1
|
Vlacho B, Molló Iniesta À, Gratacòs M, Mata-Cases M, Rubinat E, Berenguera A, Cos FX, Franch-Nadal J, Mauricio D. Effectiveness of a multicomponent healthcare intervention on blood pressure and lipids among subjects with poorly controlled type 2 diabetes: Findings from the INTEGRA study. Prim Care Diabetes 2024:S1751-9918(24)00077-9. [PMID: 38782704 DOI: 10.1016/j.pcd.2024.05.001] [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: 03/05/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
AIM We aimed to evaluate the impact of a multicomponent healthcare intervention, primarily designed to improve glycemic control, on blood pressure and lipids in individuals with poorly controlled type 2 diabetes mellitus (T2DM) in the Catalonian primary care setting METHODS: A cluster, non-randomized, controlled pragmatic trial was conducted across 11 primary care centers. The intervention group (N=225) received a comprehensive, patient-centered approach, including a dedicated monographic consultation to address therapeutic inertia. The control group (N=181) mirrored the intervention group but lacked the monographic consultation. Secondary endpoints included lipid and blood pressure control assessed at baseline and after a 12-month follow-up. RESULTS 245 participants completed the study over 12 months. We found no differences in the reduction of lipid laboratory parameters between the groups at the final visit. However, no significant differences were found between the groups for other lipids or the proportion of participants achieving lipid target values. Likewise, no differences were noted between the groups for blood pressure, its target control, and treatment at the final visit. Various clinical factors such as age, sex, diabetes duration, HbA1c levels, BMI, and macrovascular complications among the participants were associated with achieving lipid and blood pressure targets at the final visit. CONCLUSION The pragmatic multicomponent intervention proposed in the INTEGRA study, showed that including a component designed to reduce clinical inertia in the management of glycemia did not demonstrate benefits in improving lipids and blood pressure in patients with poorly controlled T2DM.
Collapse
Affiliation(s)
- Bogdan Vlacho
- 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; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Àngels Molló Iniesta
- 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
| | - Mònica Gratacòs
- 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
| | - Manel Mata-Cases
- 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; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Esther Rubinat
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRB Lleida, University of Lleida, Lleida, Spain; Department of Nursing & Physiotherapy, Serra Hunter Lecture, University of Lleida, Lleida, Spain; Society, Health, Education and Culture Research Group (GESEC) of the University of Lleida, Lleida, Spain
| | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Departament d'Infermeria, Universitat de Girona, Girona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Francesc Xavier Cos
- 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; Innovation office at Institut Català de la Salut, Barcelona, Spain
| | - Josep Franch-Nadal
- 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; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
| | - Dídac Mauricio
- 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; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, IR Sant Pau, Barcelona, Spain; Department of Medicine, University of Vic - Central University of Catalonia, Vic, Spain.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Peral Martínez IM, Martínez Pastor A, Gomariz García JJ, Barquilla García A, Martín Sánchez V, Micó Pérez R, Divisón Garrote JA. Regional differences in the degree of glycaemic diabetes control in Spain and associated factors. IBERICAN study. ENDOCRINOL DIAB NUTR 2023; 70:448-458. [PMID: 37468414 DOI: 10.1016/j.endien.2023.07.001] [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: 11/11/2021] [Accepted: 04/12/2022] [Indexed: 07/21/2023]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of type 2 diabetes (T2D) is high, it is increasing and its degree of control seems to be improvable with important social and health consequences. The objective of this study is to determine the regional differences in the degree of glycaemic control of T2D in Spain and its associated factors. MATERIAL AND METHODS Cross-sectional, multicentre, observational study in patients with T2D between 18 and 85 years of age selected by consecutive sampling between 2014 and 2018. The population was divided into four regions: north, centre, Mediterranean and south-east. The main variable was the value of glycated haemoglobin (HbA1c). Sociodemographic and clinical variables, presence or absence of other risk factors and treatment were recorded. RESULTS A total of 1587 patients with T2D were analysed, with a mean age of 65.93 years (standard deviation [SD] 10.14); 54.5% were men; the mean duration of T2D was 8.63 years (SD 6.64) and the mean HbA1c value was 7.05%. Of the total, 59.8% had an HbA1c value ≤ 7% (north 59.5%, centre 59.5%, Mediterranean 60.6% and south-east 59.8%; P=.99). The factors for poor control were: in the north, duration of T2D and being sedentary; in the centre, duration of T2D and having a low income; in the Mediterranean, duration of T2D; and in the south-east, duration of T2D and having a low level of education or income. Overall, 76.2% of the subjects had hypertension, 75.1% dyslipidaemia, and 51.7% obesity, with significant differences between regions only being observed in the case of dyslipidaemia (P<.001). CONCLUSIONS No differences were observed in the degree of diabetes control in the different regions, with the percentage of patients needing intensification in their control being high in all of them. The factors associated with poor control were the duration of the disease, a low level of education or income, and a sedentary lifestyle.
Collapse
Affiliation(s)
- Isabel María Peral Martínez
- Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain; Centro de Salud Puerto Lumbreras, Puerto Lumbreras, Murcia, Spain.
| | - Antonio Martínez Pastor
- Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain; Centro de Salud Vistalegre-La Flota, Murcia, Spain
| | - Juan José Gomariz García
- Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain; Centro de Salud Lorca Sur, Lorca, Murcia, Spain
| | | | | | - Rafael Micó Pérez
- Centro de Salud Fontanars dels Alforins, Fontanars dels Alforins, Valencia, Spain
| | - Juan Antonio Divisón Garrote
- Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain; Centro de Salud Casas Ibañez, Casas Ibáñez, Albacete, Spain
| |
Collapse
|
5
|
Tejera-Pérez C, Chico A, Azriel-Mira S, Lardiés-Sánchez B, Gomez-Peralta F. Connected Insulin Pens and Caps: An Expert's Recommendation from the Area of Diabetes of the Spanish Endocrinology and Nutrition Society (SEEN). Diabetes Ther 2023:10.1007/s13300-023-01417-1. [PMID: 37188930 DOI: 10.1007/s13300-023-01417-1] [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: 03/25/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
Undoubtedly, technological advances have revolutionised diabetes management in recent years. The development of advanced closed hybrid loop insulin pumps or continuous glucose monitoring (CGM) systems, among others, have increased the quality of life and improved glycaemic control of people with diabetes. However, only some patients have access to such technology, and only some want to use it. CGM has become much more widespread, but in terms of insulin delivery, most people with type 1 diabetes (T1D) and almost all people with type 2 diabetes (T2D) on insulin therapy are treated with multiple-dose insulin injections (MDI) rather than an insulin pump. For these patients, using connected insulin pens or caps has shown benefits in reducing missed insulin injections and promoting correct administration over time. In addition, using these devices improves the quality of life and user satisfaction. The integration of insulin injection and CGM data facilitates both users and the healthcare team to analyse glucose control and implement appropriate therapeutic changes, reducing therapeutic inertia. This expert's recommendation reviews the characteristics of the devices marketed or in the process of being marketed and their available scientific evidence. Finally, it suggests the profile of users and professionals who would benefit most, the barriers to its generalisation and the changes in the care model that implementing these devices can bring with it.
