós-Binefa A, Tort-Nasarre G. Physical Activity Interventions in People with Diabetes: A Systematic Review of The Qualitative Evidence. Healthcare (Basel) 2024; 12:1373. [PMID: 39057516 PMCID: PMC11275865 DOI: 10.3390/healthcare12141373] [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: 05/30/2024] [Revised: 06/28/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVES The aim of this systematic review is to summarize the results of qualitative research into people with type 2 diabetes mellitus (T2DM) and their propensity to engage in physical activity (PA), and to identify and analyse their experiences and opinions of interventions and programs designed to increase their adherence to PA recommendations. DESIGN Systematic review of qualitative studies extracted from databases using the SPIDER systematic search method. The review included studies that combined qualitative and mixed methods research and compiled the experiences and opinions of people with T2DM who had participated in interventions to increase their levels of PA. A thematic summary of qualitative data was performed. RESULTS The review comprised nine studies published between 2017 and 2021, which included 170 people. Four themes and ten subthemes were identified. The four themes include: (1) factors related to PA, (2) factors related to the program, (3) factors related to the support the participants received and (4) factors related to the person. CONCLUSION The support patients receive, both from family/friends and from health providers, is key to consolidating changes in habits and in promoting individualized health education. Future interventions and health policies should reinforce programs designed to promote PA that prioritize the experiences of people in order to increase their adherence to PA programs.
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Affiliation(s)
- Mireia Vilafranca-Cartagena
- Department of Nursing, Faculty of Health Sciences at Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain; (E.C.-M.); (A.P.-B.)
- Epi4health Research Group, Faculty of Health Sciences of Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain
- Althaia Foundation, C/Dr Joan Soler 1-3, 08243 Manresa, Spain
| | - Aida Bonet-Augè
- Department of Nursing and Physiotherapy, University of Lleida, 25002 Lleida, Spain; (A.B.-A.); (G.T.-N.)
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), University of Lleida, 25002 Lleida, Spain
| | - Ester Colillas-Malet
- Department of Nursing, Faculty of Health Sciences at Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain; (E.C.-M.); (A.P.-B.)
- Epi4health Research Group, Faculty of Health Sciences of Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain
| | - Antònia Puiggrós-Binefa
- Department of Nursing, Faculty of Health Sciences at Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain; (E.C.-M.); (A.P.-B.)
- Transformative Innovation and Simulation Research Group, Faculty of Health Sciences of Manresa, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Av. Universitària 4-6, 08242 Manresa, Spain
| | - Glòria Tort-Nasarre
- Department of Nursing and Physiotherapy, University of Lleida, 25002 Lleida, Spain; (A.B.-A.); (G.T.-N.)
- AFIN Research Group and Outreach Centre, Autonomous University of Barcelona, 08193 Bellaterra, Spain
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Najafi F, Moradinazar M, Khosravi Shadmani F, Pasdar Y, Darbandi M, Salimi Y, Ghasemi SR. The incidence of diabetes mellitus and its determining factors in a Kurdish population: insights from a cohort study in western Iran. Sci Rep 2024; 14:15761. [PMID: 38977871 PMCID: PMC11231219 DOI: 10.1038/s41598-024-66795-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/03/2024] [Indexed: 07/10/2024] Open
Abstract
Diabetes mellitus (DM) is among the most widespread non-communicable diseases and poses a substantial global health challenge. The aim of this study was to examine the incidence of DM and its nutritional, anthropometric, laboratory, demographic, and behavioral determinants, as well as comorbidities, within a Kurdish population residing in western Iran. This research was conducted in the Ravansar Non-Communicable Disease (RaNCD) cohort study, followed 9170 participants aged 35-65 years, for an average ± SD of 7.11 ± 1.26 years, from 2015 until 2023. A hierarchical Cox regression model was used to estimates the adjusted hazard ratios (HRs). The incidence of DM was 4.45 (95% CI 3.96, 4.99) per 1000 person-years. We found several significant predictors for DM incidence, including prediabetes, comorbidity, urban residence, total antioxidant capacity (TAC), and the interaction between gender and body mass index (BMI). Prediabetes emerged as the strongest predictor of DM incidence, with a hazard ratio of 10.13 (CI 7.84, 13.09). Additionally, having two diseases (HR = 2.18; 95% CI 1.44, 3.29) or three and more diseases (HR = 3.17; 95% CI 2.06, 4.90) increased the risk of developing DM. Also, the hazard ratios for the effects of gender on DM incidence in the normal, overweight, and obese BMI groups were 0.24, 0.81, and 1.01, respectively. The presence of prediabetes and obesity serve as the crucial indicators for the onset of DM, emphasizing the pressing need for interventions to prevent DM in these circumstances. Furthermore, there are notable disparities between urban and rural populations in this study, warranting further investigations to ascertain the underlying causes of such variations.
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Affiliation(s)
- Farid Najafi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Moradinazar
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Khosravi Shadmani
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mitra Darbandi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Salimi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Ramin Ghasemi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Student Research Committee, Department of Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Arévalo-Lorido JC, Carretero-Gomez J, Rubini A, Félix-Redondo FJ, Robles Pérez Monteoliva NR, Hernández González M, Vázquez Jarén E, Cancho-Castellanos B, González Fernández R, Fernández-Bergés D. Temporal trends on the prevalence of renal disease and outcomes among patients with diabetes mellitus hospitalized by heart failure: findings from INCAex. Expert Rev Endocrinol Metab 2024:1-11. [PMID: 38866705 DOI: 10.1080/17446651.2024.2365769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/26/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND To assess 20-year time trends in the prevalence of diabetes mellitus (DM) among inpatients with heart failure (HF) and the influence of coexisting DM and kidney disease (KD) on outcomes. RESEARCH DESIGN AND METHODS A retrospective study of patients was admitted due to HF, during the period 2000/2019. The period of follow-up was divided into three intervals according to the European Medical Agency approval of newer hypoglycemic drugs. We analyzed in-hospital mortality and outcomes during the follow-up period. RESULTS A total of 4959 patients were included. Over time, prevalence of DM was significantly raising among women with HF (50 to 53.2%) and descending among men (50% to 46.8%, p = 0.02). Total mortality and readmissions were higher in patients with DM during the and second periods. However, no significant differences were found in the third-one (HR 1.14, 95% CI 0.94-1.39, p = 0.181). A protector role of oral hypoglycemic medications was observed in this last period. According to the presence of KD, the patients with both DM and KD were who presented most of the events. CONCLUSIONS Over the time analyzed, the prevalence of DM raised among women and decreased among men. DM influenced the prognosis of HF except in the third period when more protective hypoglycemic drugs started to be used.
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Affiliation(s)
| | | | - Alessia Rubini
- Servicio Extremeño de Salud, Unidad de Investigación Área Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain
- Unidad de investigaci'ón (GRIMEX), Villanueva de la Serena, Badajoz, Spain
| | - Francisco Javier Félix-Redondo
- Servicio Extremeño de Salud, Unidad de Investigación Área Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain
| | - Nicolás Roberto Robles Pérez Monteoliva
- Unidad de investigaci'ón (GRIMEX), Villanueva de la Serena, Badajoz, Spain
- Unidad de Hipertensión Arterial, Servicio de Nefrología, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Miriam Hernández González
- Servicio Extremeño de Salud, Unidad de Investigación Área Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain
- Unidad de investigaci'ón (GRIMEX), Villanueva de la Serena, Badajoz, Spain
| | - Elena Vázquez Jarén
- Servicio Extremeño de Salud, Unidad de Investigación Área Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain
| | - Bárbara Cancho-Castellanos
- Unidad de investigaci'ón (GRIMEX), Villanueva de la Serena, Badajoz, Spain
- Unidad de Hipertensión Arterial, Servicio de Nefrología, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Reyes González Fernández
- Unidad de investigaci'ón (GRIMEX), Villanueva de la Serena, Badajoz, Spain
- Servicio de Cardiología, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Daniel Fernández-Bergés
- Servicio Extremeño de Salud, Unidad de Investigación Área Salud Don Benito-Villanueva, Villanueva de la Serena, Badajoz, Spain
- Unidad de investigaci'ón (GRIMEX), Villanueva de la Serena, Badajoz, Spain
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García-Villarino M, Lambert C, De la Hera JM, Torre ELM, Rodríguez-Lacín JMF, Delgado-Álvarez E. Use of electronic health records for the management of diabetes and its risk factors in the Principality of Asturias from 2014 to 2018. ENDOCRINOL DIAB NUTR 2024; 71:208-215. [PMID: 38897704 DOI: 10.1016/j.endien.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND In recent years, the implementation of electronic health records across all hospitals and primary care centres within the National Health System has significantly enhanced access to patients' clinical data. This study aims to estimate the prevalence of type 2 diabetes (T2DM) in primary care settings and to outline its associated cardiovascular risk factors (CVRF) and epidemiological characteristics. METHODS An observational cross-sectional study was conducted including 89,679 patients diagnosed with T2DM who attended the primary health care system from 2014 to 2018. Data was provided by the Primary Health Care System of the Principality of Asturias (SESPA). RESULTS The estimated prevalence of diagnosed T2DM was 8.01% (95% Confidence Interval [CI]: 7.96-8.06) of the total population. Additionally, it was more prevalent in males compared to females (9.90% [95% CI: 9.81-9.99] vs. 6.50% [95% CI: 6.44-6.57]) and increased with age in both sexes. People with T2DM had an average age of 74 years, 52.3% were male, and the most frequently associated CVRF were: dyslipidaemia (47.90%) and hypertension (62.20%). Glycaemic control improved during the 2014-2018 period (31.69%), as did lipid control (23.66%). However, the improvement in blood pressure control (9.34%) was less pronounced for the same period. Regarding the multifactorial control of diabetes (measured by LDL-cholesterol, HbA1C and blood pressure) the overall degree of control improved by 11.55% between 2014 and 2018. CONCLUSION In this 5-year retrospective population-based study, the utilisation of data from electronic medical records provides insights into the prevalence of T2DM in a large population, as well as real-time CVRFs. Leveraging this data facilitates the development of targeted health policies.
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Affiliation(s)
- Miguel García-Villarino
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain.
| | - Carmen Lambert
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain
| | - Jesús M De la Hera
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain; Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Edelmiro Luis Menéndez Torre
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José María Fernández Rodríguez-Lacín
- Grupo de Cronicidad, Envejecimiento, Fragilidad y Continuidad Asistencial, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Elías Delgado-Álvarez
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain
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8
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Sharma P, Dilip TR, Kulkarni A, Mishra US, Shejul Y. Risk of diabetes and expected years in life without diabetes among adults from an urban community in India: findings from a retrospective cohort. BMC Public Health 2024; 24:1048. [PMID: 38622601 PMCID: PMC11020643 DOI: 10.1186/s12889-024-18465-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Diabetes prevalence has increased over the past few decades, and the shift of the burden of diabetes from the older population to the younger population has increased the exposure of longer durations in a morbid state. The study aimed at ascertaining the likelihood of progression to diabetes and to estimate the onset of diabetes within the urban community of Mumbai. METHODS This study utilized an observational retrospective non-diabetic cohort comprising 1629 individuals enrolled in a health security scheme. Ten years of data were extracted from electronic medical records, and the life table approach was employed to assess the probability of advancing to diabetes and estimate the expected number of years lived without a diabetes diagnosis. RESULTS The study revealed a 42% overall probability of diabetes progression, with age and gender variations. Males (44%) show higher probabilities than females (40%) of developing diabetes. Diabetes likelihood rises with age, peaking in males aged 55-59 and females aged 65-69. Males aged 30-34 exhibit a faster progression (10.6 years to diagnosis) compared to females (12.3 years). CONCLUSION The study's outcomes have significant implications for the importance of early diabetes detection. Progression patterns suggest that younger cohorts exhibit a comparatively slower rate of progression compared to older cohorts.
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Affiliation(s)
- Palak Sharma
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, 400088, India.
| | - T R Dilip
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, 400088, India
| | - Anjali Kulkarni
- Medical Division, Bhabha Atomic Research Center, Mumbai, 400088, India
| | - Udaya Shankar Mishra
- Department of Bio-statistics and Epidemiology, International Institute for Population Sciences, Mumbai, 400088, India
| | - Yogesh Shejul
- Medical Division, Bhabha Atomic Research Center, Mumbai, 400088, India
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Álvarez-Guisasola F, Quesada JA, López-Pineda A, García RN, Carratalá-Munuera C, Gil-Guillén VF, Orozco-Beltrán D. Multicausal analysis of mortality due to diabetes mellitus in Spain, 2016-2018. Prim Care Diabetes 2024; 18:138-145. [PMID: 38326176 DOI: 10.1016/j.pcd.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/09/2024] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES This study aimed to assess multicausal mortality due to diabetes from 2016-2018 in Spain. Specific objectives were to quantify the occurrence of diabetes as an underlying cause or as any registered cause on the death certificate. MATERIALS AND METHODS A cross-sectional descriptive study taking a multicausal approach. RESULTS Diabetes appears as an underlying cause of 2.3% of total deaths in Spain, and as any cause in 6.2%. In patients in whom Diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases in men(prevalence ratio 1,59)and women (PR1,31). In men, the causes associated with diabetes as any cause were skin diseases(prevalence ratio 1.33), followed by endocrine diseases(prevalence ratio 1.26)and genitourinary diseases (prevalence ratio1.14). In women, the causes associated with the presence of diabetes as any cause were endocrine (prevalence ratio 1.13)and genitourinary (prevalence ratio 1.04)diseases. CONCLUSIONS In patients in whom diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases. In men, the causes associated with the presence of diabetes as any cause of death are skin, endocrine and genitourinary diseases. In women, the causes associated with diabetes as any cause are endocrine and genitourinary.
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Affiliation(s)
| | - José A Quesada
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, 03550 San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain
| | - Adriana López-Pineda
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, 03550 San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain
| | - Rauf Nouni García
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, 03550 San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain; Institute of Health and Biomedical Research of Alicante, Alicante General University Hospital, Diagnostic Center, Fifth floor. Calle Pintor Baeza 12, 03110 Alicante, Spain.
| | - Concepción Carratalá-Munuera
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, 03550 San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain
| | - Vicente F Gil-Guillén
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, 03550 San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain; Institute of Health and Biomedical Research of Alicante, Alicante General University Hospital, Diagnostic Center, Fifth floor. Calle Pintor Baeza 12, 03110 Alicante, Spain; Primary care research center, Miguel Hernández University, Elche, 03002 Alicante, Spain
| | - Domingo Orozco-Beltrán
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, 03550 San Juan de Alicante, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain
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10
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Montero E, Bujaldón R, Montanya E, Calle-Pascual AL, Rojo-Martínez G, Castaño L, Franch-Nadal J, Delgado E, Chaves F, Alonso B, Sanz M, Herrera D. Cross-sectional association between severe periodontitis and diabetes mellitus: A nation-wide cohort study. J Clin Periodontol 2024; 51:368-379. [PMID: 38140803 DOI: 10.1111/jcpe.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 11/25/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023]
Abstract
AIM To evaluate the cross-sectional association between severe periodontitis and diabetes mellitus (DM), in a representative sample of Spanish population. MATERIALS AND METHODS The di@bet.es epidemiological study is a population-based cohort study aimed to determine the prevalence and incidence of DM in the adult population of Spain. The at-risk sample at the final examination (2016-2017) included 1751 subjects who completed an oral health questionnaire. This questionnaire, together with demographic and risk factors, had been previously validated to build an algorithm to predict severe periodontitis in the Spanish population. Logistic regression models were used to evaluate the association between severe periodontitis and DM with adjustment for confounding factors. RESULTS In total, 144 subjects developed DM, which yielded 8.2% cumulative incidence. Severe periodontitis was detected in 59.0%, 54.7% or 68.8% of the subjects depending on three different selected criteria at the 2016-2017 exam. All criteria used to define severe periodontitis were associated with DM in unadjusted analysis, but the magnitude of the association decreased after adjusting for significant confounders. The criteria '≥50% of teeth with clinical attachment loss ≥5 mm' presented an odds ratio of 4.9 (95% confidence interval: 2.2-10.7; p ≤ .001) for DM. CONCLUSIONS Severe periodontitis is associated with DM in the Spanish population.
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Affiliation(s)
- Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
- Working Group "Diabetes and Periodontal Diseases" of the Spanish Society of Diabetes (SED) and the Spanish Society of Periodontology (SEPA), Spain
| | - Rocío Bujaldón
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Eduard Montanya
- Bellvitge Hospital-IDIBELL, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Alfonso L Calle-Pascual
- Medical School, University Complutense, Madrid, Spain
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Gemma Rojo-Martínez
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- UGC Endocrinología y Nutrición, Hospital regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, Spain
| | - Luis Castaño
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Endo-ERN, UPV/EHU, Barakaldo, Spain
- Spanish Biomedical Research Network in Rare Disease (CIBERER), Madrid, Spain
| | - Josep Franch-Nadal
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- EAP Raval Sud, Catalan Institute of Health, GEDAPS Network, Primary Care, Research Support Unit (IDIAP-Jordi Gol Foundation), Barcelona, Spain
| | - Elías Delgado
- Department of Endocrinology and Nutrition, Central University Hospital of Asturias/University of Oviedo, Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
| | - Felipe Chaves
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Genomic and Genetic Diagnosis Unit, Research Foundation of Valencia University Clinical Hospital-INCLIVA, Valencia, Spain
| | - Bettina Alonso
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
- Working Group "Diabetes and Periodontal Diseases" of the Spanish Society of Diabetes (SED) and the Spanish Society of Periodontology (SEPA), Spain
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11
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Barranco-Altirriba M, Alonso N, Weber RJM, Lloyd GR, Hernandez M, Yanes O, Capellades J, Jankevics A, Winder C, Falguera M, Franch-Nadal J, Dunn WB, Perera-Lluna A, Castelblanco E, Mauricio D. Lipidome characterisation and sex-specific differences in type 1 and type 2 diabetes mellitus. Cardiovasc Diabetol 2024; 23:109. [PMID: 38553758 PMCID: PMC10981308 DOI: 10.1186/s12933-024-02202-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/14/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND In this study, we evaluated the lipidome alterations caused by type 1 diabetes (T1D) and type 2 diabetes (T2D), by determining lipids significantly associated with diabetes overall and in both sexes, and lipids associated with the glycaemic state. METHODS An untargeted lipidomic analysis was performed to measure the lipid profiles of 360 subjects (91 T1D, 91 T2D, 74 with prediabetes and 104 controls (CT)) without cardiovascular and/or chronic kidney disease. Ultra-high performance liquid chromatography-electrospray ionization mass spectrometry (UHPLC-ESI-MS) was conducted in two ion modes (positive and negative). We used multiple linear regression models to (1) assess the association between each lipid feature and each condition, (2) determine sex-specific differences related to diabetes, and (3) identify lipids associated with the glycaemic state by considering the prediabetes stage. The models were adjusted by sex, age, hypertension, dyslipidaemia, body mass index, glucose, smoking, systolic blood pressure, triglycerides, HDL cholesterol, LDL cholesterol, alternate Mediterranean diet score (aMED) and estimated glomerular filtration rate (eGFR); diabetes duration and glycated haemoglobin (HbA1c) were also included in the comparison between T1D and T2D. RESULTS A total of 54 unique lipid subspecies from 15 unique lipid classes were annotated. Lysophosphatidylcholines (LPC) and ceramides (Cer) showed opposite effects in subjects with T1D and subjects with T2D, LPCs being mainly up-regulated in T1D and down-regulated in T2D, and Cer being up-regulated in T2D and down-regulated in T1D. Also, Phosphatidylcholines were clearly down-regulated in subjects with T1D. Regarding sex-specific differences, ceramides and phosphatidylcholines exhibited important diabetes-associated differences due to sex. Concerning the glycaemic state, we found a gradual increase of a panel of 1-deoxyceramides from normoglycemia to prediabetes to T2D. CONCLUSIONS Our findings revealed an extensive disruption of lipid metabolism in both T1D and T2D. Additionally, we found sex-specific lipidome changes associated with diabetes, and lipids associated with the glycaemic state that can be linked to previously described molecular mechanisms in diabetes.
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Affiliation(s)
- Maria Barranco-Altirriba
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament d'Enginyeria de Sistemes, Automàtica i Informàtica Industrial, Universitat Politècnica de Catalunya, B2SLab, Barcelona, Spain
- Networking Biomedical Research Centre in the subject area of Bioengineering, Biomaterials and Nanomedicine, CIBER-BBN), Madrid, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Núria Alonso
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain
- Servicio de Endocrinología y Nutrición, Hospital Universitario e Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ralf J M Weber
- School of Biosciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Phenome Centre Birmingham, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Gavin R Lloyd
- School of Biosciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Phenome Centre Birmingham, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Marta Hernandez
- Department of Endocrinology & Nutrition, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Oscar Yanes
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain
- Department of Electronic Engineering, Universitat Rovira i Virgili, IISPV, Tarragona, Spain
| | - Jordi Capellades
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain
- Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
| | - Andris Jankevics
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, The Netherlands
- Netherlands Proteomics Center, Utrecht, The Netherlands
| | - Catherine Winder
- School of Biosciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Phenome Centre Birmingham, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Metabolomics Research, Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, L69 7ZB, Liverpool, UK
| | - Mireia Falguera
- Institut d'Investigació Biomèdica, Centre Atenció Primària Cervera, Gerència d'Atenció Primària, Universitat de Lleida, Institut Català de la Salut, Lleida, Spain
| | - Josep Franch-Nadal
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain
- DAP-Cat Group, Unitat de Suport a La Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Warwick B Dunn
- School of Biosciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Phenome Centre Birmingham, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Metabolomics Research, Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, L69 7ZB, Liverpool, UK
| | - Alexandre Perera-Lluna
- Departament d'Enginyeria de Sistemes, Automàtica i Informàtica Industrial, Universitat Politècnica de Catalunya, B2SLab, Barcelona, Spain
- Networking Biomedical Research Centre in the subject area of Bioengineering, Biomaterials and Nanomedicine, CIBER-BBN), Madrid, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Esmeralda Castelblanco
- Division of Endocrinology, Metabolism and Lipid Research, Department of Internal Medicine, Washington University School of Medicine, 63110, St. Louis, MO, USA.
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina, 08007, Barcelona, Spain.
| | - Didac Mauricio
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain.
- Institut d'Investigació Biomèdica Sant Pau (IR Sant Pau), 08041, Barcelona, Spain.
- Faculty of Medicine, University of Vic, Vic, Spain.
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12
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Pérez Unanua MP, López Simarro F, Novillo López CI, Olivares Loro AG, Yáñez Freire S. [Diabetes and women, why are we different?]. Semergen 2024; 50:102138. [PMID: 38052103 DOI: 10.1016/j.semerg.2023.102138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/30/2023] [Accepted: 10/29/2023] [Indexed: 12/07/2023]
Abstract
Diabetes affects men and women differently and the mistaken assumption of equality in its clinical expression can lead to errors and delays in the diagnostic process and the therapeutic strategy adopted. The objective is to show the gender differences that influence the approach to this pathology and what the role of the family doctor is in the monitoring of women with diabetes. It is a review of the impact of diabetes at different stages of a woman's life, how hormonal changes affect glycemic control, gestational diabetes, how diabetes affects the development of chronic complications in women and their consequences, the existing differences in the control of cardiovascular risk factors and the differential aspects by sex of the different families of drugs used in the treatment of diabetes.
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Affiliation(s)
- M P Pérez Unanua
- Medicina de Familia, Centro de Salud Dr. Castroviejo, Madrid, España.
| | | | | | - A G Olivares Loro
- Medicina de Familia, Centro de Salud Esperanza Macarena, Sevilla, España
| | - S Yáñez Freire
- Medicina de Familia, Centro de Salud A Estrada, Santiago de Compostela, A Coruña, España
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13
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Ramírez-Morros A, Franch-Nadal J, Real J, Miró-Catalina Q, Bundó M, Vlacho B, Mauricio D. Clinical characteristics and degree of cardiovascular risk factor control in patients with newly-diagnosed type 2 diabetes in Catalonia. Front Endocrinol (Lausanne) 2024; 15:1339879. [PMID: 38390201 PMCID: PMC10883380 DOI: 10.3389/fendo.2024.1339879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Women with type 2 diabetes mellitus (T2DM) face a greater risk of cardiovascular disease (CVD) and encounter challenges in managing cardiovascular risk factors (CVRF); however, limited data are available in individuals with newlydiagnosed T2DM. Methods This study aimed to examine differences between women and men at the onset of T2DM in terms of clinical characteristics, glycaemic status, and CVRF management. This was a retrospective cohort study including subjects with newly-diagnosed T2DM from the System for the Development of Research in Primary Care (SIDIAP) database in Catalonia (Spain). Sex differences (Dif) were assessed at baseline and 1-year post-diagnosis, by calculating the absolute difference of means or proportions. Results A total of 13,629 subjects with newly-diagnosed T2DM were analyzed. Women were older and had a higher BMI than men. At baseline, women had higher total cholesterol [Dif (95%CI) 10 mg/dL (9.1/10.8)] and low-density lipoprotein cholesterol (LDL-c) [Dif (95%CI) 7 mg/dL (6.3/7.7)], while men had higher rates of smoking and alcohol intake. Lipid target achievement was lower in women, in both primary prevention (LDL-c < 100 mg/dL) [Dif (95%CI) -7.3 mg/dL (-10.5/-4.1)] and secondary prevention (LDL-c < 70 mg/dL) [Dif (95%CI) -8.3 mg/dL (-17.3/0.7)], along with lower statin and antiplatelet prescriptions, especially one year after diagnosis. Changes in clinical and laboratory data one year post-diagnosis revealed that, in the primary prevention group, men experienced greater improvements in total cholesterol, LDL-c and triglycerides, while women had less success in achieving CVRF control targets compared to men. Additionally, cardiovascular events, such as coronary artery disease and peripheral artery disease increased more in men than in women within the first year of diagnosis, especially in primary prevention subjects. Conclusion Differences between men and women CVRF are already apparent at the onset of T2DM, particularly in primary prevention, with notable differences in lipid profile and target level attainment.
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Affiliation(s)
- Anna Ramírez-Morros
- Grup de Recerca Epidemiològica en Diabetes des de l’Atenció Primària (DAP-CAT) Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Josep Franch-Nadal
- Grup de Recerca Epidemiològica en Diabetes des de l’Atenció Primària (DAP-CAT) Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Jordi Real
- Grup de Recerca Epidemiològica en Diabetes des de l’Atenció Primària (DAP-CAT) Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
- Digital Health and Clinical Validation Center for Digital Health Solutions, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Queralt Miró-Catalina
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Sant Fruitós de Bages, Spain
| | - Magdalena Bundó
- Grup de Recerca Epidemiològica en Diabetes des de l’Atenció Primària (DAP-CAT) Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Health Care Center Ronda Prim, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord de Barcelona, Institut Català de la Salut, Mataró, Spain
| | - Bogdan Vlacho
- Grup de Recerca Epidemiològica en Diabetes des de l’Atenció Primària (DAP-CAT) Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
- Institut de Recerca Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Didac Mauricio
- Grup de Recerca Epidemiològica en Diabetes des de l’Atenció Primària (DAP-CAT) Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
- Institut de Recerca Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, University of Vic – Central University of Catalonia, Vic, Spain
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14
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Hormigo Pozo A, Torres Ortega D, García Ruiz AJ, Escribano Serrano J, Escribano Cobalea M, García-Agua Soler N. Approach to patients with diabetes and obesity in primary care. Aten Primaria 2024; 56:102807. [PMID: 37972467 PMCID: PMC10684366 DOI: 10.1016/j.aprim.2023.102807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023] Open
Abstract
AIMS The aim of this study is to analyse the effect of pharmacological and non-pharmacological treatment on weight control in patients with diabetes and obesity. DESIGN Epidemiological, descriptive, cross-sectional study. SITE: Primary care. In 11 health centres in Málaga and Cádiz during April and October 2022. PARTICIPANTS 281 patients over 18 years old with type 2 diabetes and obesity are included. MAIN MEASUREMENTS Socio-demographics, clinical, treatment and lifestyle habits variables were obtained from medical records and personal interview. Descriptive statistics were obtained for continuous variables. Statistical tests were performed based on the nature of the variables. RESULTS Variables like marital status, level of education and occupation, and smoking habit, shows differences regarding the sex (p<0.05). 82.3% of those who received education lost weight, compared to 67.5% of lost weight who received no health education (p=0.004). GLP1 and SGLT2 were more commonly prescribed for women (p=0.048), and SGLT2 more commonly prescribed for men (p=0.047). Patients taking GLP1, SGLT2 or both, regardless of sex, weight loss during the study period was -3.1kg (SE: 0.60), while the loss of those who took other medications was -1.33kg (SE: 0.62). The mean difference was 1.75kg (p=0.046). CONCLUSIONS In terms of weight loss, obese diabetics who took GLP1, SGLT2 or both were 2.5 times more likely to lose weight than those who did not. Healthy lifestyle choices are key to weight loss in obese diabetic patients.