Collapse
Affiliation(s)
- Cristina Tejera-Pérez
- Servicio Endocrinología y Nutriciós, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Ana Chico
- Servicio Endocrinología y Nutrición, Hospital Santa Creu i Sant Pau, Barcelona, Spain
- CIBER-OBN, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sharona Azriel-Mira
- Servicio de Endocrinología y Nutrición, Hospital Universitario Infanta Sofia, Madrid, Spain
| | | | - Fernando Gomez-Peralta
- Endocrinology and Nutrition Unit, Hospital General de Segovia, Unidad de Endocrinología y Nutrición, Luis Erik Clavería Neurólogo S.N street, 40002, Segovia, Spain.
| |
Collapse
|
6
|
Franch-Nadal J, Granado-Casas M, Mata-Cases M, Ortega E, Vlacho B, Mauricio D. Determinants of response to the glucagon-like peptide-1 receptor agonists in a type 2 diabetes population in the real-world. Prim Care Diabetes 2022; 16:810-817. [PMID: 36336605 DOI: 10.1016/j.pcd.2022.10.005] [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: 05/15/2021] [Revised: 05/02/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
AIMS To identify clinical predictors associated with a response in terms of glycemic control and weight loss in patients with type 2 diabetes treated with glucagon-like peptide-1 receptor agonists (GLP-1RAs). METHODS A retrospective observational study was performed with real-world databases in primary care. Patients with type 2 diabetes-initiated treatment with GLP-1RAs during the study period, and response to GLP-1RAs were determined six months from treatment initiation. An optimal glycated hemoglobin (HbA1c) or weight response was defined as a reduction of ≥ 1% or ≥ 3%, respectively. A "great" response was defined as both an optimal HbA1c and weight response. Bivariate and multivariate analyses with intention-to-treat were performed. RESULTS A sample of 2944 patients with type 2 diabetes was recruited. Higher HbA1c at baseline was the main clinical predictor of an optimal HbA1c response (odds ratio [OR]: 2.30, 95% confidence interval [CI]: 1.96-2.71 in men and OR: 2.03, 95% CI: 1.76-2.33 in women). Treatment without insulin at baseline was associated with a greater weight reduction in men (OR: 2.50, 95% CI: 1.41-4.44). Older age and a higher weight at baseline were related with this in women (OR: 1.02, 95% CI: 1.00-1.05 and OR: 1.01, 95% CI: 1.00-1.02, respectively). CONCLUSIONS A high HbA1c at baseline and previous non-insulin therapy were the main predictors of a greater response (optimal HbA1c and weight response) to GLP1ra in both men and women. This may aid in treatment decision-making before initiating treatment with GLP-1RAs.
Collapse
Affiliation(s)
- Josep Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Institut Universitari per a la Recerca a l'Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), C/ Sardanya 375, 08025 Barcelona, Spain; Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut, Av. de les Drassanes, 17-21, 08001 Barcelona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain.
| | - Minerva Granado-Casas
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Institut Universitari per a la Recerca a l'Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), C/ Sardanya 375, 08025 Barcelona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain; Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRB Lleida, University of Lleida, Av. Rovira Roure, 80, 25198 Lleida, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Institut Universitari per a la Recerca a l'Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), C/ Sardanya 375, 08025 Barcelona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain; Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Pl. Maria Angels Rosell Simplicio, 1, 08930 Barcelona, Spain.
| | - Emilio Ortega
- Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Suñer, Hospital Clinic, C/ de Villarroel, 170, 08036 Barcelona, Spain; Center for Biomedical Research on Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain.
| | - Bogdan Vlacho
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Institut Universitari per a la Recerca a l'Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), C/ Sardanya 375, 08025 Barcelona, Spain.
| | - Didac Mauricio
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Institut Universitari per a la Recerca a l'Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), C/ Sardanya 375, 08025 Barcelona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Carrer de Sant Quintí, 89, 08041 Barcelona, Spain; Faculty of Medicine, University of Vic (UVIC/UCC), Ctra. de Roda, 70, 08500 Vic, Spain.
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
López-Cobo I, Rodriguez-Latre L, Cunillera O, Ruiz I, Copetti S, Albareda M, Vila L. Trends in glycemic control, cardiovascular risk factors and chronic complications of type 2 diabetes, 2012-2016, in a healthcare area of Barcelona. Diabetes Res Clin Pract 2022; 190:110014. [PMID: 35870572 DOI: 10.1016/j.diabres.2022.110014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/23/2022] [Accepted: 07/18/2022] [Indexed: 01/04/2023]
Abstract
AIMS This study aimed to analyse the evolution of the metabolic control, cardiovascular risk factors and chronic complications in a Type 2 Diabetes (T2D) population in a healthcare area of Barcelona. METHODS We carried out a comparative study of T2D patients (20.457) between 2012 and 2016 (data recorded in the "Electronic Clinical-Station in Primary Care") concerning: age, gender, body mass index (BMI), arterial blood pressure (BP), HbA1c, LDL-Cholesterol, smoking, heart failure (HF), micro and macrovascular complications. RESULTS Average HbA1c was 6.9 % in 2012 and 7 % in 2016 (Non significant differences)(NS). In 2012, 57.9 % of patients presented proper glycaemic control, 42.8 % LDL-Cholesterol < 100 mg/dL and 76.9 % BP < 140/90 while in 2016 it was 61.2 % (NS), 59.2 % (p = 0.001) and 82.9 % (p = 0.016) respectively. No changes were found in BMI or active smoking. Significant increases were found in the prevalence of microvascular complications, HF and peripheral vasculopathy (PV). Patients with vascular diseases (PVD) and adequate metabolic control increased from 57.5 % to 62.7 % (p = 0.006). Albuminuria > 30 mg/g were more frequent among PVD. CONCLUSIONS Between 2012 and 2016 it was observed that, amongst our study population, glycaemic control was steady and cholesterol and BP levels were improved, while there was a significant increase of diabetic complications, HF and PV.
Collapse
Affiliation(s)
- Irela López-Cobo
- Servei d'Endocrinologia i Nutrició, Complex Hospitalari Moisès Broggi, c/Oriol Martorell, 12 -08970- Sant Joan Despí, Barcelona, Spain
| | - Lluïsa Rodriguez-Latre
- Servei d'Atenció Primària Baix Llobregat Centre, Direcció d'Atenció Primària, Costa de Ponent, Institut Català de la Salut, c/ Bellaterra, 41 -08940- Cornellà de Llobregat, Barcelona, Spain
| | - Oriol Cunillera
- Unitat de Suport a la Recerca Costa de Ponent, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), c/ Bellaterra, 41, Cornellà de Llobregat - 08940- Cornellà, Barcelona, Spain; Universitat Autònoma de Barcelona, Campus Bellaterra, - 08193 - Cerdanyola del Vallés, Barcelona, Spain
| | - Irene Ruiz
- Centre d'Atenció Primària Torrassa, Consorci Sanitari Integral, Rda. la Torrassa, 151-153, - 08903 - L'Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia Copetti
- Servei d'Atenció Primària Baix Llobregat Centre, Direcció d'Atenció Primària, Costa de Ponent, Institut Català de la Salut, c/ Bellaterra, 41 -08940- Cornellà de Llobregat, Barcelona, Spain
| | - Mercè Albareda
- Servei d'Endocrinologia i Nutrició, Complex Hospitalari Moisès Broggi, c/Oriol Martorell, 12 -08970- Sant Joan Despí, Barcelona, Spain
| | - Lluís Vila
- Servei d'Endocrinologia i Nutrició, Complex Hospitalari Moisès Broggi, c/Oriol Martorell, 12 -08970- Sant Joan Despí, Barcelona, Spain.
| |
Collapse
|
9
|
Peral Martínez IM, Martínez Pastor A, Gomariz García JJ, Barquilla García A, Martín Sánchez V, Micó Pérez R, Divisón Garrote JA. Diferencias regionales en el grado de control glucémico de la diabetes en España y factores asociados. Estudio IBERICAN. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
10
|
SEA 2022 Standards for Global Control of Cardiovascular Risk. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2022; 34:130-179. [PMID: 35090775 DOI: 10.1016/j.arteri.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023]
Abstract
One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known that cardiovascular diseases are the leading cause of death in our country and entail a high degree of disability and health care costs. Arteriosclerosis is a multifactorial disease and therefore its prevention requires a global approach that takes into account the different risk factors with which it is associated. Therefore, this document summarizes the current level of knowledge and includes recommendations and procedures to be followed in patients with established cardiovascular disease or at high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or requested for those in special situations. It also includes vascular risk estimation, the diagnostic criteria of the different entities that are cardiovascular risk factors, and makes general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not usually referenced in the literature, such as the organization of a vascular risk consultation.
Collapse
|
11
|
Ramírez-Morros A, Franch-Nadal J, Real J, Gratacòs M, Mauricio D. Sex Differences in Cardiovascular Prevention in Type 2: Diabetes in a Real-World Practice Database. J Clin Med 2022; 11:jcm11082196. [PMID: 35456292 PMCID: PMC9032335 DOI: 10.3390/jcm11082196] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023] Open
Abstract
Women with type 2 diabetes mellitus (T2DM) have a 40% excess risk of cardiovascular diseases (CVD) compared to men due to the interaction between sex and gender factors in the development, risk, and outcomes of the disease. Our aim was to assess differences between women and men with T2DM in the management and degree of control of cardiovascular risk factors (CVRF). This was a matched cross-sectional study including 140,906 T2DM subjects without previous CVD and 39,186 T2DM subjects with prior CVD obtained from the System for the Development of Research in Primary Care (SIDIAP) database. The absolute and relative differences between means or proportions were calculated to assess sex differences. T2DM women without previous CVD showed higher levels of total cholesterol (12.13 mg/dL (0.31 mmol/L); 95% CI = 11.9−12.4) and low-density lipoprotein cholesterol (LDL-c; 5.50 mg/dL (0.14 mmol/L); 95% CI = 5.3−5.7) than men. The recommended LDL-c target was less frequently achieved by women as it was the simultaneous control of different CVRF. In secondary prevention, women showed higher levels of total cholesterol (16.89 mg/dL (0.44 mmol/L); 95% CI = 16.5−17.3), higher levels of LDL-c (8.42 mg/dL (0.22 mmol/L); 95% CI = 8.1−8.8), and higher levels of triglycerides (11.34 mg/dL (0.13 mmol/L); 95% CI = 10.3−12.4) despite similar rates of statin prescription. Recommended targets were less often achieved by women, especially LDL-c < 100 mg/dL (2.59 mmol/L). The composite control was 22% less frequent in women than men. In conclusion, there were substantial sex differences in CVRF management of people with diabetes, with women less likely than men to be on LDL-c target, mainly those in secondary prevention. This could be related to the treatment gap between genders.
Collapse
Affiliation(s)
- Anna Ramírez-Morros
- DAP-Cat Group, Unitat de Suport a la Recerca de la Catalunya Central, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08272 Sant Fruitós de Bages, Spain;
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain
| | - Josep Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca de Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain; (J.F.-N.); (J.R.); (M.G.)
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain
| | - Jordi Real
- DAP-Cat Group, Unitat de Suport a la Recerca de Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain; (J.F.-N.); (J.R.); (M.G.)
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain
| | - Mònica Gratacòs
- DAP-Cat Group, Unitat de Suport a la Recerca de Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain; (J.F.-N.); (J.R.); (M.G.)
| | - Didac Mauricio
- DAP-Cat Group, Unitat de Suport a la Recerca de Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain; (J.F.-N.); (J.R.); (M.G.)
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau and Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041 Barcelona, Spain
- Department of Medicine, University of Vic and Central University of Catalonia, 08500 Vic, Spain
- Correspondence: ; Tel.: +34-93-556-5661
| |
Collapse
|
12
|
Mahmoud K, Youniss S, Elamami AH. Clinical Inertia of Discharge Planning Among Patients with Diabetes in Elhwari General Hospital. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/21-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Khaled Mahmoud
- Internal Medicine, Faculty of Medicine, Benghazi University, Libya
| | - Safia Youniss
- Internal Medicine, Faculty of Medicine, Benghazi University, Libya
| | - Adela H. Elamami
- Internal Medicine, Faculty of Medicine, Benghazi University, Libya
| |
Collapse
|
13
|
Franch-Nadal J, Gatius JR, Mata-Cases M, Ortega E, Valles JA, Vlacho B, Mauricio D. Compliance with the DPP-4 inhibitors dose adjustment recommendations based on renal function in a population database. ENDOCRINOL DIAB NUTR 2022; 69:83-91. [PMID: 35256063 DOI: 10.1016/j.endien.2022.02.011] [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: 11/19/2020] [Accepted: 01/05/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To examine the prescription pattern of the different dipeptidyl peptidase-4 inhibitors (DPP4is), depending on the estimated glomerular filtration rate (eGFR) under real-world clinical practice conditions. METHOD This was a descriptive, observational study using a population database (SIDIAP Catalonia). Subjects diagnosed with T2DM with kidney function assessed and on active treatment with DPP4is were enrolled. Patients were included at the time of the measurement of eGFR (CKD-epi) and were monitored for 6 months after enrolment. For each subject, the prescribed daily dose (PDD) of DPP4i, the theoretical dose according to the degree of renal failure established by the recommendations in the summary of product characteristics (DDD-adj), and the PDR ratio (PDD/DDD-adj) were estimated. A subject was considered overtreated if his/her RDR was greater than 1.2 (>20%). RESULTS The study sample consisted of 72,135 subjects with a mean age of 69.7 (±11.6) years and 55.9% males. The proportion of patients overtreated varied depending on the type of DPP4i and the renal function stage. Overall, overdosage was recorded in 7.15% of all DPP4i treatments. In advanced stages (IIIb, IV, and V), overdosage was much higher (36.8% for all DPP4is, and 58.7% if linagliptin is excluded). DISCUSSION Under real-world clinical practice conditions, more than one third of T2DM patients with advanced renal failure were overdosed with DPP4is because the doses were not adequately adjusted to the glomerular filtration rate of each patient.