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Affiliation(s)
- Antonio Hormigo Pozo
- Unidad de Gestión Clínica San Andres-Torcal Clinical, Distrito Málaga-Guadalhorce, Málaga, Spain
| | - Desireé Torres Ortega
- Programa de Doctorado en Biomedicina, Investigación Traslacional, y Nuevas Tecnologías en Salud, Facultad de Medicina, Universidad de Málaga, Málaga, Spain.
| | - Antonio J García Ruiz
- Departamento de Farmacología, Facultad de Medicina, Universidad de Málaga, Málaga, Spain; IBIMA (Instituto de Investigación Biomédica de Malaga), Málaga, Spain
| | - José Escribano Serrano
- Unidad de Gestión Clínica San Roque, Área de Gestión Sanitaria Campo de Gibraltar Este, San Roque, Cádiz, Spain
| | | | - Nuria García-Agua Soler
- Departamento de Farmacología, Facultad de Medicina, Universidad de Málaga, Málaga, Spain; IBIMA (Instituto de Investigación Biomédica de Malaga), Málaga, Spain
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15
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Pérez A, Redondo-Antón J, Romera I, Lizán L, Rubio-de Santos M, Díaz-Cerezo S, Orozco-Beltrán D. Disease and Economic Burden of Poor Metabolic and Weight Control in Type 2 Diabetes in Spain: A Systematic Literature Review. Diabetes Ther 2024; 15:325-341. [PMID: 37989829 PMCID: PMC10838877 DOI: 10.1007/s13300-023-01503-4] [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: 08/18/2023] [Accepted: 10/23/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Poor metabolic control and excess body weight are frequently present in people with type 2 diabetes (PwT2D). METHODS A systematic literature review was conducted to identify observational studies reporting clinical, economic, and health-related quality of life (HRQoL) outcomes associated with poor metabolic (according to HbA1c, blood pressure [BP] and low density lipoprotein cholesterol [LDL-C] levels) and/or weight control (defined by a body mass index [BMI] ≥ 30 kg/m2) in adults with T2D in Spain, including articles published in either Spanish or English between 2013 and 2022 and conference abstracts from the last 2 years. RESULTS Nine observational studies were included in the analysis. Poor glycemic control (HbA1c ≥ 7%) was associated with cardiovascular disease (CVD), increased requirements for antidiabetic medications, higher and more frequent weight gain, a greater probability of hypoglycemia and dyslipidemia, and worse health-related quality of life (HRQoL). Uncontrolled BP in PwT2D was related with the presence of CVD, worse metabolic control, and higher BMI and abdominal perimeter values. Poor LDL-C control or dyslipidemia was associated with CVD, hypoglycemia, and elevated HbA1c and triglycerides levels. The presence of a BMI ≥ 30 kg/m2 was related to CVD and hypoglycemia, a higher prevalence of metabolic syndrome and worse BP control. Direct medical costs were found to be higher in PwT2D when coexisting with HbA1c levels ≥ 7%, uncontrolled BP or obesity. Increased total costs, including productivity losses, were also detected in those who presented uncontrolled BP and a BMI ≥ 30 kg/m2, and when poor weight control existed together with HbA1c ≥ 8% and poorly controlled BP. CONCLUSION Gathered evidence supports the high clinical, economic and HRQoL burden of poor metabolic and/or weight control in PwT2D in Spain and reinforces the importance of prioritizing its control to reduce the associated burden, at both the individual and healthcare system levels.
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Affiliation(s)
- Antonio Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | | | - Irene Romera
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Luís Lizán
- Outcomes'10, S.L., Castellón de la Plana, Spain
- Departamento de Medicina, Universidad Jaume I, Castellón de la Plana, Spain
| | | | - Silvia Díaz-Cerezo
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
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Bellido V, Duque N, Newson RS, Artime E, Spaepen E, Rubio de Santos M, Redondo-Antón J, Díaz-Cerezo S, Navarro J. The Burden of Suboptimal Insulin Dosing in People with Diabetes in Spain: Barriers and Solutions from the Physician Perspective. Patient Prefer Adherence 2024; 18:151-164. [PMID: 38259955 PMCID: PMC10800280 DOI: 10.2147/ppa.s439814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Background This study aimed to determine physicians' perceptions of the extent of suboptimal insulin dosing and the barriers and solutions to optimal dosing in people with diabetes (PwD) treated with insulin. Methods A cross-sectional online survey was conducted in four countries with primary care physicians and endocrinologists treating PwD using insulin pens, which included 53 questions on physicians' characteristics and their perceptions of the behaviors of PwD in relation to insulin dosing routines, unmet needs and potential solutions. Analyses were descriptive. Results Of the 160 physicians (80 primary care physicians, 80 specialists) surveyed in Spain, 58.1% were male and 88.8% had been qualified to practice for more than five years. Most physicians (>65%) indicated that 0-30% of PwD missed or skipped, mistimed, or miscalculated an insulin dose in the last 30 days. Common reasons for these actions were that PwD forgot, were out of their normal routine, were too busy or distracted, or were unsure of how much insulin to take. To optimize insulin dosing, over 75% of physicians considered it very helpful for PwD to have real-time insulin dosing calculation guidance, mobile app reminders, a device automatically recording glucose measurements and/or insulin, having insulin and glucose data in one place, and having the time for more meaningful conversations about insulin dosing routines. Conclusion According to physicians' perspectives, suboptimal insulin dosing remains common among PwD. This survey highlights the need for integrated and automated insulin dosing support to manage the complexity of insulin treatment, improve communications between PwD and physicians, and ultimately improve outcomes for PwD.
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Affiliation(s)
- Virginia Bellido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Natalia Duque
- Medical Department, Medical Affairs, Eli Lilly and Company, Madrid, Spain
| | - Rachel S Newson
- NAPAC Real World Evidence, Medical Affairs, Eli Lilly and Company, Sydney, NSW, Australia
| | - Esther Artime
- Medical Department, Medical Affairs, Eli Lilly and Company, Madrid, Spain
| | | | | | | | - Silvia Díaz-Cerezo
- Medical Department, Medical Affairs, Eli Lilly and Company, Madrid, Spain
| | - Jorge Navarro
- Department of Medicine, University of Valencia, Valencia, Spain
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17
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González-Lleó AM, Sánchez-Hernández RM, Plana N, Ibarretxe D, Rehues P, Ribalta J, Llop D, Wägner AM, Masana L, Boronat M. Impact of PCSK9 inhibitors in glycaemic control and new-onset diabetes. Cardiovasc Diabetol 2024; 23:4. [PMID: 38172901 PMCID: PMC10765818 DOI: 10.1186/s12933-023-02077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The diabetogenic effect of statins has been well established by clinical trials, Mendelian randomisation studies and meta-analyses. According to large clinical trials, PCSK9 inhibitors (PCSK9i) have no deleterious impact on glucose metabolism. However, few real-life studies have yet evaluated the long-term effects of these drugs on glucose homeostasis and their impact on new-onset diabetes (NODM). METHODS We studied 218 patients treated with either alirocumab or evolocumab (70% with familial hypercholesterolemia) for at least three years (PCSK9iG). We studied the NODM rate in the nondiabetic group at baseline (168) and overall glucose metabolism control in the whole group. Incidental DM was compared with two groups. The first was a propensity score matching (PSM)-selected group (n = 168) from the database of patients attending the Reus lipid unit (Metbank, n = 745) who were not on PCSK9i (PSMG). The second was a subgroup with a similar age range (n = 563) of the Di@bet.es study (Spanish prospective study on diabetes development n = 5072) (D@G). The incidence was reported as the percentage of NODM cases per year. RESULTS The fasting glucose (FG) level of the subjects with normoglycaemia at baseline increased from 91 (86-95.5) to 93 (87-101) mg/dL (p = 0.014). There were 14 NODM cases in the PCSK9i group (2.6%/y), all among people with prediabetes at baseline. The incidence of NODM in PSMG and D@G was 1.8%/y (p = 0.69 compared with the PCSK9iG). The incidence among the subjects with prediabetes was 5.1%/y in the PCSK9iG, 4.8%/y in the PSMG and 3.9%/y in the D@G (p = 0.922 and p = 0.682, respectively). In the multivariate analysis, only the FG level was associated with the development of NODM in the PCSK9iG (OR 1.1; 95% CI: 1.0-1.3; p = 0.027). Neither FG nor A1c levels changed significantly in patients with DM at baseline. CONCLUSION A nonsignificant increase in NODM occurred in the PCSK9iG, particularly in patients with prediabetes, compared with the PSMG and D@G groups. Baseline FG levels were the main variable associated with the development of DM. In the subjects who had DM at baseline, glucose control did not change. The impact of PCSK9i on glucose metabolism should not be of concern when prescribing these therapies.
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Affiliation(s)
- Ana M González-Lleó
- Sección de Endocrinología y Nutrición. Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria (CHUIMI), Las Palmas de Gran Canaria, España.
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, España.
| | - Rosa M Sánchez-Hernández
- Sección de Endocrinología y Nutrición. Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria (CHUIMI), Las Palmas de Gran Canaria, España
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, España
| | - Núria Plana
- Universitat Rovira i Virgili. Unidad de Medicina Vascular y Metabolismo. Unitat de Recerca Lipids i Arteriosclerosi. Hospital Universitari Sant Joan, IISPV: CIBERDEM., Reus, España
| | - Daiana Ibarretxe
- Universitat Rovira i Virgili. Unidad de Medicina Vascular y Metabolismo. Unitat de Recerca Lipids i Arteriosclerosi. Hospital Universitari Sant Joan, IISPV: CIBERDEM., Reus, España
| | - Pere Rehues
- Universitat Rovira i Virgili. Unidad de Medicina Vascular y Metabolismo. Unitat de Recerca Lipids i Arteriosclerosi. Hospital Universitari Sant Joan, IISPV: CIBERDEM., Reus, España
| | - Josep Ribalta
- Universitat Rovira i Virgili. Unidad de Medicina Vascular y Metabolismo. Unitat de Recerca Lipids i Arteriosclerosi. Hospital Universitari Sant Joan, IISPV: CIBERDEM., Reus, España
| | - Dídac Llop
- Universitat Rovira i Virgili. Unidad de Medicina Vascular y Metabolismo. Unitat de Recerca Lipids i Arteriosclerosi. Hospital Universitari Sant Joan, IISPV: CIBERDEM., Reus, España
| | - Ana M Wägner
- Sección de Endocrinología y Nutrición. Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria (CHUIMI), Las Palmas de Gran Canaria, España
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, España
| | - Lluís Masana
- Universitat Rovira i Virgili. Unidad de Medicina Vascular y Metabolismo. Unitat de Recerca Lipids i Arteriosclerosi. Hospital Universitari Sant Joan, IISPV: CIBERDEM., Reus, España
| | - Mauro Boronat
- Sección de Endocrinología y Nutrición. Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria (CHUIMI), Las Palmas de Gran Canaria, España
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, España
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18
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Fleifel M, Fleifel B, El Alam A. Diabetes Mellitus across the Arabo-Islamic World: A Revolution. Int J Endocrinol 2023; 2023:5541808. [PMID: 38021083 PMCID: PMC10656201 DOI: 10.1155/2023/5541808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Mankind continues to suffer from the ever-growing diabetes epidemic and the rapid rise of type 2 diabetes mellitus (T2DM). This metabolic disease has been studied since ancient civilizations. The Arabo-Islamic civilization excelled in establishing some of the most notable discoveries and teachings that remained the blueprint for years to come in the field of diabetology. Aim This article aimed to review the ancient history of diabetes mellitus, with its main focus on the Arabo-Islamic civilization, and to report our subjective views and analysis of some of the past recommendations based on modern-day findings. Discussion. It is natural to have the teachings of medicine dynamically inspired by one civilization to another, as various fields continue to expand and evolve. This also applies to diabetology as the Arabo-Islamic world used the outlines of prior civilizations to revolutionize the understanding of the disease. Al-Razi and Ibn Sina are probably two of the most renowned polymaths in history, and their contributions to diabetology are well documented. Ibn Maymun's postulation about the higher prevalence of diabetes in Egypt as compared to Andalusia is something to be carefully studied. It could be that diabetes mellitus' underdiagnosis and late-stage detection are some of the major reasons for the disparity between the two mentioned regions. Modern-day Arabo-Islamic scholars continue to excel in revolutionizing diabetology. Conclusion The Arabo-Islamic world houses an impressive bout of scholars who have contributed since the ancient times to diabetology. This scientific locomotion shows no signs of stopping, as it continues to shine during the present day, and likely in the future.
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Affiliation(s)
- Mohamad Fleifel
- Endocrinology and Metabolism Division, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Andrew El Alam
- Endocrinology Division, Centre Hospitalier de Chartres, Louis Pasteur Hospital, Chartres, France
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19
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Sacramento-Pacheco J, Sánchez-Gómez MB, Gómez-Salgado J, Novo-Muñoz MM, Duarte-Clíments G. Prevalence of Cardiovascular Risk Factors in Spain: A Systematic Review. J Clin Med 2023; 12:6944. [PMID: 37959409 PMCID: PMC10650307 DOI: 10.3390/jcm12216944] [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: 10/16/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
Cardiovascular diseases are the leading cause of death in Spain, according to data from the National Institute of Statistics, with the lack of control of cardiovascular risk factors (CVRF) being the main contributing factor. The CVRFs of greatest clinical interest are high blood pressure (HBP), smoking, diabetes mellitus (DM2), overweight, obesity, hypercholesterolaemia, and sedentary lifestyle. The main objective of this review was to compare the prevalence of the different CVRFs according to population-based studies carried out in Spain. For this, a systematic review based on publications assessing CVRFs in the adult population and estimating their national prevalence was conducted. Pubmed and Dialnet databases were consulted, and the selected articles were analysed using the Critical Appraisal Skills Programme Español (CASPe) tool for cohort studies and the Berra et al. tool for cross-sectional studies. A total of 33 studies were obtained from the autonomous regions of Andalusia, the Canary Islands, Castilla-Leon, Castilla-La Mancha, Catalonia, Extremadura, the Balearic Islands, Madrid, Murcia, and Navarra. In all the population-based studies, there was a greater representation of women in the sample. The most prevalent CVRFs differed across the studies according to the autonomous region targeted, with dyslipidaemia, sedentary lifestyle, high blood pressure, hypercholesterolaemia, overweight, and obesity standing out. Numerous differences exist between the studies included in this review, such as the age range, the CVRFs analysed and their prevalence, and remarkable aspects such as the over-representation of the female sex in all cases. It can be concluded that, based on the presented results, the prevalence of CVRFs in Spain varies according to the autonomous region, the sex of the individual, and the studied age range.