Collapse
Affiliation(s)
- Josep Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
| | - Jordi Real Gatius
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Barcelona, Spain
| | - Emilio Ortega
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Suñer, Hospital Clinic, Barcelona, Spain; CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Joan-Anton Valles
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Drug Area, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
| | - Bogdan Vlacho
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
| | - Didac Mauricio
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| |
Collapse
|
14
|
Genua I, Franch-Nadal J, Navas E, Mata-Cases M, Giménez-Pérez G, Vlacho B, Mauricio D, Goday A. Obesity and related comorbidities in a large population-based cohort of subjects with type 1 diabetes in Catalonia. Front Endocrinol (Lausanne) 2022; 13:1015614. [PMID: 36531459 PMCID: PMC9756841 DOI: 10.3389/fendo.2022.1015614] [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: 08/09/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Obesity, an increasing global health problem, can affect people with other disease conditions. The prevalence of obesity in people with type 1 diabetes (T1D) is not well known. The aim of this study was to describe extensively the characteristics and prevalence of different classes of obesity according to BMI (body mass index) categories in a large cohort of patients with T1D. MATERIAL AND METHODS This was a retrospective, cross-sectional study in Catalonia. We reviewed all patients with T1D diagnosis, ≥ 18 years old and with BMI data from the SIDIAP database. Sociodemographic and clinical data, cardiovascular risk factors, laboratory parameters and concomitant medications were collected. RESULTS A total of 6,068 patients with T1D were analyzed. The prevalence of obesity in the total sample was 18% (13.8% with class 1 obesity [BMI 30-34.9 kg/m2]). Patients with obesity had a higher prevalence of other cardiovascular risk factors (i.e. hypertension was 61.4% vs. 37.5%; dyslipidemia 63.6% vs 44%, and chronic kidney disease 38.4% vs. 24.4%; p<0.001 in all cases) and poorer control of them. The higher prevalence was regardless of sex, age and duration of diabetes. The increase in these comorbidities was noticeable from a BMI > 25 kg/m2. Patients with obesity did not have poorer glycemic control. CONCLUSION The presence of obesity in people with T1D is frequent and cardiovascular risk factors are more common and more poorly controlled in T1D patients with obesity.
Collapse
Affiliation(s)
- Idoia Genua
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Josep Franch-Nadal
- Diabetis en Atenció Primaria-Catalunya (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 Raval Sud, Gerència d’Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Elena Navas
- Unitat de Suport a la Recerca|, Barcelona, Spain
| | - Manel Mata-Cases
- Diabetis en Atenció Primaria-Catalunya (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
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Primary Health Care Center La Mina, Gerència d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
| | - Gabriel Giménez-Pérez
- Endocrinology Section, Department of Medicine, Hospital General de Granollers, Granollers, Spain
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Bogdan Vlacho
- Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Diabetis en Atenció Primaria-Catalunya (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
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Didac Mauricio
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Diabetis en Atenció Primaria-Catalunya (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
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Medicine, Universitat de Vic - Universitat Central de Catalunya, Barcelona, Spain
- *Correspondence: Didac Mauricio,
| | - Albert Goday
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Deparment of Endocrinology & Nutrition, Hospital del Mar, IMIM Institut Mar d’Investigacions Mediques. Parc de Salut Mar, Barcelona, Spain
- CIBERobn, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| |
Collapse
|
15
|
Puig-Jové C, Castelblanco E, Falguera M, Hernández M, Soldevila B, Julián MT, Teis A, Julve J, Barranco-Altirriba M, Franch-Nadal J, Puig-Domingo M, Ortega E, Amigó N, Alonso N, Mauricio D. Advanced lipoprotein profile in individuals with normal and impaired glucose metabolism. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:22-30. [PMID: 33785266 DOI: 10.1016/j.rec.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/18/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Several types of lipoproteins beyond low-density lipoproteins (LDL) are causally related to cardiovascular disease. We aimed to analyze an advanced lipoprotein profile in individuals with normal and impaired glucose metabolism from different cohorts of a Mediterranean region. METHODS Cross-sectional study in 929 participants (463 normoglycemia, 250 prediabetes, and 216 type 2 diabetes mellitus) with normal renal function, free from cardiovascular disease, and without lipid-lowering treatment. Conventional and advanced (nuclear magnetic resonance [NMR] spectroscopy) lipoprotein profiles were analyzed. RESULTS Compared with men, normoglycemic women showed lower serum triglyceride and LDL cholesterol concentrations, lower total LDL particles (P) as well as their subclasses and their cholesterol and triglyceride content, higher high-density lipoproteins (HDL)-P and all HDL-related variables (P≤ .05 for all comparisons). Compared with normoglycemic participants, diabetic participants showed higher large and small very LDL-P concentrations (P <.05) and lower total HDL-P and medium HDL-P concentrations (P <.05). Waist circumference and Fatty Liver Index were positively associated with a proatherogenic profile. CONCLUSIONS Women had a better advanced lipoprotein profile than did men. Adiposity indexes related to insulin-resistance were positively associated with a proatherogenic lipid profile. NMR revealed altered lipoprotein particles other than LDL in participants with diabetes, frequently associated with an increased cardiovascular risk. Our findings support the usefulness of extended lipoprotein analysis by NMR spectroscopy to uncover new therapeutic targets to prevent cardiovascular events in at-risk participants.