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Affiliation(s)
- Jennifer Sacramento-Pacheco
- Nuestra Señora de Candelaria Nursing University School, University of La Laguna, 38010 San Cristóbal de La Laguna, Spain
- Europa Sur Educational Centre (CESUR Tenerife), 38006 Santa Cruz de Tenerife, Spain
| | - María Begoña Sánchez-Gómez
- Cátedra de Enfermería, Universidad de La Laguna, 38200 San Cristóbal de La Laguna, Spain
- Cieza Este Health Centre, Area IX, Servicio Murciano de Salud, 30530 Murcia, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21071 Huelva, Spain
- Safety and Health Postgraduate Program, Universidad Espíritu Santo, Guayaquil 092301, Ecuador
| | - María Mercedes Novo-Muñoz
- Department of Nursing, Faculty of Health Sciences, University of La Laguna, 38200 San Cristóbal de La Laguna, Spain
| | - Gonzalo Duarte-Clíments
- Cátedra de Enfermería, Universidad de La Laguna, 38200 San Cristóbal de La Laguna, Spain
- Case Management, Area IX, Servicio Murciano de Salud, 30530 Murcia, Spain
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20
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Galeano-Fernández TF, Carretero-Gómez J, Vidal-Ríos AS, García-García GM, García-Carrasco C, Monreal-Periañez FJ, González-González P, Córdoba-Bueno S, Pijierro-Amador A, Carlos Arévalo-Lorido J. Impact of diabetes, malnutrition and sarcopenia on the prognosis of patients admitted to internal medicine. Rev Clin Esp 2023; 223:523-531. [PMID: 37716428 DOI: 10.1016/j.rceng.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To describe patients hospitalized in internal medicine in terms of malnutrition and sarcopenia, depending on the presence or absence of type 2 diabetes mellitus (DM2), as well as to evaluate short- and long-term mortality related to both. METHODS Cross-sectional, single-center study, which included consecutive patients admitted to internal medicine in May and October 2021. Malnutrition was determined using the Mini Nutritional Assessment-Short Form (MNA-SF) and sarcopenia using SARC-F and handgrip strength. Patients hospitalized for more than 48 h are excluded. RESULTS 511 patients were analyzed, 49.1% male, mean age 75.2 +/- 15 years, 210 (41.1%) DM2. 6 groups (2 × 3 design) are generated based on the presence of DM2 and the nutritional status according to the result of the MNA-SF: 12-14 points, without risk; MNA-SF 8-12 points, high risk; MNA-SF 0-7 points, malnourished. Malnourished patients with DM2 had significantly higher sarcopenia, comorbidity, inflammation, and pressure ulcers. The main determinants of in-hospital mortality were sarcopenia (OR 1.27, 95%CI 1.06-1.54, p = 0.01), comorbidity (OR 1.27, 95%CI 1,08-1,49, p = 0.003) and inflammation (OR 1.01, 95%CI 1.00-1.02, p = 0.02). The 120-day prognosis was worse among malnourished patients (p = 0.042). CONCLUSION Patients admitted with DM2 have a similar degree of malnutrition than the rest, but with greater sarcopenia. This sarcopenia, together with inflammation and comorbidity determine a worse prognosis. The active and early identification of malnutrition and sarcopenia and their subsequent approach could improve the prognosis of patients.
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Affiliation(s)
- T F Galeano-Fernández
- Departamento de Medicina Interna, Hospital Universitario, Complejo Hospitalario Universitario de Badajoz, Spain
| | - J Carretero-Gómez
- Departamento de Medicina Interna, Hospital Universitario, Complejo Hospitalario Universitario de Badajoz, Spain.
| | - A S Vidal-Ríos
- Departamento de Medicina Interna, Hospital Universitario, Complejo Hospitalario Universitario de Badajoz, Spain
| | - G M García-García
- Departamento de Medicina Interna, Hospital Universitario, Complejo Hospitalario Universitario de Badajoz, Spain
| | - C García-Carrasco
- Departamento de Medicina Interna, Hospital Universitario, Complejo Hospitalario Universitario de Badajoz, Spain
| | - F J Monreal-Periañez
- Departamento de Medicina Interna, Hospital Universitario, Complejo Hospitalario Universitario de Badajoz, Spain
| | - P González-González
- Departamento de Medicina Interna, Hospital Universitario, Complejo Hospitalario Universitario de Badajoz, Spain
| | - S Córdoba-Bueno
- Departamento de Medicina Interna, Hospital Universitario, Complejo Hospitalario Universitario de Badajoz, Spain
| | - A Pijierro-Amador
- Departamento de Medicina Interna, Hospital Universitario, Complejo Hospitalario Universitario de Badajoz, Spain
| | - J Carlos Arévalo-Lorido
- Departamento de Medicina Interna, Hospital Universitario, Complejo Hospitalario Universitario de Badajoz, Spain
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21
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Araujo-Castro M, Paja Fano M, Pla Peris B, González Boillos M, Pascual-Corrales E, García Cano AM, Parra Ramírez P, Martín Rojas-Marcos P, Ruiz-Sanchez JG, Vicente Delgado A, Gómez Hoyos E, Ferreira R, García Sanz I, Recasens Sala M, Barahona San Millan R, Picón César MJ, Díaz Guardiola P, Perdomo CM, Manjón Miguélez L, García Centeno R, Percovich JC, Rebollo Román Á, Gracia Gimeno P, Robles Lázaro C, Morales-Ruiz M, Calatayud Gutiérrez M, Furio Collao SA, Meneses D, Sampedro Nuñez MA, Escudero Quesada V, Mena Ribas E, Sanmartín Sánchez A, Gonzalvo Diaz C, Lamas C, Guerrero-Vázquez R, Del Castillo Tous M, Serrano Gotarredona J, Michalopoulou Alevras T, Moya Mateo EM, Hanzu FA. Prevalence, risk factors and evolution of diabetes mellitus after treatment in primary aldosteronism. Results from the SPAIN-ALDO registry. J Endocrinol Invest 2023; 46:2343-2352. [PMID: 37037973 DOI: 10.1007/s40618-023-02090-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/05/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To evaluate the prevalence, risk factors and evolution of diabetes mellitus (DM) after targeted treatment in patients with primary aldosteronism (PA). METHODS A retrospective multicenter study of PA patients in follow-up at 27 Spanish tertiary hospitals (SPAIN-ALDO Register). RESULTS Overall, 646 patients with PA were included. At diagnosis, 21.2% (n = 137) had DM and 67% of them had HbA1c levels < 7%. In multivariate analysis, family history of DM (OR 4.00 [1.68-9.53]), the coexistence of dyslipidemia (OR 3.57 [1.51-8.43]) and advanced age (OR 1.04 per year of increase [1.00-1.09]) were identified as independent predictive factors of DM. Diabetic patients were on beta blockers (46.7% (n = 64) vs. 27.5% (n = 140), P < 0.001) and diuretics (51.1% (n = 70) vs. 33.2% (n = 169), p < 0.001) more frequently than non-diabetics. After a median follow-up of 22 months [IQR 7.5-63.0], 6.9% of patients developed DM, with no difference between those undergoing adrenalectomy and those treated medically (HR 1.07 [0.49-2.36], p = 0.866). There was also no significant difference in the evolution of glycemic control between DM patients who underwent surgery and those medically treated (p > 0.05). CONCLUSION DM affects about one quarter of patients with PA and the risk factors for its development are common to those of the general population. Medical and surgical treatment provides similar benefit in glycemic control in patients with PA and DM.
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Affiliation(s)
- M Araujo-Castro
- Endocrinology and Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Colmenar Viejo Street Km 9, 28034, Madrid, Spain.
- University of Alcalá, Madrid, Spain.
| | - M Paja Fano
- Endocrinology and Nutrition Department, OSI Bilbao-Basurto, Hospital Universitario de Basurto, Bilbao, Spain
- Medicine Department, Basque Country University, Bilbao, Spain
| | - B Pla Peris
- Endocrinology and Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain
| | - M González Boillos
- Endocrinology and Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain
| | - E Pascual-Corrales
- Endocrinology and Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Colmenar Viejo Street Km 9, 28034, Madrid, Spain
| | - A M García Cano
- Biochemistry Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - P Parra Ramírez
- Endocrinology and Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain
| | - P Martín Rojas-Marcos
- Endocrinology and Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain
| | - J G Ruiz-Sanchez
- Endocrinology and Nutrition Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Vicente Delgado
- Endocrinology and Nutrition Department, Hospital Universitario de Toledo, Toledo, Spain
| | - E Gómez Hoyos
- Endocrinology and Nutrition Department, Hospital Universitario de Valladolid, Valladolid, Spain
| | - R Ferreira
- Endocrinology and Nutrition Department, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - I García Sanz
- General and Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - M Recasens Sala
- Endocrinology and Nutrition Department, Institut Català de La Salut Girona, Girona, Spain
| | - R Barahona San Millan
- Endocrinology and Nutrition Department, Institut Català de La Salut Girona, Girona, Spain
| | - M J Picón César
- Endocrinology and Nutrition Department, Hospital Universitario Virgen de La Victoria de Málaga, IBIMA, Málaga, Spain
- CIBEROBN, Madrid, Spain
| | - P Díaz Guardiola
- Endocrinology and Nutrition Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - C M Perdomo
- Endocrinology and Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - L Manjón Miguélez
- Endocrinology and Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - R García Centeno
- Endocrinology and Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - J C Percovich
- Endocrinology and Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Á Rebollo Román
- Endocrinology and Nutrition Department, Hospital Reina Sofía, Córdoba, Spain
| | - P Gracia Gimeno
- Endocrinology and Nutrition Department, Hospital Rollo Villanova, Saragossa, Spain
| | - C Robles Lázaro
- Endocrinology and Nutrition Department, Complejo Universitario de Salamanca, Salamanca, Spain
| | - M Morales-Ruiz
- Biochemistry and Molecular Genetics Department-CDB, CIBERehd, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | | | - S A Furio Collao
- Endocrinology and Nutrition Department, Hospital Doce de Octubre, Madrid, Spain
| | - D Meneses
- Endocrinology and Nutrition Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - M A Sampedro Nuñez
- Endocrinology and Nutrition Department, Hospital Universitario La Princesa Madrid, Madrid, Spain
| | - V Escudero Quesada
- Nephrology Department, Hospital Universitario Doctor Peser, Valencia, Spain
| | - E Mena Ribas
- Endocrinology and Nutrition Department, Hospital Universitario Son Espases, Palma, Islas Baleares, Spain
| | - A Sanmartín Sánchez
- Endocrinology and Nutrition Department, Hospital Universitario Son Espases, Palma, Islas Baleares, Spain
| | - C Gonzalvo Diaz
- Endocrinology and Nutrition Department, Hospital Universitario De Albacete, Albacete, Spain
| | - C Lamas
- Endocrinology and Nutrition Department, Hospital Universitario De Albacete, Albacete, Spain
| | - R Guerrero-Vázquez
- Endocrinology and Nutrition Department, Hospital Virgen de La Macarena, Seville, Spain
| | - M Del Castillo Tous
- Endocrinology and Nutrition Department, Hospital Virgen de La Macarena, Seville, Spain
| | - J Serrano Gotarredona
- Endocrinology and Nutrition Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - E M Moya Mateo
- Internal Medicine, Hospital Infanta Leonor de Vallecas, Madrid, Spain
| | - F A Hanzu
- Endocrinology and Nutrition Department, Hospital Clinic, IDIPAS, Barcelona, Spain
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22
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Zamanillo-Campos R, Fiol-deRoque MA, Serrano-Ripoll MJ, Mira-Martínez S, Ricci-Cabello I. Development and evaluation of DiabeText, a personalized mHealth intervention to support medication adherence and lifestyle change behaviour in patients with type 2 diabetes in Spain: A mixed-methods phase II pragmatic randomized controlled clinical trial. Int J Med Inform 2023; 176:105103. [PMID: 37267809 DOI: 10.1016/j.ijmedinf.2023.105103] [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: 01/24/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Despite the increasing interest in text-messaging interventions to support healthcare delivery, the available evidence about their effectiveness is still limited. OBJECTIVES 1) to develop DiabeText, an intervention delivering automated, tailored brief text messages to support diabetes self-management; 2) to explore the potential impact of DiabeText on self-management behavior and glycaemic control, and; 3) to examine the feasibility of conducting a future phase III randomized clinical trial to evaluate the effectiveness of DiabeText. METHODS 3-month, two-arm, randomized feasibility trial (ClinicalTrials.gov: NCT04738591) with patients with type 2 diabetes (HbA1c > 8%). Participants were allocated to the control (usual care) or DiabeText group (usual care + five text messages per week). Outcomes were: recruitment rate; follow-up rate, missing data; medication adherence; adherence to Mediterranean diet; physical activity; and HbA1c. In addition, after delivering the intervention, we conducted a qualitative study involving 14 semi-structured interviews with participants allocated to the DiabeText group, to understand their views about the intervention. RESULTS From 444 screened people, we recruited 207 participants (recruitment rate = 47%), of which 179 completed the post-intervention interview (follow-up rate = 86%). We sent 7,355 SMS during the intervention period, of which 99% successfully reached the participants. At post-intervention, DiabeText was associated with non-statistically significant (p > 0.05) improvements in adherence to medication (OR = 2.0; 95%CI 1.0 to 4.2), Mediterranean diet (1.7; 0.9 to 3.2), and physical activity (1.7; 0.9 to 3.1). No between-group differences were observed in mean HbA1c (p = 0.670). The qualitative study indicated that participants perceived DiabeText as a helpful resource because it increased their awareness about the importance of adequate self-management and the sense of being cared for. CONCLUSIONS DiabeText is the first system in Spain to integrate patient-generated and routinely collected clinical data to deliver tailored text messages to support diabetes self-management. More robust trials are needed to determine its effectiveness and cost-efficacy.
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Affiliation(s)
- Rocío Zamanillo-Campos
- Balearic Islands Health Research Institute (IdISBa) Carretera de Valldemossa, 79, Hospital Universitari Son Espases. Edifici S, 07120 Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain
| | - Maria Antonia Fiol-deRoque
- Balearic Islands Health Research Institute (IdISBa) Carretera de Valldemossa, 79, Hospital Universitari Son Espases. Edifici S, 07120 Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain.
| | - Maria Jesús Serrano-Ripoll
- Balearic Islands Health Research Institute (IdISBa) Carretera de Valldemossa, 79, Hospital Universitari Son Espases. Edifici S, 07120 Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS, RD21/0016/0005), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Sofía Mira-Martínez
- Balearic Islands Health Research Institute (IdISBa) Carretera de Valldemossa, 79, Hospital Universitari Son Espases. Edifici S, 07120 Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain
| | - Ignacio Ricci-Cabello
- Balearic Islands Health Research Institute (IdISBa) Carretera de Valldemossa, 79, Hospital Universitari Son Espases. Edifici S, 07120 Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain
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23
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Llamas-Saez C, Saez-Vaquero T, Jiménez-García R, López-de-Andrés A, Carabantes-Alarcón D, Zamorano-León JJ, Cuadrado-Corrales N, Pérez-Farinos N, Wärnberg J. Cross Sectional and Case-Control Study to Assess Time Trend, Gender Differences and Factors Associated with Physical Activity among Adults with Diabetes: Analysis of the European Health Interview Surveys for Spain (2014 & 2020). J Clin Med 2023; 12:jcm12062443. [PMID: 36983443 PMCID: PMC10057052 DOI: 10.3390/jcm12062443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: We aim to assess the time trend from 2014 to 2020 in the prevalence of physical activity (PA), identify gender differences and sociodemographic and health-related factors associated with PA among people with diabetes, and compare PA between people with and without diabetes. (2) Methods: We conducted a cross-sectional and a case-control study using as data source the European Health Interview Surveys for Spain (EHISS) conducted in years 2014 and 2020. The presence of diabetes and PA were self-reported. Covariates included socio-demographic characteristics, health-related variables, and lifestyles. To compare people with and without diabetes, we matched individuals by age and sex. (3) Results: The number of participants aged ≥18 years with self-reported diabetes were 1852 and 1889 in the EHISS2014 and EHISS2020, respectively. The proportion of people with diabetes that had a medium or high frequency of PA improved from 48.3% in 2014 to 52.6% in 2020 (p = 0.009), with 68.5% in 2014 and 77.7% in 2020 being engaged in two or more days of PA (p < 0.001). Males with diabetes reported more PA than females with diabetes in both surveys. After matching by age and gender, participants with diabetes showed significantly lower engagement in PA than those without diabetes. Among adults with diabetes, multivariable logistic regression showed confirmation that PA improved significantly from 2014 to 2020 and that male sex, higher educational level, and better self-rated health were variables associated to more PA. However, self-reported comorbidities, smoking, or BMI > 30 were associated to less PA. (4) Conclusions: The time trend of PA among Spanish adults with diabetes is favorable but insufficient. The prevalence of PA in this diabetes population is low and does not reach the levels of the general population. Gender differences were found with significantly more PA among males with diabetes. Our result could help to improve the design and implementation of public health strategies to improve PA among people with diabetes.