Collapse
Affiliation(s)
- Carlos Puig-Jové
- Servicio de Endocrinología y Nutrición, Hospital Universitario e Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Esmeralda Castelblanco
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau e Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Mireia Falguera
- Instituto de Investigación Biomédica y Universidad de Lleida, Centro de Atención Primaria Cervera, Gerencia de Atención Primaria, Institut Català de la Salut, Lleida, Spain
| | - Marta Hernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario Arnau de Vilanova e Instituto de Investigación Biomédica de Lleida (IRBLleida), Lleida, Spain
| | - Berta Soldevila
- Servicio de Endocrinología y Nutrición, Hospital Universitario e Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - María Teresa Julián
- Servicio de Endocrinología y Nutrición, Hospital Universitario e Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Albert Teis
- Servicio de Cardiología, Institut del Cor (iCor), Hospital Universitario Germans Trias i Pujol, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Josep Julve
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - María Barranco-Altirriba
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau e Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Josep Franch-Nadal
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; 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
| | - Manel Puig-Domingo
- Servicio de Endocrinología y Nutrición, Hospital Universitario e Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Emilio Ortega
- Servicio de Endocrinología y Nutrición, Hospital Cínico de Barcelona, Institut d'investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Núria Amigó
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Departamento de Ingeniería Electrónica y Automática, Universidad Rovira i Virgili, Instituto de Investigación Sanitaria Pere Virgili (IISPV), Tarragona, Spain
| | - Núria Alonso
- Servicio de Endocrinología y Nutrición, Hospital Universitario e Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain.
| | - Didac Mauricio
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau e Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain; Facultad de Medicina, Universidad de Vic - Universidad Central de Cataluña (UVic/UCC), Vic, Barcelona, Spain
| |
Collapse
|
16
|
Sotorra-Figuerola G, Ouchi D, García-Sangenís A, Giner-Soriano M, Morros R. Pharmacological treatment after acute coronary syndrome: Baseline clinical characteristics and gender differences in a population-based cohort study. Aten Primaria 2022; 54:102157. [PMID: 34717156 PMCID: PMC8566964 DOI: 10.1016/j.aprim.2021.102157] [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: 05/03/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe baseline socio-demographic and clinical characteristics and drugs prescribed for secondary prevention after a first episode of ACS and to assess differences between men and women. SETTING PHC in Catalonia. DATA SOURCE SIDIAP (Information System for Research in Primary Care). PARTICIPANTS Patients who suffered an ACS during 2009-2016 and followed-up in PHC centres of the Catalan Health Institute in Catalonia. INTERVENTIONS Not applicable. MAIN MEASURES Socio-demographic and clinical characteristics at baseline: sex, age, socioeconomic index, toxic habits, comorbidities, study drugs (prescribed for cardiovascular secondary prevention: antiplatelets, betablockers, statins, drugs acting on the renin-angiotensin system) and comedications. RESULTS 8071 patients included, 71.3% of them were men and 80.2% had an acute myocardial infarction. Their mean age was 65.3 and women were older than men. The most frequent comorbidities were hypertension, dyslipidaemia and diabetes and they were more common in women. Antiplatelets (91.3%) and statins (85.7%) were the study drugs most prescribed. The uses of all comedications were significantly higher in women, except for nitrates. The combination of four study groups was initially prescribed in 47.7% of patients and combination of beta-blockers, statins and antiplatelets was prescribed in 18.4%. More men than women received all recommended pharmacological groups. CONCLUSION Women were older, had more comorbidities and received more comedications. Most patients were treated with a combination of four or three study drugs for secondary prevention. Men initiated more drug treatments for secondary prevention and dual antiplatelet therapy than women. EUPAS REGISTER EUPAS19017.
Collapse
Affiliation(s)
- Gerard Sotorra-Figuerola
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Dan Ouchi
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Ana García-Sangenís
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
| | - Rosa Morros
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Institut Català de la Salut, Barcelona, Spain; Universitat Autònoma de Barcelona, Departament de Farmacologia, Terapèutica i Toxicologia, Bellaterra (Cerdanyola del Vallès), Spain; Plataforma SCReN, UICEC IDIAP Jordi Gol, Barcelona, Spain
| |
Collapse
|
17
|
|
18
|
Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study. J Clin Med 2021; 10:jcm10245854. [PMID: 34945149 PMCID: PMC8703537 DOI: 10.3390/jcm10245854] [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: 11/15/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 01/14/2023] Open
Abstract
Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. This study aimed to analyze how the differences in delivered care (variability of glycosylated hemoglobin (HbA1c) achieved targets) affect hospital admissions for cardiovascular events (CVEs) in T2D patients. Methods: We analyzed the electronic records in primary care health centers at Navarra (Spain) and hospital admission for CVEs. We followed 26,435 patients with T2D from 2012 to 2016. The variables collected were age, sex, health center, general practitioner practice (GPP), and income. The clinical variables were diagnosis of T2D, weight, height, body mass index (BMI), blood pressure (BP), HbA1c, low-density lipoprotein cholesterol (LDL-C), smoking, and antecedents of CVEs. We calculated, in each GPP practice, the proportion of patients with HbA1c ≥ 9. A non-hierarchical K-means cluster analysis classified GPPs into two clusters according to the level of compliance with HbA1C ≥ 9% control indicators. We used logistic and Cox regressions. Results: T2D patients had a higher probability of admission for CVEs when they belonged to a GPP in the worst control cluster of HbA1C ≥ 9% (HR = 1.151; 95% CI, 1.032–1.284).
Collapse
|
19
|
An L, Wang Y, Cao C, Chen T, Zhang Y, Chen L, Ren S, Tang M, Ma F, Li X, Yuan S, Zhao W, Lee Y, Xiao J. Screening cardiovascular risk factors of diabetes patients in the primary diabetes clinics. Medicine (Baltimore) 2021; 100:e26722. [PMID: 34397707 PMCID: PMC8322505 DOI: 10.1097/md.0000000000026722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/05/2021] [Accepted: 07/04/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT To evaluate the atherosclerotic cardiovascular diseases (ASCVD) risk factors in type 2 diabetes patients from the primary diabetes clinics for further comprehensive intervention in China.A cross-sectional study was conducted in 5 primary diabetes chain hospitals in Beijing, Lanzhou, Harbin, Chengdu, and Taiyuan in continuous patients with type 2 diabetes from March 2016 to December 2019. The data collected at the first visit were analyzed, and proportions of patients reached the targets (glycosylated hemoglobin [HbA1c] < 7%, blood pressure < 130/80 mm Hg, and low-density lipoprotein cholesterol [LDL-C] < 2.6mmol/l) were calculated. The clinical characteristics and the associated factors with achievement in HbA1c, blood pressure, and LDL-C targets were analyzed.A total of 20,412 participants, including 11,353 men (55.6%), with an average age of (59.4 ± 10.4) years were enrolled. Nearly 95% diabetes had one or more ASCVD risk factors other than hyperglycemia. The control rates of HbA1c, blood pressure, and LDL-C were 26.5%, 27.8%, and 42.6%, respectively. Only 4.1% patients achieved all 3 targets. Nearly 95% patients had one or more ASCVD risk factors other than hyperglyciemia. Diabetes duration, family history, and overweight/obesity were associated with the number of aggregated ASCVD risk factors. The patients with older age, no overweight/obesity, not smoking, less ASCVD risk factors, and having special diabetes care insurance (Chengdu) were associated with a higher control rates.To deal with poor control status, global management of ASCVD risk factors, weight loss, and smoking cessation must be emphasized in the primary diabetes care settings. Special diabetes care insurance should be advocated.Current ClinicalTrial.gov protocol ID NCT03707379. Date of Registration: October 16, 2018. https://clinicaltrials.gov.