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Affiliation(s)
- Carlos Llamas-Saez
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | | | - Rodrigo Jiménez-García
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - Ana López-de-Andrés
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - David Carabantes-Alarcón
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - José J Zamorano-León
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - Natividad Cuadrado-Corrales
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - Napoleón Pérez-Farinos
- Epi-PHAAN Research Group, School of Medicine, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain
| | - Julia Wärnberg
- Epi-PHAAN Research Group, School of Health Sciences, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain
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24
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Vázquez-Ruiz Z, Martínez-González MÁ, Vitelli-Storelli F, Bes-Rastrollo M, Basterra-Gortari FJ, Toledo E. Effect of Dietary Phenolic Compounds on Incidence of Type 2 Diabetes in the "Seguimiento Universidad de Navarra" (SUN) Cohort. Antioxidants (Basel) 2023; 12:antiox12020507. [PMID: 36830064 PMCID: PMC9952475 DOI: 10.3390/antiox12020507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
The global incidence of type 2 diabetes (T2D) has been steadily increasing in recent decades. The Mediterranean dietary pattern has shown a preventive effect on the risk of T2D. Evaluating the association between bioactive compounds such as phenolic compounds (PC) in a Mediterranean cohort could help to better understand the mechanisms implicated in this protection. We evaluated the association between dietary intake of PC and the risk of T2D in a relatively young cohort of 17,821 Spanish participants initially free of T2D, through the University of Navarra Follow-up Project ("Seguimiento Universidad de Navarra" or SUN cohort) after 10 years of median follow-up using time-dependent Cox models. Intake of PC was estimated at baseline and repeatedly at 10-year follow-up using a 136-item validated food frequency and the Phenol-Explorer database. The incidence of T2D was identified by a biennial follow-up, and only medically confirmed cases were included. During 224,751 person-years of follow-up, 186 cases of T2D were confirmed. A suboptimal intake of stilbenes was independently associated with a higher risk of T2D in subjects over 50 years (HR: 1.75, 95% CI: 1.06-2.90, p value < 0.05) after adjusting for potential confounders. Our results suggest that a moderate-high intake of stilbenes can decrease the risk of developing T2D in subjects over 50 years in our cohort.
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Affiliation(s)
- Zenaida Vázquez-Ruiz
- Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), University of Navarra, 31008 Pamplona, Spain
- Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), University of Navarra, 31008 Pamplona, Spain
- Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Facundo Vitelli-Storelli
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS), Instituto de Biomedicina (IBIOMED), University of León, 24004 León, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), University of Navarra, 31008 Pamplona, Spain
- Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
| | - Francisco Javier Basterra-Gortari
- Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), University of Navarra, 31008 Pamplona, Spain
- Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Estefanía Toledo
- Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), University of Navarra, 31008 Pamplona, Spain
- Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, 28029 Madrid, Spain
- Correspondence:
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25
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Mathieu C, Soderberg J, Del Prato S, Felton AM, Cos X, de Beaufort C, Gautier JF, Hauck B, Forbes A, Heine R, Schwarz P, Torbeyns B. The European Diabetes Forum (EUDF): a forum for turning the tide on diabetes in Europe. Diabetologia 2023; 66:247-252. [PMID: 36394645 PMCID: PMC9670050 DOI: 10.1007/s00125-022-05831-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | | | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy
| | | | - Xavier Cos
- Innovation and Research Support Office, Institut Català de la Salut, Universitat Autònoma de Barcelona, Generalitat de Catalunya, Barcelona, Spain
| | - Carine de Beaufort
- Department of Pediatric Diabetes and Endocrinology, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
| | - Jean-François Gautier
- Service de Diabétologie et d'Endocrinologie, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Angus Forbes
- Division of Care in Long Term Conditions, King's College London, London, UK
| | | | - Peter Schwarz
- Department for Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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26
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Domingo-Relloso A, Gribble MO, Riffo-Campos AL, Haack K, Cole SA, Tellez-Plaza M, Umans JG, Fretts AM, Zhang Y, Fallin MD, Navas-Acien A, Everson TM. Epigenetics of type 2 diabetes and diabetes-related outcomes in the Strong Heart Study. Clin Epigenetics 2022; 14:177. [PMID: 36529747 PMCID: PMC9759920 DOI: 10.1186/s13148-022-01392-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes has dramatically increased in the past years. Increasing evidence supports that blood DNA methylation, the best studied epigenetic mark, is related to diabetes risk. Few prospective studies, however, are available. We studied the association of blood DNA methylation with diabetes in the Strong Heart Study. We used limma, Iterative Sure Independence Screening and Cox regression to study the association of blood DNA methylation with fasting glucose, HOMA-IR and incident type 2 diabetes among 1312 American Indians from the Strong Heart Study. DNA methylation was measured using Illumina's MethylationEPIC beadchip. We also assessed the biological relevance of our findings using bioinformatics analyses. RESULTS Among the 358 differentially methylated positions (DMPs) that were cross-sectionally associated either with fasting glucose or HOMA-IR, 49 were prospectively associated with incident type 2 diabetes, although no DMPs remained significant after multiple comparisons correction. Multiple of the top DMPs were annotated to genes with relevant functions for diabetes including SREBF1, associated with obesity, type 2 diabetes and insulin sensitivity; ABCG1, involved in cholesterol and phospholipids transport; and HDAC1, of the HDAC family. (HDAC inhibitors have been proposed as an emerging treatment for diabetes and its complications.) CONCLUSIONS: Our results suggest that differences in peripheral blood DNA methylation are related to cross-sectional markers of glucose metabolism and insulin activity. While some of these DMPs were modestly associated with prospective incident type 2 diabetes, they did not survive multiple testing. Common DMPs with diabetes epigenome-wide association studies from other populations suggest a partially common epigenomic signature of glucose and insulin activity.
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Affiliation(s)
- Arce Domingo-Relloso
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain.
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
- Department of Statistics and Operations Research, University of Valencia, Valencia, Spain.
| | - Matthew O Gribble
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Angela L Riffo-Campos
- Millennium Nucleus On Sociomedicine (SocioMed) and Vicerrectoría Académica, Universidad de La Frontera, Temuco, Chile
- Department of Computer Science, ETSE, University of Valencia, Valencia, Spain
| | - Karin Haack
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Shelley A Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Maria Tellez-Plaza
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, USA
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
| | - Amanda M Fretts
- Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - Ying Zhang
- Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - M Daniele Fallin
- Emory University Rollins School of Public Health, Atlanta, GA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Todd M Everson
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
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27
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Marco A, Pazos-Couselo M, Moreno-Fernandez J, Díez-Fernández A, Alonso-Sampedro M, Fernández-Merino C, Gonzalez-Quintela A, Gude F. Time above range for predicting the development of type 2 diabetes. Front Public Health 2022; 10:1005513. [PMID: 36568777 PMCID: PMC9772988 DOI: 10.3389/fpubh.2022.1005513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Aim To investigate the prognostic value of time range metrics, as measured by continuous glucose monitoring, with respect to the development of type 2 diabetes (T2D). Research design and methods A total of 499 persons without diabetes from the general population were followed-up for 5 years. Time range metrics were measured at the start and medical records were checked over the period study. Results Twenty-two subjects (8.3 per 1,000 person-years) developed T2D. After adjusting for age, gender, family history of diabetes, body mass index and glycated hemoglobin concentration, multivariate analysis revealed 'time above range' (TAR, i.e., with a plasma glucose concentration of >140 mg/dL) to be significantly associated with a greater risk (OR = 1.06, CI 1.01-1.11) of developing diabetes (AUC = 0.94, Brier = 0.035). Conclusions Time above range provides additional information to that offered by glycated hemoglobin to identify patients at a higher risk of developing type 2 diabetes in a population-based study.
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Affiliation(s)
- Alejandra Marco
- Primary Care Center, Santiago de Compostela, Spain,Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Marcos Pazos-Couselo
- Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain,*Correspondence: Marcos Pazos-Couselo
| | - Jesús Moreno-Fernandez
- Endocrinology and Nutrition Service, Ciudad Real General University Hospital, Ciudad Real, Spain
| | - Ana Díez-Fernández
- Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Manuela Alonso-Sampedro
- Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,Department of Clinical Epidemiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmen Fernández-Merino
- Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,Primary Care Center, A Estrada, Spain
| | - Arturo Gonzalez-Quintela
- Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,Department of Internal Medicine, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Francisco Gude
- Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain,Department of Clinical Epidemiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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28
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Gonzalez-Hernandez M, Gonzalez-Hernandez D, Betancor-Caro N, Guedes-Guedes I, Guldager MK, Gonzalez de la Rosa M. Glaucoma Incidence and Progression in Diabetics: The Canary Islands Study Using the Laguna ONhE Application. J Clin Med 2022; 11:jcm11247294. [PMID: 36555912 PMCID: PMC9786827 DOI: 10.3390/jcm11247294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/25/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Background: Laguna ONhE provides a globin distribution function (GDF), in which a glaucoma discriminator based on deep learning plays an important role, and there is also an optimized globin individual pointer (GIP) for progression analysis. Methods: Signs of optic nerve glaucoma were identified in 1,124,885 fundus images from 203,115 diabetics obtained over 15 years and 117,813 control images. Results: A total of 743,696 images from 313,040 eyes of 173,661 diabetics were analysed. Some exclusions occurred due to excessive illumination, poor quality, or the absence of optic discs. Suspicion of glaucoma was reported in 6.70%, for an intended specificity of 99% (GDF < −15). More signs of glaucoma occur in diabetics as their years of disease increase, and after age 60, compared to controls. The GIP detected progression (p < 0.01) in 2.59% of cases with 4 controls and in 42.6% with 14 controls was higher in cases with lower GDF values. The GDF was corrected for the disc area and proved to be independent of it (r = 0.001925; p = 0.2814). Conclusions: The GDF index suggests a higher and increasing glaucoma probability in diabetics over time. Doubling the number of check-ups from four to eight increases the ability to detect GIP index progression by a factor of 5.
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Affiliation(s)
- Marta Gonzalez-Hernandez
- INSOFT S.L. 25 de Julio, 34, 38004 Santa Cruz de Tenerife, Spain
- Ophthalmology Department, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristobal de La Laguna, Spain
| | | | - Nisamar Betancor-Caro
- Ophthalmology Department, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristobal de La Laguna, Spain
| | - Isabel Guedes-Guedes
- Ophthalmology Department, Hospital Insular de Gran Canaria, Avenida de Canarias, S/N, 35016 Las Palmas de Gran Canaria, Spain
| | - Morten Kirk Guldager
- RetinaLyze System A/S, Sankt Lukas Stiftelsen, Bernstorffsvej 20, 2900 Hellerup, Denmark
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Gaggero A, Gil J, Jiménez-Rubio D, Zucchelli E. Does health information affect lifestyle behaviours? The impact of a diabetes diagnosis. Soc Sci Med 2022; 314:115420. [PMID: 36327630 DOI: 10.1016/j.socscimed.2022.115420] [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: 04/25/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
Despite an increasing interest in the effect of health information on health-behaviours, evidence on the causal impact of a diagnosis on lifestyle factors is still mixed and does not often account for long-term effects. We explore the role of health information in individual health-related decisions by identifying the causal impact of a type-2 diabetes diagnosis on body mass index (BMI) and lifestyle behaviours. We employ a fuzzy regression discontinuity design (RDD) exploiting the exogenous cut-off value in the diagnosis of type-2 diabetes provided by a biomarker (glycated haemoglobin) drawn from unique administrative longitudinal data from Spain. We find that following a type-2 diabetes diagnosis individuals appear to reduce their weight in the short-term. Differently from previous studies, we also provide evidence of statistically significant long-term impacts of a type-2 diabetes diagnosis on BMI up to three years from the diagnosis. We do not find perceivable effects of a type-2 diabetes diagnosis on quitting smoking or drinking. Overall, health information appears to have a sustained causal impact on weight reduction, a key lifestyle and risk factor among individuals with type-2 diabetes.
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Affiliation(s)
- Alessio Gaggero
- Department of Quantitative Methods, University of Granada, Granada, Spain
| | - Joan Gil
- Department of Economics and BEAT, Universitat de Barcelona, Spain
| | | | - Eugenio Zucchelli
- Madrid Institute for Advanced Study (MIAS) and Department of Economic Analysis, Universidad Autónoma de Madrid (UAM), Spain; Lancaster University, UK; IZA, Germany
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30
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Fernández LP, Deleyto-Seldas N, Colmenarejo G, Sanz A, Wagner S, Plata-Gómez AB, Gómez-Patiño M, Molina S, Espinosa-Salinas I, Aguilar-Aguilar E, Ortega S, Graña-Castro O, Loria-Kohen V, Fernández-Marcos PJ, Efeyan A, Ramírez de Molina A. Folliculin-interacting protein FNIP2 impacts on overweight and obesity through a polymorphism in a conserved 3' untranslated region. Genome Biol 2022; 23:230. [PMID: 36316722 PMCID: PMC9620695 DOI: 10.1186/s13059-022-02798-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/19/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Overweight and obesity are defined by an anomalous or excessive fat accumulation that may compromise health. To find single-nucleotide polymorphisms (SNPs) influencing metabolic phenotypes associated with the obesity state, we analyze multiple anthropometric and clinical parameters in a cohort of 790 healthy volunteers and study potential associations with 48 manually curated SNPs, in metabolic genes functionally associated with the mechanistic target of rapamycin (mTOR) pathway. RESULTS We identify and validate rs2291007 within a conserved region in the 3'UTR of folliculin-interacting protein FNIP2 that correlates with multiple leanness parameters. The T-to-C variant represents the major allele in Europeans and disrupts an ancestral target sequence of the miRNA miR-181b-5p, thus resulting in increased FNIP2 mRNA levels in cancer cell lines and in peripheral blood from carriers of the C allele. Because the miRNA binding site is conserved across vertebrates, we engineered the T-to-C substitution in the endogenous Fnip2 allele in mice. Primary cells derived from Fnip2 C/C mice show increased mRNA stability, and more importantly, Fnip2 C/C mice replicate the decreased adiposity and increased leanness observed in human volunteers. Finally, expression levels of FNIP2 in both human samples and mice negatively associate with leanness parameters, and moreover, are the most important contributor in a multifactorial model of body mass index prediction. CONCLUSIONS We propose that rs2291007 influences human leanness through an evolutionarily conserved modulation of FNIP2 mRNA levels.