Collapse
Affiliation(s)
| | - Yanlei Wang
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Chenxiang Cao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Tao Chen
- Chengdu Ryan Diabetes Hospital, Chengdu
| | | | | | | | | | | | | | - Shuang Yuan
- Heilongjiang Ruijing Diabetes Hospital, Harbin, Heilongjiang, China
| | - Wenhui Zhao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Yaujiunn Lee
- Lee's Clinic, No. 130, Min-Zu Rd, Pingtung, Taiwan
| | - Jianzhong Xiao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| |
Collapse
|
20
|
Mata-Cases M, Franch-Nadal J, Real J, Vlacho B, Gómez-García A, Mauricio D. Evaluation of clinical and antidiabetic treatment characteristics of different sub-groups of patients with type 2 diabetes: Data from a Mediterranean population database. Prim Care Diabetes 2021; 15:588-595. [PMID: 33602606 DOI: 10.1016/j.pcd.2021.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022]
Abstract
AIMS To describe the characteristics and antidiabetic treatment among type 2 diabetes patients according to the clinical conditions prioritized in the Spanish 2020 RedGDPS (Primary Care Diabetes Study Groups Network) therapeutic algorithm: obesity, older than 75 years, chronic kidney disease, cardiovascular disease, and heart failure. METHODS Retrospective, cross-sectional study. Clinical characteristics, the use of antidiabetic drugs and the KDIGO renal risk categories at 31.12.2016 were retrieved from the SIDIAP (Information System for Research in Primary Care) database (Catalonia, Spain). RESULTS From a total of 373,185 type 2 diabetes patients, 37% were older than 75 years, 45% obese, 33% had chronic kidney disease, 23.2% cardiovascular disease and 6.9% heart failure. Insulin was more frequently prescribed in chronic kidney disease, cardiovascular disease and heart failure whereas Sodium-Glucose cotransporter 2 inhibitors and Glucagon Like Peptide 1 receptor agonists were scarcely prescribed (2.6% and 1.4%, respectively). Among patients with severe renal failure, contraindicated drugs like metformin (16%) and sulfonylureas (6.1%) were still in use. The 2012 KDIGO renal risk categories distribution was: Low: 60.9%, Moderate: 21.6%, High: 9.8% and Very high: 7.7%. CONCLUSIONS Almost 80% of our T2DM patients meet one of the five clinical conditions that should be considered for treatment individualization. Importantly, a relevant number of patients with severe renal failure were found to use contraindicated drugs.
Collapse
Affiliation(s)
- Manel Mata-Cases
- DAP-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain; Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
| | - Josep Franch-Nadal
- DAP-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain; Primary Health Care Center Raval Sud, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain.
| | - Jordi Real
- DAP-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Internacional de Catalunya, Epidemiologia i Salut Pública, Sant Cugat, Spain
| | - Bogdan Vlacho
- DAP-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | | | - Dídac Mauricio
- DAP-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain; Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Departament of Medicine, University of Vic - Central University of Catalonia, Vic, Barcelona, Spain
| |
Collapse
|
21
|
Franch-Nadal J, Real J, Mata-Cases M, Ortega E, Antoni Vallès J, Vlacho B, Mauricio D. Compliance with the DPP-4 inhibitors dose adjustment recommendations based on renal function in a population database. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00118-X. [PMID: 34088634 DOI: 10.1016/j.endinu.2021.01.013] [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: 11/19/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the prescription pattern of the different dipeptidyl peptidase-4 inhibitors (DPP4is), depending on the estimated glomerular filtration rate (eGFR) under real-world clinical practice conditions. METHOD This was a descriptive, observational study using a population database (SIDIAP Catalonia). Subjects diagnosed with T2DM with kidney function assessed and on active treatment with DPP4is were enrolled. Patients were included at the time of the measurement of eGFR (CKD-EPI) and were monitored for 6 months after enrolment. For each subject, the prescribed daily dose (PDD) of DPP4i, the theoretical dose according to the degree of renal failure established by the recommendations in the summary of product characteristics (DDD-adj), and the PDR ratio (PDD/DDD-adj) were estimated. A subject was considered overtreated if his/her RDR was greater than 1.2 (>20%). RESULTS The study sample consisted of 72,135 subjects with a mean age of 69.7 (±11.6) years and 55.9% males. The proportion of patients overtreated varied depending on the type of DPP4i and the renal function stage. Overall, overdosage was recorded in 7.15% of all DPP4i treatments. In advanced stages (IIIb, IV and V), overdosage was much higher (36.8% for all DPP4is, and 58.7% if linagliptin is excluded). DISCUSSION Under real-world clinical practice conditions, more than one third of T2DM patients with advanced renal failure were overdosed with DPP4is because the doses were not adequately adjusted to the glomerular filtration rate of each patient.
Collapse
Affiliation(s)
- Josep Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España; Centre d'Atenció Primària Raval Sud, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España
| | - Jordi Real
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España
| | - Manel Mata-Cases
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España; Centre d'Atenció Primària La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, España
| | - Emilio Ortega
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Servei d'endocrinologia i nutrició, Institut d'Investigacions Biomèdiques August Pi i Suñer, Hospital Clinic, Barcelona, España; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Joan Antoni Vallès
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Gerència del Medicament, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, España
| | - Bogdan Vlacho
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España.
| | - Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España; Servei d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| |
Collapse
|
22
|
Artime E, Romera I, Díaz-Cerezo S, Delgado E. Epidemiology and Economic Burden of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus in Spain: A Systematic Review. Diabetes Ther 2021; 12:1631-1659. [PMID: 33942247 PMCID: PMC8179862 DOI: 10.1007/s13300-021-01060-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in people with type 2 diabetes mellitus (T2DM). The objectives of this systematic literature review were to identify and synthesize published data describing the epidemiology and mortality of CVD in the T2DM population and the associated economic burden. METHODS We conducted a systematic review searching the PubMed and MEDES databases from 2009 to 2019 using predefined selection criteria. Peer-reviewed observational studies reporting primary or secondary data on CVD prevalence, incidence, mortality, resource use and costs in patients with T2DM in Spain, written in English and Spanish, were included. Data were tabulated and summarized descriptively. RESULTS Of 706 articles identified, 52 were included in the review. Most studies were based on data from hospital discharge databases and registries. The reported prevalence of CVD among patients with T2DM ranged from 6.9 to 40.8%. The prevalence of coronary heart disease ranged from 4.7 to 37%, stroke from 3.5 to 19.6%, peripheral artery disease from 2.5 to 13.0%, and heart failure from 4.3 to 20.1%. In-hospital CVD mortality rates ranged from 5.6 to 10.8%. Direct costs due to CVD in hospitalized patients with T2DM were increased (> 50%) compared with patients without CVD. No studies analysed indirect costs of CVD in patients with T2DM. CONCLUSIONS The burden of CVD among patients with T2DM, combined with the elevated costs of care, highlights the importance of early prevention as part of integrated management of the disease to improve clinical and economic outcomes.