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Affiliation(s)
- Lara P Fernández
- Molecular Oncology Group, IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | | | - Gonzalo Colmenarejo
- Biostatistics and Bioinformatics Unit, IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Alba Sanz
- Spanish National Cancer Research Center, Madrid, Spain
| | - Sonia Wagner
- Molecular Oncology Group, IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | | | - Mónica Gómez-Patiño
- GENYAL Platform on Nutrition and Health, IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Susana Molina
- GENYAL Platform on Nutrition and Health, IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Isabel Espinosa-Salinas
- GENYAL Platform on Nutrition and Health, IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Elena Aguilar-Aguilar
- GENYAL Platform on Nutrition and Health, IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Sagrario Ortega
- Mouse Genome Editing Unit, Spanish National Cancer Research Center, Madrid, Spain
| | - Osvaldo Graña-Castro
- Bioinformatics Unit, Spanish National Cancer Research Center, Madrid, Spain
- Institute of Applied Molecular Medicine (IMMA-Nemesio Díez), Department of Basic Medical Sciences, School of Medicine, San Pablo-CEU University, CEU Universities, Boadilla del Monte, Madrid, Spain
| | - Viviana Loria-Kohen
- GENYAL Platform on Nutrition and Health, IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | | | - Alejo Efeyan
- Spanish National Cancer Research Center, Madrid, Spain.
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Velicia Peñas C, Del Campo Pérez VM, Rivero Calle I, Armenteros Del Olmo L, Pérez Rodríguez MT, Gestal Otero JJ. [Expert opinion on strategies to improve vaccination coverage against seasonal influenza]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:435-443. [PMID: 35726347 PMCID: PMC9548073 DOI: 10.37201/req/031.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/10/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
Seasonal flu continues to be a major public health concern, and the influenza vaccine remains the most effective preventive measure. In Spain, vaccination coverage data from previous seasons show vaccination rates well below official targets; however, these figures improved significantly after the COVID-19 pandemic. Given the importance of achieving and maintaining high vaccination rates in order to avoid the clinical and economic impact of influenza, our multidisciplinary group of experts on vaccines analyzed the impact of low vaccination rates in Spain and drafted a series of measures to boost influenza vaccination coverage, particularly among priority groups.
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Affiliation(s)
| | | | | | | | | | - J J Gestal Otero
- Prof. Dr. Juan Jesús Gestal Otero. Profesor emérito de Medicina Preventiva y Salud Pública de la USC, Facultad de Medicina. c/ San Francisco s/n. 15701. Santiago de Compostela, Spain.
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Carretero-Gómez J, Arévalo-Lorido JC. The meaning of words in diabetes. Language matters. Rev Clin Esp 2022; 222:502-503. [PMID: 36114147 DOI: 10.1016/j.rceng.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Affiliation(s)
- J Carretero-Gómez
- Servicio de Medicina Interna, Hospital Universitario de Badajoz, Badajoz, Spain.
| | - J C Arévalo-Lorido
- Servicio de Medicina Interna, Hospital Universitario de Badajoz, Badajoz, Spain
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El significado de las palabras en la diabetes. El lenguaje importa. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Orozco-Beltrán D, Brotons Cuixart C, Banegas Banegas JR, Gil Guillén VF, Cebrián Cuenca AM, Martín Rioboó E, Jordá Baldó A, Vicuña J, Navarro Pérez J. [Cardiovascular preventive recommendations. PAPPS 2022 thematic updates. Working groups of the PAPPS]. Aten Primaria 2022; 54 Suppl 1:102444. [PMID: 36435583 PMCID: PMC9705225 DOI: 10.1016/j.aprim.2022.102444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; cardiovascular (CV) risk and recommendations for the calculation of CV risk; main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation, and recommendations for management of chronic conditions. The quality of testing and the strength of the recommendation are included in the main recommendations.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Medicina Familiar y Comunitaria, Unidad de Investigación Centro de Salud Cabo Huertas, Departamento San Juan de Alicante. Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España.
| | - Carlos Brotons Cuixart
- Medicina Familiar y Comunitaria. Instituto de Investigación Biomédica (IIB) Sant Pau. Equipo de Atención Primaria Sardenya, Barcelona, España
| | - Jose R Banegas Banegas
- Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Vicente F Gil Guillén
- Medicina Familiar y Comunitaria, Hospital Universitario de Elda. Departamento de Medicina Clínica. Universidad Miguel Hernández, San Juan de Alicante, España
| | - Ana M Cebrián Cuenca
- Medicina Familiar y Comunitaria, Centro de Salud Cartagena Casco Antiguo, Instituto Murciano de Investigación Biosanitaria (IMIB), 30120 Murcia, España
| | - Enrique Martín Rioboó
- Medicina Familiar y Comunitaria, Especialista en Medicina Familiar y Comunitaria, Centro de Salud Poniente, Córdoba, IMIBIC Hospital Reina Sofía Córdoba. Colaborador del grupo PAPPS
| | - Ariana Jordá Baldó
- Medicina Familiar y Comunitaria, Centro de Salud San Miguel, Plasencia, Badajoz, España
| | - Johanna Vicuña
- Medicina Preventiva y Salud Pública, Hospital de la Sant Creu i Sant Pau, Barcelona, España
| | - Jorge Navarro Pérez
- Medicina Familiar y Comunitaria, Hospital Clínico Universitario. Departamento de Medicina. Universidad de Valencia. Instituto de Investigación INCLIVA, Valencia, España
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Duarte-Díaz A, González-Pacheco H, Rivero-Santana A, Ramallo-Fariña Y, Perestelo-Pérez L, Peñate W, Carrion C, Serrano-Aguilar P. Factors associated with patient empowerment in Spanish adults with type 2 diabetes: A cross-sectional analysis. Health Expect 2022; 25:2762-2774. [PMID: 36047480 DOI: 10.1111/hex.13501] [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: 11/12/2021] [Revised: 03/14/2022] [Accepted: 04/02/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The aim of the present study is to identify factors associated with patient empowerment in people living with type 2 diabetes mellitus (T2DM) in the Canary Islands (Spain). METHODS Secondary cross-sectional analysis was carried out of data obtained in the INDICA study: A 24-month cluster randomized-controlled trial evaluating the effectiveness of educational interventions supported by new technology decision tools for T2DM patients. Sociodemographic variables, clinical data (years since diagnosis, glycated haemoglobin level, creatine, triglycerides, waist hip index, body mass index and number of comorbidities), diabetes knowledge (DIATEK), affective outcomes (Beck Depression Inventory-II, the State subscale of the State-Trait Anxiety Inventory and The Diabetes Distress Scale) and diabetes-related quality of life (The Audit of Diabetes-Dependent Quality of life) were assessed as potential correlates of patient empowerment, assessed using the Diabetes Empowerment Scale-Short Form. Multilevel mixed linear regression models on patient empowerment were developed. RESULTS The analysis included the baseline data of 2334 patients. Results showed that age (B = -0.14; p < .001), diabetes knowledge (B = 0.61; p < .001) and state-anxiety (B = -0.09; p < .001) are significantly associated with patient empowerment. Sex, education level, living alone, employment status, country of birth, time since diagnosis, number of comorbidities, glycated haemoglobin level, depression and distress were not independently associated with patient empowerment in the multivariate analyses. CONCLUSION Younger age, lower state-anxiety and greater diabetes-specific knowledge are important correlates of patient empowerment. In line with the results of the INDICA study, interventions based on patient-centred care might be effective in improving patient empowerment in adults with T2DM. Understanding the factors associated with empowerment may help clinicians and policymakers to identify high-risk groups, prioritize resources and target evidence-based interventions to better support people with T2DM to be actively involved in their own care. PATIENT OR PUBLIC CONTRIBUTION Patients with T2DM were actively involved in the design of the INDICA study. Two patient associations were included as part of the research team and actively participated in designing the interventions and selecting outcome measures.
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Affiliation(s)
- Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna (ULL), Tenerife, Spain
| | | | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Lilisbeth Perestelo-Pérez
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
| | - Wenceslao Peñate
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna (ULL), Tenerife, Spain
| | - Carme Carrion
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Pedro Serrano-Aguilar
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
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36
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Blancas-Sánchez IM, Del Rosal Jurado M, Aparicio-Martínez P, Quintana Navarro G, Vaquero-Abellan M, Castro Jiménez RA, Fonseca Pozo FJ. A Mediterranean-Diet-Based Nutritional Intervention for Children with Prediabetes in a Rural Town: A Pilot Randomized Controlled Trial. Nutrients 2022; 14:3614. [PMID: 36079871 PMCID: PMC9460785 DOI: 10.3390/nu14173614] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/26/2022] Open
Abstract
Prediabetes is a pathological condition in which the blood glucose concentration is higher than normal concentrations but lower than those considered necessary for a type 2 diabetes mellitus diagnosis. Various authors have indicated that the Mediterranean Diet is one of the dietary patterns with the most healthy outcomes, reducing high levels of HbA1c, triglycerides, BMI, and other anthropometric parameters. The main objective of this study was to determine the efficacy of the nutritional intervention for children with prediabetes, including the effectiveness of this nutritional education regarding anthropometric parameters. A randomized pilot trial with two groups, an experimental group (EG) and a control group (CG), using intervention in dietary habits with nutritional reinforcement was carried out on 29 children with prediabetes from a rural area. The nutritional intervention was analyzed through astrophotometric and glycemic measurements and validated surveys. Results: The results indicated improvement in eating habits, adherence to the Mediterranean diet, anthropometric measurements, mainly body mass index and perimeters, and analytical parameters, with a significant decrease in glycated hemoglobin in the EG compared to the CG (p < 0.001). Although the results showed that both groups’ anthropometric parameters improved, a more significant decrease was observed in the experimental group compared to the control.
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Affiliation(s)
- Isabel María Blancas-Sánchez
- Emergency Department, Reina Sofia’s University Hospital, Andalusian Health Care System, 14004 Cordoba, Spain
- Grupo Investigación GC09 Nutrigenomics, Metabolic Syndrome, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia’s University Hospital, 14004 Cordoba, Spain
| | - María Del Rosal Jurado
- Departamento de Enfermería, Farmacología y Fisioterapia, Campus de Menéndez Pidal, Universidad de Córdoba, 14071 Córdoba, Spain
| | - Pilar Aparicio-Martínez
- Departamento de Enfermería, Farmacología y Fisioterapia, Campus de Menéndez Pidal, Universidad de Córdoba, 14071 Córdoba, Spain
- Grupo Investigación GC12 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia’s University Hospital, 14071 Cordoba, Spain
| | - Gracia Quintana Navarro
- Grupo Investigación GC09 Nutrigenomics, Metabolic Syndrome, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia’s University Hospital, 14004 Cordoba, Spain
| | - Manuel Vaquero-Abellan
- Departamento de Enfermería, Farmacología y Fisioterapia, Campus de Menéndez Pidal, Universidad de Córdoba, 14071 Córdoba, Spain
- Grupo Investigación GC12 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia’s University Hospital, 14071 Cordoba, Spain
| | - Rafael A. Castro Jiménez
- Grupo Investigación GC12 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia’s University Hospital, 14071 Cordoba, Spain
| | - Francisco Javier Fonseca Pozo
- Grupo Investigación GC09 Nutrigenomics, Metabolic Syndrome, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia’s University Hospital, 14004 Cordoba, Spain
- Grupo Investigación GC12 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia’s University Hospital, 14071 Cordoba, Spain
- Distrito Sanitario Córdoba Guadalquivir, Andalusian Health Care System, 14004 Cordoba, Spain
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Serum vascular endothelial growth factor b and metabolic syndrome incidence in the population based cohort Di@bet.es study. Int J Obes (Lond) 2022; 46:2013-2020. [PMID: 35987953 PMCID: PMC9584818 DOI: 10.1038/s41366-022-01212-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/08/2022]
Abstract
Abstract
Background/Objectives
Although vascular endothelial growth factor b (VEGFb) might have an impact on the development of obesity, diabetes and related disorders, the possible relationship between VEGFb serum levels and the incidence of these metabolic complications in humans is still unknown. The aim of our study was to evaluate the association between VEGFb serum levels and the new-onset of metabolic syndrome (MS) and its components in the Spanish adult population after 7.5 years of follow-up.
Subjects/Methods
A total of 908 subjects from the Di@bet.es cohort study without MS at cross-sectional stage according to International Diabetes Federation (IDF) or Adult Treatment Panel III (ATP-III) criteria were included. Additionally, five sub-populations were grouped according to the absence of each MS component at baseline. Socio-demographic, anthropometric and clinical data were recorded. The Short Form of International Physical Activity Questionnaire (SF-IPAQ) was used to estimate physical activity. A fasting blood extraction and an oral glucose tolerance test were performed. Serum determinations of glucose, lipids, hsCRP and insulin were made. VEGFb levels were determined and categorized according to the 75th percentile of the variable. New cases of MS and its components were defined according to ATPIII and IDF criteria.
Results
A total of 181 or 146 people developed MS defined by IDF or ATP-III criteria respectively. Serum triglyceride levels, hs-CRP and systolic blood pressure at the baseline study were significantly different according to the VEGFb categories. Adjusted logistic regression analysis showed that the likelihood of developing MS and abdominal obesity was statistically reduced in subjects included in the higher VEGFb category.
Conclusion
Low serum levels of VEGFb may be considered as early indicators of incident MS and abdominal obesity in the Spanish adult population free of MS, independently of other important predictor variables.
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Manuello J, Verdejo-Román J, Torres Espínola F, Escudero-Marín M, Catena A, Cauda F, Campoy C. Influence of Gestational Diabetes and Pregestational Maternal BMI on the Brain of Six-Year-Old Offspring. Pediatr Neurol 2022; 133:55-62. [PMID: 35759804 DOI: 10.1016/j.pediatrneurol.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/02/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gestational diabetes (GD) and maternal excess weight are common pregnancy conditions that increase the risk of future complications for both the mother and her offspring. Their consequences on neurodevelopment are widely described in the literature, but less is known concerning the potential transgenerational influence on the brain structure. METHODS We used a combination of support vectors machine and hierarchical clustering to investigate the potential presence of anatomical brain differences in a sample of 109 children aged six years, born to mothers with overweight or obesity, or to mothers diagnosed with GD during pregnancy. RESULTS Significant effects are visible in the brain of children born to mothers with GD associated with pregestational excess weight, especially overweight instead of obesity. No differences in children's brain were observed when considering those born to normal-weight mothers. CONCLUSIONS Our study highlights the need for clinical attention of pregnant women at risk to develop GD, and especially those with pregestational excess weight, since this status was found to be associated with detectable transgenerational brain changes. These effects may be due to the absence of specific and individualized intervention in these mothers during pregnancy.
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Affiliation(s)
- Jordi Manuello
- Gcs-Fmri, Koelliker Hospital and Department of Psychology, University of Turin, Turin, Italy; Focus Lab, Department of Psychology, University of Turin, Turin, Italy
| | - Juan Verdejo-Román
- Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
| | - Francisco Torres Espínola
- Euristikos Excellence Centre For Pediatric Research, University of Granada, Granada, Spain; Department of Pediatrics, School of Medicine, University of Granada, Granada, Spain; DR. Federico Oloriz Neurosciences Institute, University of Granada, Granada, Spain
| | - Mireia Escudero-Marín
- Euristikos Excellence Centre For Pediatric Research, University of Granada, Granada, Spain; Department of Pediatrics, School of Medicine, University of Granada, Granada, Spain; DR. Federico Oloriz Neurosciences Institute, University of Granada, Granada, Spain
| | - Andrés Catena
- Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
| | - Franco Cauda
- Gcs-Fmri, Koelliker Hospital and Department of Psychology, University of Turin, Turin, Italy; Focus Lab, Department of Psychology, University of Turin, Turin, Italy
| | - Cristina Campoy
- Euristikos Excellence Centre For Pediatric Research, University of Granada, Granada, Spain; Department of Pediatrics, School of Medicine, University of Granada, Granada, Spain; DR. Federico Oloriz Neurosciences Institute, University of Granada, Granada, Spain; Spanish Network of Biomedical Research In Epidemiology and Public Health (Ciberesp), Granada's Node, Institute of Health Carlos III, Madrid, Spain; Biohealth Research Institute (IBS), Granada, Health Sciences Technological Park, Granada, Spain.
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Changes in the Epidemiology of Diabetic Retinopathy in Spain: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10071318. [PMID: 35885844 PMCID: PMC9320037 DOI: 10.3390/healthcare10071318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background. The aim of the present study was to determine the prevalence and incidence of diabetic retinopathy (DR) and its changes in the last 20 years in type 2 diabetes mellitus (T2DM) patients in Spain. Methods. A systematic review with a meta-analysis was carried out on the studies published between 2001–2020 on the prevalence and incidence of DR and sight-threatening diabetic retinopathy (STDR) in Spain. The articles included were selected from four databases and publications of the Spanish Ministry of Health and Regional Health Care System (RHCS). The meta-analysis to determine heterogeneity and bias between studies was carried out with the MetaXL 4.0. Results. Since 2001, we have observed an increase in the detection of patients with DM, and at the same time, screening programs for RD have been launched; thus, we can deduce that the increase in the detection of patients with DM, many of them in the initial phases, far exceeds the increased detection of patients with DR. The prevalence of DR was higher between 2001 and 2008 with values of 28.85%. These values decreased over the following period between 2009 and 2020 with a mean of 15.28%. Similarly the STDR prevalence decrease from 3.67% to 1.92% after 2008. The analysis of the longitudinal studies determined that the annual DR incidence was 3.83%, and the STDR annual incidence was 0.41%. Conclusion. In Spain, for T2DM, the current prevalence of DR is 15.28% and 1.92% forSTDR. The annual incidence of DR is 3.83% and is 0.41% for STDR.
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Franch-Nadal J, Malkin SJP, Hunt B, Martín V, Gallego Estébanez M, Vidal J. The Cost-Effectiveness of Oral Semaglutide in Spain: A Long-Term Health Economic Analysis Based on the PIONEER Clinical Trials. Adv Ther 2022; 39:3180-3198. [PMID: 35553372 DOI: 10.1007/s12325-022-02156-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/30/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Novel glucagon-like peptide-1 (GLP-1) receptor agonist oral semaglutide has demonstrated greater improvements in glycated hemoglobin (HbA1c) and body weight versus oral medications empagliflozin and sitagliptin, and injectable GLP-1 analog liraglutide, in the PIONEER clinical trial program. Based on these data, the present analysis aimed to evaluate the long-term cost-effectiveness of oral semaglutide versus empagliflozin, sitagliptin and liraglutide in Spain. METHODS Outcomes were projected over patients' lifetimes using the IQVIA CORE Diabetes Model (v9.0), discounted at 3.0% annually. Cohort characteristics and treatment effects were sourced from PIONEER 2 and 4 for the comparisons of oral semaglutide 14 mg versus empagliflozin 25 mg and liraglutide 1.8 mg, respectively, and PIONEER 3 for oral semaglutide 7 and 14 mg versus sitagliptin 100 mg. Costs were accounted from a healthcare payer perspective in 2020 euros (EUR). Patients were assumed to receive initial therapies until HbA1c exceeded 7.5% and then treatment-intensified to basal insulin. RESULTS Oral semaglutide 14 mg was associated with improvements in quality-adjusted life expectancy of 0.13, 0.19 and 0.06 quality-adjusted life years (QALYs) versus empagliflozin 25 mg, sitagliptin 100 mg and liraglutide 1.8 mg, respectively, with direct costs EUR 168 higher versus empagliflozin and EUR 236 and 1415 lower versus sitagliptin and liraglutide, respectively. Oral semaglutide 14 mg was associated with an incremental cost-effectiveness ratio (ICER) of EUR 1339 per QALY gained versus empagliflozin and was considered dominant (clinically superior and cost saving) versus sitagliptin and liraglutide. Additional analyses demonstrated that oral semaglutide 7 mg was associated with improvements of 0.11 QALYs and increased costs of EUR 226 versus sitagliptin and was therefore associated with an ICER of EUR 2011 per QALY gained. CONCLUSION Oral semaglutide 14 mg was dominant versus sitagliptin and liraglutide, and cost-effective versus empagliflozin, for the treatment of type 2 diabetes in Spain.
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Affiliation(s)
- Josep Franch-Nadal
- Centro de Investigación Biomédica en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.,Primary Health Care Center Raval Sud, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de La Salut, Barcelona, Spain
| | - Samuel J P Malkin
- Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051, Basel, Switzerland.
| | - Barnaby Hunt
- Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051, Basel, Switzerland
| | | | | | - Josep Vidal
- Centro de Investigación Biomédica en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain
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Rojano-Toimil A, Rivera-Esteban J, Manzano-Nuñez R, Bañares J, Martinez Selva D, Gabriel-Medina P, Ferrer R, Pericàs JM, Ciudin A. When Sugar Reaches the Liver: Phenotypes of Patients with Diabetes and NAFLD. J Clin Med 2022; 11:jcm11123286. [PMID: 35743358 PMCID: PMC9225139 DOI: 10.3390/jcm11123286] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 01/27/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) have been traditionally linked to one another. Recent studies suggest that NAFLD may be increasingly common in other types of diabetes such as type 1 diabetes (T1DM) and less frequently ketone-prone and Maturity-onset Diabetes of the Young (MODY) diabetes. In this review, we address the relationship between hyperglycemia and insulin resistance and the onset and progression of NAFLD. In addition, despite the high rate of patients with T2DM and other diabetes phenotypes that can alter liver metabolism and consequently develop steatosis, fibrosis, and cirrhosis, NALFD screening is not still implemented in the daily care routine. Incorporating a clinical algorithm created around a simple, non-invasive, cost-effective model would identify high-risk patients. The principle behind managing these patients is to improve insulin resistance and hyperglycemia states with lifestyle changes, weight loss, and new drug therapies.
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Affiliation(s)
- Alba Rojano-Toimil
- Endocrinology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
| | - Jesús Rivera-Esteban
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
- Medicine Department Bellaterra, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Liver Unit, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Ramiro Manzano-Nuñez
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
- Liver Unit, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Juan Bañares
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
- Liver Unit, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - David Martinez Selva
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
- Spanish Network of Biomedical Research Centers, Diabetes and Metabolic Associated Disorders (CIBERdem), 28029 Madrid, Spain
| | - Pablo Gabriel-Medina
- Biochemistry Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (P.G.-M.); (R.F.)
- Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, 08193 Barcelona, Spain
| | - Roser Ferrer
- Biochemistry Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (P.G.-M.); (R.F.)
| | - Juan M Pericàs
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
- Liver Unit, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
- Spanish Network of Biomedical Research Centers, Liver and Digestive Diseases (CIBERehd), 28801 Madrid, Spain
- Correspondence: (J.M.P.); (A.C.)
| | - Andreea Ciudin
- Endocrinology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
- Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain; (J.R.-E.); (R.M.-N.); (J.B.); (D.M.S.)
- Medicine Department Bellaterra, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Spanish Network of Biomedical Research Centers, Diabetes and Metabolic Associated Disorders (CIBERdem), 28029 Madrid, Spain
- Correspondence: (J.M.P.); (A.C.)
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Duarte-Díaz A, González-Pacheco H, Rivero-Santana A, Ramallo-Fariña Y, Perestelo-Pérez L, Álvarez-Pérez Y, Peñate W, Carrion C, Serrano-Aguilar P. Increased Patient Empowerment Is Associated with Improvement in Anxiety and Depression Symptoms in Type 2 Diabetes Mellitus: Findings from the INDICA Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4818. [PMID: 35457686 PMCID: PMC9028935 DOI: 10.3390/ijerph19084818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022]
Abstract
Introduction. In cross-sectional analyses, higher levels of patient empowerment have been related to lower symptoms of anxiety and depression. The aims of this study are: (1) to assess if patient empowerment predicts anxiety and depression symptoms after 12 and 24 months among patients with type 2 diabetes mellitus, and (2) to analyze whether a change in patient empowerment is associated with a change in anxiety and depression level. Methods. This is a secondary analysis of the INDICA study, a 24 month-long, multi-arm randomized controlled trial. Patient empowerment (DES-SF), depression (BDI-II), and state-anxiety (STAI-S) were assessed at the baseline (pre-intervention) and after 12 and 24 months. Multilevel mixed linear models with a random intercept were performed to correct for our clustered data. Results. The multilevel regression models showed that the baseline empowerment did not significantly predict anxiety and depression after 12 and 24 months. However, a higher increase in patient empowerment was significantly associated with reductions of anxiety (p < 0.001) and depression levels (p < 0.001). This association was not significantly different between the two follow-ups. Conclusion. This study contributes to the knowledge on how to reduce affective symptoms in patients with uncomplicated T2DM through comprehensive patient-centered interventions, and it highlights patient empowerment as a significant contributor.
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Affiliation(s)
- Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), 38109 El Rosario, Spain; (A.D.-D.); (H.G.-P.); (A.R.-S.); (Y.R.-F.); (Y.Á.-P.)
- Department of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna (ULL), 38200 San Cristóbal de La Laguna, Spain;
| | - Himar González-Pacheco
- Canary Islands Health Research Institute Foundation (FIISC), 38109 El Rosario, Spain; (A.D.-D.); (H.G.-P.); (A.R.-S.); (Y.R.-F.); (Y.Á.-P.)
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), 38109 El Rosario, Spain; (A.D.-D.); (H.G.-P.); (A.R.-S.); (Y.R.-F.); (Y.Á.-P.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 38109 El Rosario, Spain;
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 El Rosario, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), 38109 El Rosario, Spain; (A.D.-D.); (H.G.-P.); (A.R.-S.); (Y.R.-F.); (Y.Á.-P.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 38109 El Rosario, Spain;
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 El Rosario, Spain
| | - Lilisbeth Perestelo-Pérez
- Research Network on Health Services in Chronic Diseases (REDISSEC), 38109 El Rosario, Spain;
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 El Rosario, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 El Rosario, Spain
| | - Yolanda Álvarez-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), 38109 El Rosario, Spain; (A.D.-D.); (H.G.-P.); (A.R.-S.); (Y.R.-F.); (Y.Á.-P.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 El Rosario, Spain
| | - Wenceslao Peñate
- Department of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna (ULL), 38200 San Cristóbal de La Laguna, Spain;
| | - Carme Carrion
- eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya (UOC), 08035 Barcelona, Spain;
| | - Pedro Serrano-Aguilar
- Research Network on Health Services in Chronic Diseases (REDISSEC), 38109 El Rosario, Spain;
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 El Rosario, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 El Rosario, Spain
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Chiva-Blanch G, Giró O, Cofán M, Calle-Pascual AL, Delgado E, Gomis R, Jiménez A, Franch-Nadal J, Rojo Martínez G, Ortega E. Low Percentage of Vegetable Fat in Red Blood Cells Is Associated with Worse Glucose Metabolism and Incidence of Type 2 Diabetes. Nutrients 2022; 14:nu14071368. [PMID: 35405981 PMCID: PMC9002701 DOI: 10.3390/nu14071368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
The identification of nutritional patterns associated with the development of type 2 diabetes (T2D) might help lead the way to a more efficient and personalized nutritional intervention. Our study is aimed at evaluating the association between fatty acids (FA) in red blood cell (RBC) membranes, as a quantitative biomarker of regular dietary fat intake, and incident type 2 diabetes in a Spanish population. We included 1032 adult Spaniards (57% women, age 49 ± 15 years, 18% prediabetes), without diabetes at study entry, from the Di@bet.es cohort. Incident diabetes was diagnosed at the end of the study follow-up. The FA percentage in RBC was determined at baseline by gas chromatography. Participants were followed on average 7.5 ± 0.6 years. Lower percentages of linoleic acid (LA), α-linolenic (ALA), and eicosapentaenoic acid (EPA), and higher percentages of docosahexaenoic acid (DHA) in RBC membranes were associated, independently of classical risk factors, with worse glucose metabolism at the end of the study follow-up. In addition, higher percentages of ALA and EPA, and moderate percentages of DHA, were associated with lower risk of diabetes. No significant associations were found for LA and diabetes risk. Dietary patterns rich in vegetables are independently associated with lower risk of both deterioration of glucose regulation and incident diabetes, and should be reinforced for the prevention of diabetes.
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Affiliation(s)
- Gemma Chiva-Blanch
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, 08036 Barcelona, Spain; (G.C.-B.); (O.G.); (M.C.); (R.G.); (A.J.)
- Spanish Biomedical Research Network in Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Oriol Giró
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, 08036 Barcelona, Spain; (G.C.-B.); (O.G.); (M.C.); (R.G.); (A.J.)
- Spanish Biomedical Research Network in Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Montserrat Cofán
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, 08036 Barcelona, Spain; (G.C.-B.); (O.G.); (M.C.); (R.G.); (A.J.)
- Spanish Biomedical Research Network in Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alfonso L. Calle-Pascual
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.L.C.-P.); (J.F.-N.); (G.R.M.)
- Department of Endocrinology and Nutrition, San Carlos University Hospital of Madrid, 28040 Madrid, Spain
| | - Elías Delgado
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Department of Endocrinology and Nutrition, Central University Hospital of Asturias, University of Oviedo, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Ramon Gomis
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, 08036 Barcelona, Spain; (G.C.-B.); (O.G.); (M.C.); (R.G.); (A.J.)
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.L.C.-P.); (J.F.-N.); (G.R.M.)
| | - Amanda Jiménez
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, 08036 Barcelona, Spain; (G.C.-B.); (O.G.); (M.C.); (R.G.); (A.J.)