Collapse
Affiliation(s)
- Esther Artime
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain.
| | - Irene Romera
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Silvia Díaz-Cerezo
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Elías Delgado
- Department of Endocrinology and Nutrition, University of Oviedo, Oviedo, Spain
- Central University Hospital of Asturias, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Spanish Biomedical Research Network in Rare Diseases, Madrid, Spain
| |
Collapse
|
23
|
Sotorra-Figuerola G, Ouchi D, Giner-Soriano M, Morros R. Impact of adherence to drugs for secondary prevention on mortality and cardiovascular morbidity: A population-based cohort study. IMPACT study. Pharmacoepidemiol Drug Saf 2021; 30:1250-1257. [PMID: 33938603 DOI: 10.1002/pds.5261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/28/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE Adherence to pharmacological therapy for secondary prevention after an acute coronary syndrome (ACS) reduces the risk of new cardiovascular events. However, several studies showed poor adherence. Our study aim was to assess the risk of a composite endpoint of major cardiovascular events (MACE) and all-cause mortality according to the adherence to these drugs in patients after an ACS in a primary health care cohort. METHODS Population-based observational cohort study of patients with a first episode of ACS during 2009-2016. DATA SOURCE Information System for Research in Primary Care (SIDIAP) database. Drug adherence was evaluated through proportion of days covered (PDC). RESULTS We included 7152 patients and 5692 (79.6%) were adherent (PDC ≥ 75%) to the study drugs during the first year after the event. Adherents to any combination showed a significant reduction of the composite endpoint risk (HR 0.80 [0.73-0.88]), and a significant lower probability of the composite endpoint than nonadherents for all drugs, except beta-blockers. Adherents to 2 (HR 1.2; 95% CI 1.0-1.3) and 1 drug (HR 1.5; 95% CI 1.2-1.8) had higher composite endpoint risk compared to adherents to 4-3 drugs. CONCLUSION Adherence to any combination of recommended drugs reduced the composite endpoint risk, regardless the number of drugs prescribed. Adherence to a combination of 4-3 drugs was significantly associated with a reduced mortality risk compared with adherents to 2 or 1, but it was not significant for MACE.
Collapse
Affiliation(s)
- Gerard Sotorra-Figuerola
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Dan Ouchi
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Rosa Morros
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Institut Català de la Salut, Barcelona, Spain.,Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Plataforma SCReN, UICEC IDIAP Jordi Gol, Barcelona, Spain
| |
Collapse
|
24
|
Clinical Characteristics and Degree of Glycemic and Cardiovascular Risk Factor Control in Patients with Type 1 Diabetes in Catalonia (Spain). J Clin Med 2021; 10:jcm10071536. [PMID: 33917523 PMCID: PMC8038775 DOI: 10.3390/jcm10071536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 01/04/2023] Open
Abstract
Background: This study aims to evaluate the clinical characteristics, complications, degree of glycemic control, and cardiovascular risk factor control in patients with type 1 diabetes in Catalonia (Northwest of Spain). Methods: Cross-sectional study using a database including clinical, laboratory, and treatment data. Patients with an ICD10 diagnosis of type 1 diabetes were included, excluding those treated with glucose-lowering agents other than insulin, or treated only with basal insulin two years after diagnosis. Results: 15,008 patients were analysed. Median IQR age was 42 (31–53) years, diabetes duration 11.8 (6.8–16.0) years, 56.5% men. Median (IQR) HbA1c was 7.9% (7.1–8.8). Microvascular complications were present in 24.4% of patients, 43.6% in those with a diabetes duration >19 years. In presence of known cardiovascular disease 69.3% of patients showed an LDL-C concentration >70 mg/dL, 37% had a systolic blood pressure >135 mmHg and 22.4% were smokers. Conclusions: This study provides a reliable snapshot about the clinical situation of a large population of patients with T1D in Catalonia, which is similar to that of other western areas. The lack of adequate control of cardiovascular risk factors in a significant proportion of patients with cardiovascular disease deserves a more detailed analysis and urges the need for improvement strategies.
Collapse
|
25
|
Mata-Cases M, Vlacho B, Real J, Puig-Treserra R, Bundó M, Franch-Nadal J, Mauricio D. Trends in the Degree of Control and Treatment of Cardiovascular Risk Factors in People With Type 2 Diabetes in a Primary Care Setting in Catalonia During 2007-2018. Front Endocrinol (Lausanne) 2021; 12:810757. [PMID: 35082758 PMCID: PMC8784522 DOI: 10.3389/fendo.2021.810757] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/16/2021] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To assess the trends in cardiovascular risk factor control and drug therapy from 2007 to 2018 in subjects with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS Cross-sectional analysis using yearly clinical data and treatment obtained from the SIDIAP database. Patients aged ≥18 years with a diagnosis of T2DM seen in primary care in Catalonia, Spain. RESULTS The number of T2DM patients increased from 299,855 in 2007 to 394,266 in 2018. We also found an increasing prevalence of cardiovascular disease, heart failure, and chronic kidney disease (from 18.4 to 24.4%, from 4.5 to 7.3%, and from 20.2 to 31.3%, respectively). The achievement of glycemic targets (HbA1c<7%) scarcely changed (54.9% to 55.9%). Major improvements were seen in blood pressure (≤140/90 mmHg: from 55% to 71.8%), and in lipid control (low-density lipoprotein cholesterol <100 mg/dl: 33.4% to 48.4%), especially in people with established cardiovascular disease (48.8 to 69.7%). Simultaneous achievement of all three targets improved from 12.5% to 20.1% in the overall population and from 24.5% to 32.2% in those with cardiovascular disease but plateaued after 2013. There was an increase in the percentage of patients treated with any antidiabetic drug (70.1% to 81.0%), especially metformin (47.7% to 67.7%), and DPP4i (0 to 22.6%). The use of SGLT-2 and GLP-1ra increased over the years, but remained very low in 2018 (5.5% and 2.1% of subjects, respectively). There were also relevant increases in the use of statins (38.0% to 49.2%), renin-angiotensin system (RAS) drugs (52.5% to 57.2%), and beta-blockers (14.3% to 22.7%). CONCLUSIONS During the 2007-2018 period, relevant improvements in blood pressure and lipid control occurred, especially in people with cardiovascular disease. Despite the increase in the use of antidiabetic and cardiovascular drugs, the proportion of patients in which the three objectives were simultaneously achieved is still insufficient and plateaued after 2013. The use of antidiabetic drugs with demonstrated cardio renal benefits (SGLT-2 and GLP-1ra) increased over the years, but their use remained quite low.