- Spanish Biomedical Research Network in Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Josep Franch-Nadal
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.L.C.-P.); (J.F.-N.); (G.R.M.)
- EAP Raval Sud, Catalan Institute of Health, GEDAPS Network, Primary Care, Research Support Unit (IDIAP-Jordi Gol Foundation), 08001 Barcelona, Spain
| | - Gemma Rojo Martínez
- Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.L.C.-P.); (J.F.-N.); (G.R.M.)
- Biomedical Research Institute of Malaga (IBIMA), Endocrinology and Nutrition Department, Regional University Hospital of Malaga, 29010 Malaga, Spain
| | - Emilio Ortega
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, 08036 Barcelona, Spain; (G.C.-B.); (O.G.); (M.C.); (R.G.); (A.J.)
- Spanish Biomedical Research Network in Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
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Escobar C, Morales C, Capel M, Simón S, Pérez-Alcántara F, Pomares E. Cost-effectiveness analysis of dapagliflozin for the treatment of type 2 diabetes mellitus in Spain: results of the DECLARE-TIMI 58 study. BMC Health Serv Res 2022; 22:217. [PMID: 35177053 PMCID: PMC8851809 DOI: 10.1186/s12913-022-07567-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study was to carry out a cost-effectiveness analysis of dapagliflozin, as an add-on therapy to standard of care (SoC), for the treatment of type 2 diabetes mellitus (T2DM) in Spain, based on the results of the DECLARE-TIMI 58 trial. METHODS A discrete event simulation model (Cardiff T2DM) based on the data observed in the DECLARE-TIMI 58 trial was adapted to the Spanish setting to estimate the costs and health outcomes of treatment with dapagliflozin in patients with T2DM who had or were at risk of atherosclerotic cardiovascular disease. Macrovascular events (hospitalization for heart failure, myocardial infarction, stroke, and unstable angina), end-stage renal disease and cardiovascular and non-cardiovascular mortality were modeled according to the survival equations of the DECLARE-TIMI 58 study. Microvascular events (blindness and ulcers) were estimated based on the risk equations of the UK Prospective Diabetes Study. The analysis was conducted from the Spanish National Health System perspective and the time horizon was 30 years. The results were evaluated in terms of cost per quality-adjusted life year (QALY) gained. Only direct health costs were included, and a 3% discount rate was applied to costs and health outcomes. Univariate and probabilistic sensitivity analyses (PSA) were made to assess the robustness of the results. RESULTS In the main analysis, dapagliflozin was a dominant therapeutic option compared with placebo, with greater effectiveness (0.08 QALYs) and lower associated total costs per patient (€ -2,921). The univariate sensitivity analysis and the PSA confirmed the robustness of the results. The PSA showed the probability that dapagliflozin was a dominant alternative compared with placebo was 84.2% and that it was cost-effective of 92.1%, under a willingness-to-pay of € 20,000/QALY gained. CONCLUSIONS The analysis of data from the DECLARE-TIMI 58 trial shows that dapagliflozin would be a cost-effective option in Spain for the treatment of adult patients with T2DM, as an add-on therapy to SoC, compared with placebo.
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Affiliation(s)
| | | | | | - Susana Simón
- HEOR & Market Access, AstraZeneca, Madrid, Spain
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López Sánchez GF, Smith L, Jacob L, Shin JI, Koyanagi A, Pardhan S. Gender Differences in the Association Between Cataract and Mental Health in Adults With Diabetes: A Cross-Sectional Analysis From the Spanish National Health Survey 2017. Front Public Health 2021; 9:769155. [PMID: 34950629 PMCID: PMC8688691 DOI: 10.3389/fpubh.2021.769155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to explore gender differences in the associations between cataracts and self-reported depression and chronic anxiety in Spanish adults with diabetes. Methods: Cross-sectional data from the Spanish Health Survey 2017 were analyzed. Inclusion criterion was a positive response to the question “Have you ever been diagnosed with diabetes?” Diabetes, cataracts, depression and chronic anxiety were based on self-reported lifetime diagnosis. Multivariable logistic regression was conducted to assess the association between cataracts and depression or anxiety among respondents with diabetes, stratifying by gender. Results: Out of a total 23,089 respondents, 2,266 people self-reported suffering from diabetes (50.2% women; average age 69.7 ± 12.7 years; age range 15-98 years). In people with diabetes, the presence of cataracts was associated with significantly higher odds for depression (OR = 1.655; 95% CI = 1.295-2.115). Gender-stratified analyses showed that only women with cataracts were significantly associated with higher odds for depression (OR = 1.762; 95% CI = 1.307-2.374) and chronic anxiety (OR = 1.519; 95% CI = 1.067-2.163). Conclusion: Cataracts are a significant risk factor for depression and chronic anxiety in Spanish women with diabetes, but not in men. Women with both diabetes and cataracts require assessment for depression and chronic anxiety, and possibly earlier interventions in order to reduce the potential risk of further mental health complications.
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Affiliation(s)
- Guillermo F López Sánchez
- Faculty of Health, Education, Medicine and Social Care, School of Medicine, Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, United Kingdom
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Boi de Llobregat, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Boi de Llobregat, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Shahina Pardhan
- Faculty of Health, Education, Medicine and Social Care, School of Medicine, Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, United Kingdom
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Prognostic Value of the Acute-to-Chronic Glycemic Ratio at Admission in Heart Failure: A Prospective Study. J Clin Med 2021; 11:jcm11010006. [PMID: 35011747 PMCID: PMC8745704 DOI: 10.3390/jcm11010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 01/08/2023] Open
Abstract
Acute hyperglycemia has been associated with worse prognosis in patients hospitalized for heart failure (HF). Nevertheless, studies evaluating the impact of glycemic control on long-term prognosis have shown conflicting results. Our aim was to assess the relationship between acute-to-chronic (A/C) glycemic ratio and 4-year mortality in a cohort of subjects hospitalized for acute HF. A total of 1062 subjects were consecutively included. We measured glycaemia at admission and estimated average chronic glucose levels and the A/C glycemic ratio were calculated. Subjects were stratified into groups according to the A/C glycemic ratio tertiles. The primary endpoint was 4-year mortality. Subjects with diabetes had higher risk for mortality compared to those without (HR 1.35 [95% CI: 1.10–1.65]; p = 0.004). A U-shape curve association was found between glucose at admission and mortality, with a HR of 1.60 [95% CI: 1.22–2.11]; p = 0.001, and a HR of 1.29 [95% CI: 0.97–1.70]; p = 0.078 for the first and the third tertile, respectively, in subjects with diabetes. Additionally, the A/C glycemic ratio was negatively associated with mortality (HR 0.76 [95% CI: 0.58–0.99]; p = 0.046 and HR 0.68 [95% CI: 0.52–0.89]; p = 0.005 for the second and third tertile, respectively). In multivariable analysis, the A/C glycemic ratio remained an independent predictor. In conclusion, in subjects hospitalized for acute HF, the A/C glycemic ratio is significantly associated with mortality, improving the ability to predict mortality compared with glucose levels at admission or average chronic glucose concentrations, especially in subjects with diabetes.
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Gracia-Sánchez A, López-Pineda A, Chicharro-Luna E, Gil-Guillén VF. A Delphi Study Protocol to Identify Recommendations on Physical Activity and Exercise in Patients with Diabetes and Risk of Foot Ulcerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10988. [PMID: 34682736 PMCID: PMC8536116 DOI: 10.3390/ijerph182010988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 01/05/2023]
Abstract
Patients with diabetes mellitus are exposed to important complications, such as diabetic neuropathy or peripheral vascular disease. The evidence on the guidelines that these patients, with a certain risk of suffering foot ulcerations, should follow before, during and after physical exercise is scarce. The objective of this study is to identify the physical exercise guidelines to recommend based on the risk of the foot of the patient with diabetes through a consensus of experts. A three-round Delphi study will be conducted. A scientific committee (multidisciplinary group of four national experts) will review the proposal of experts and the Delphi questionnaire before submitting. A group of experts in the management and approach of the diabetic foot of an international and multidisciplinary nature will form the panel of experts, who must express their degree of (dis)agreement with each of the statements contained in the Delphi questionnaire. The percentage will be calculated in response categories, and a cut-off point of 80% will be set to define the consensus of (dis)agreement of the panelists. The results of the study could provide a series of recommendations on the realization of physical exercise in diabetic patients at risk of suffering foot ulcerations.
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Affiliation(s)
- Alba Gracia-Sánchez
- Department of Behavioral and Health Sciences, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (A.G.-S.); (E.C.-L.)
| | - Adriana López-Pineda
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain;
| | - Esther Chicharro-Luna
- Department of Behavioral and Health Sciences, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (A.G.-S.); (E.C.-L.)
| | - Vicente F. Gil-Guillén
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain;
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48
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Barrios-Rodríguez R, Pérez-Carrascosa FM, Gómez-Peña C, Mustieles V, Salcedo-Bellido I, Requena P, Martín-Olmedo P, Jiménez-Moleón JJ, Arrebola JP. Associations of accumulated selected persistent organic pollutants in adipose tissue with insulin sensitivity and risk of incident type-2 diabetes. ENVIRONMENT INTERNATIONAL 2021; 155:106607. [PMID: 33971459 DOI: 10.1016/j.envint.2021.106607] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 06/12/2023]
Abstract
Continuous exposure to low doses of persistent organic pollutant (POPs), such as those occurring in the general population, might contribute to the burden of type 2 diabetes mellitus (T2DM). However, evidences from longitudinal studies are scarce. We aimed to explore the associations of accumulated POP exposure with the development of T2DM by means of 1) longitudinal associations with the 16-year incidence of the disease, and 2) complementary cross-sectional analyses with markers of glucose homeostasis at recruitment. Organochlorine pesticide and polychlorinated biphenyl (PCB) concentrations were analyzed in adipose tissue samples and incident T2DM cases were retrieved from clinical records. Homeostatic model assessment values of insulin sensitivity/resistance and β-cell function at recruitment were calculated. Linear and Cox-regression models were performed. In individuals with normal weight/overweight (n = 293), we observed positive dose-response relationships between the studied POPs and T2DM risk, particularly for hexachlorobenzene (HCB) [hazard ratio (HR): 3.96 for 4th quartile versus 1st quartile (Q1); confidence interval (CI) 95%: 0.79, 19.71]. PCB-180 showed a positive but seemingly non-linear association with T2DM risk [HR of 3er quartile (Q3) versus Q1: 6.48; CI 95%: 0.82, 51.29]. Unadjustment for body mass index considerably increased the magnitude of the associations. In the cross-sectional study (n = 180), HCB and PCB-180 were inversely associated with insulin sensitivity and positively associated with insulin resistance parameters. Our results suggest that a higher burden of specific POPs in adipose tissue may disrupt glucose homeostasis, possibly contributing to increase T2DM risk, especially in non-obese adults.
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Affiliation(s)
- Rocío Barrios-Rodríguez
- Universidad de Granada. Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Francisco M Pérez-Carrascosa
- Universidad de Granada. Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Servicio de Oncología Radioterápica. Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - Celia Gómez-Peña
- Department of Pharmacy, San Cecilio University Hospital, Granada, Spain.
| | - Vicente Mustieles
- Universidad de Granada. Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; University of Granada, Center for Biomedical Research (CIBM), Spain.
| | - Inmaculada Salcedo-Bellido
- Universidad de Granada. Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Pilar Requena
- Universidad de Granada. Departamento de Medicina Preventiva y Salud Pública, Granada, Spain.
| | - Piedad Martín-Olmedo
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Andalusian School of Public Health (EASP), Granada, Spain.
| | - José Juan Jiménez-Moleón
- Universidad de Granada. Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Juan Pedro Arrebola
- Universidad de Granada. Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
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49
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Antonio-Arques V, Franch-Nadal J, Caylà JA. Diabetes and tuberculosis: A syndemic complicated by COVID-19. ACTA ACUST UNITED AC 2021; 157:288-293. [PMID: 34541325 PMCID: PMC8433042 DOI: 10.1016/j.medcle.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
Tuberculosis (TB) is the leading cause of infectious mortality in the world, affecting mainly developing countries (DC), while diabetes (DM) is one of the most prevalent chronic diseases. This review analyzes the fact that diabetes is currently an important risk factor for developing TB, also presenting more complicated TB, more relapses and higher mortality. The DCs and the fourth world of the large cities are those with the highest incidence of TB and an increase in DM, which will make it difficult to control tuberculosis disease. At the same time, the COVID-19 pandemic is complicating the management of both diseases due to the difficulty of access to control and treatment and the worsening of socioeconomic inequalities. It is necessary to establish a bidirectional screening for TB and DM and promote recommendations for the joint management of both diseases.
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Affiliation(s)
- Violeta Antonio-Arques
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain.,Equip d'Atenció Primària (EAP) Bordeta Magòria, Institut Català de la Salut, Barcelona, Spain
| | - Josep Franch-Nadal
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain.,Equip d'Atenció Primària (EAP) Raval Sud - Drassanes, Institut Català de la Salut, Barcelona, Spain
| | - Joan A Caylà
- Fundación de la Unidad de Investigación en Tuberculosis de Barcelona, Barcelona, Spain
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50
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Obaya Rebollar JC, Miravet Jiménez S, Aranbarri Osoro I, Carramiñana Barrera FC, García Soidán FJ, Cebrián Cuenca AM. [Management of patient profiles with type2 diabetes mellitus in Primary Care in Spain: CONTROVERTI2 Program]. Semergen 2021; 48:23-37. [PMID: 34452834 DOI: 10.1016/j.semerg.2021.07.009] [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: 04/27/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 01/14/2023]
Abstract
AIM To identify existing controversies in the routine management of patients with T2D and to contrast them with the latest scientific evidence and clinical guidelines, in order to help optimize and homogenize the treatment of patients with T2D in Primary Care (PC) in Spain. MATERIAL AND METHODS 240 family doctors responded to an online questionnaire about the management of 6 patient profiles with T2D of increasing complexity. RESULTS The main drivers for the antihyperglycemic treatment choice are an HbA1c>10% and the presence of cardiovascular disease (CVD), although in evolved patients, the estimated glomerular filtration rate and the risk of hypoglycemia become more relevant. In newly diagnosed patients with an HbA1c>9%, treatment is still initiated with monotherapy (24%). In patients not controlled with metformin, dipeptidyl peptidase 4 inhibitors (DPP4-I, 54%) or sodium-glucose cotransporter 2 inhibitors (SGLT2-I, 39%) are usually added. On the other hand, type1 glucagon-like peptide receptor agonists (GLP1-RA) are mainly associated with obese patients with T2D. In patients not controlled with metformin+sulfonylurea (SU), SU replacement is preferred to adding a third antihyperglycemic agent to background therapy (77% vs. 23%). CONCLUSIONS T2D treatment in PC is still focused on HbA1c reduction and treatment safety. Thus, DPP4-I are widely used. SGLT2-I are usually preferred for patients with T2D and CVD and GLP1-RA for patients with T2D and obesity, although their use in PC is low.
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