Collapse
Affiliation(s)
- Manel Mata-Cases
- Grup de Recerca Epidemiològica en Diabetis des de l'Atenció Primària (DAP-CAT), 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
- Centre d’Atenció Primària La Mina, Gerència d’Àmbit d’Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, (CIBERDEM), Barcelona, Spain
| | - Bogdan Vlacho
- Grup de Recerca Epidemiològica en Diabetis des de l'Atenció Primària (DAP-CAT), 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
| | - Jordi Real
- Grup de Recerca Epidemiològica en Diabetis des de l'Atenció Primària (DAP-CAT), 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
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, (CIBERDEM), Barcelona, Spain
| | - Ramon Puig-Treserra
- Grup de Recerca Epidemiològica en Diabetis des de l'Atenció Primària (DAP-CAT), 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
| | - Magdalena Bundó
- Grup de Recerca Epidemiològica en Diabetis des de l'Atenció Primària (DAP-CAT), 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
- Centre d’Atenció Primària Ronda Prim, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord de Barcelona, Institut Català de la Salut, Mataro, Spain
| | - Josep Franch-Nadal
- Grup de Recerca Epidemiològica en Diabetis des de l'Atenció Primària (DAP-CAT), 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
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, (CIBERDEM), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d’Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
- *Correspondence: Josep Franch-Nadal,
| | - Didac Mauricio
- Grup de Recerca Epidemiològica en Diabetis des de l'Atenció Primària (DAP-CAT), 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
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, (CIBERDEM), Barcelona, Spain
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Spain
- Departament of Medicine, University of Vic, Central University of Catalonia, Vic, Spain
| |
Collapse
|
26
|
Orozco-Beltrán D, Brotons Cuixart C, Alemán Sánchez JJ, Banegas Banegas JR, Cebrián-Cuenca AM, Gil Guillen VF, Martín Rioboó E, Navarro Pérez J. [Cardiovascular preventive recommendations. PAPPS 2020 update]. Aten Primaria 2020; 52 Suppl 2:5-31. [PMID: 33388118 PMCID: PMC7801219 DOI: 10.1016/j.aprim.2020.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/14/2020] [Indexed: 12/16/2022] 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 tables 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. The quality of testing and the strength of the recommendation are included in the main recommendations.
Collapse
Affiliation(s)
- Domingo Orozco-Beltrán
- Unidad de Investigación CS Cabo Huertas, Departamento San Juan de Alicante, Departamento de Medicina Clínica. Universidad Miguel Hernández, España.
| | | | | | | | | | | | - Enrique Martín Rioboó
- Instituto Maimónides de Investigación Biomédica de Córdoba IMIBIC Hospital Reina Sofía. Unidad de gestión clínica Poniente. Distrito sanitario Córdoba Guadalquivir, Córdoba, España
| | - Jorge Navarro Pérez
- Hospital Clínico Universitario, Departamento de Medicina, Universidad de Valencia, Instituto de Investigación INCLIVA, Valencia, España
| |
Collapse
|
27
|
Menéndez Torre EL, Ares Blanco J, Conde Barreiro S, Rojo Martínez G, Delgado Alvarez E. Prevalence of diabetes mellitus in Spain in 2016 according to the Primary Care Clinical Database (BDCAP). ENDOCRINOLOGIA, DIABETES Y NUTRICION 2020; 68:109-115. [PMID: 32988801 DOI: 10.1016/j.endinu.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 12/25/2022]
Abstract
The prevalence of type 2 diabetes mellitus is increasing worldwide, including in Spain, and this disease has become a major challenge for health care. In Spain, the computerization of medical records in primary care, in the Primary Care Clinical Database (BDCAP), has made possible the diagnoses of diabetes in a representative sample of the nation as a whole. This article analyzes the prevalence of diabetes recorded in this database and compares the data of the different autonomous communities. The prevalence of diabetes in Spain is 6.66% of the total population assigned to primary care in the National Health System, is higher in men than in women (7.27% vs. 6.06%), and increases with age up to 80 years. There are significant differences in the adjusted prevalence of diabetes between autonomous communities, with lower prevalence rates in North and Central Spain and higher rates in the South and East, as well as the islands. The lowest prevalence is seen in Castile and Leon (4.51%), and the highest in the Canary Islands (9.72%).
Collapse
Affiliation(s)
- Edelmiro Luis Menéndez Torre
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España.
| | - Jessica Ares Blanco
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España
| | | | - Gemma Rojo Martínez
- Servicio de Endocrinología y Nutrición, Hospital Regional de Málaga, IBIMA, Málaga, España
| | - Elías Delgado Alvarez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España
| | | |
Collapse
|
28
|
Altobelli E, Angeletti PM, Profeta VF, Petrocelli R. Lifestyle Risk Factors for Type 2 Diabetes Mellitus and National Diabetes Care Systems in European Countries. Nutrients 2020; 12:nu12092806. [PMID: 32933175 PMCID: PMC7551066 DOI: 10.3390/nu12092806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background. Diabetes is increasing by 3.09% per year in males and 1.92% in females. Lifestyle risk factors are related to diabetes. The aim of this work is to highlight within EU-28 countries the distribution percentages of some lifestyle risk factors and some components of diabetes health care. Methods. A literature search was conducted to highlight the presence of diabetes registries, which are fundamental tools for disease surveillance and health planning; the presence of a national diabetes plan (NDP); the care setting; and methods used for reimbursement of drugs, devices, and coverage of any comorbidities associated with diabetes. A multiple correspondence analysis (MCA) was carried out to evaluate the possible associations between the variables considered. Results. The highest percentages of diabetes (>10%) are registered in Bulgaria, Malta, and Hungary. Concerning the prevalence of overweight, no European country shows overall percentages of less than 50%. Regarding obesity, 57% of countries show prevalence rates of 25%. The record for physical inactivity belongs to Malta, with 45% of individuals being inactive. The percentage of physical inactivity for females is higher than for males across Europe. In total, 57% of the countries have an insurance-based health system, while 12 countries have public national health systems. Further, 57% of countries have an NDP, while 42% of the EU countries have established a prevalence register for diabetes. Conclusions. Prevalence rates for type 2 DM in the range of 8–9% are noted in 50% of EU-28 countries. In total, 21 out of EU countries show a high prevalence rate for overweight, while 7% of EU-28 countries have an obesity prevalence rate of 25%. Diabetes treatment is entrusted to general practitioners in most countries. The results of this work highlight the differences between countries, but also between genders.
Collapse
Affiliation(s)
- Emma Altobelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
- Epidemiology and Biostatistics Unit, Local Health Unit, 64100 Teramo, Italy
- Correspondence: ; Tel.: +39-0862-434-666
| | - Paolo Matteo Angeletti
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
- Rianimazione e TIPO Cardiochirurgica, Ospedale G. Mazzini, Local Health Unit, 64100 Teramo, Italy
| | | | | |
Collapse
|
29
|
Mata-Cases M, Mahon J, Mauricio D, Franch-Nadal J, Real J, Hex N. Improving management of glycaemic control in people with T2DM in primary care: estimation of the impact on the clinical complications and associated costs. BMC Health Serv Res 2020; 20:803. [PMID: 32847581 PMCID: PMC7448435 DOI: 10.1186/s12913-020-05360-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 05/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To estimate the potential benefits in terms of avoided complications and cost reduction if the Spanish health system would encourage the intensification of treatment for better glycaemic control in adults with Type 2 diabetes from the current HbA1c target used in clinical practice of 68 mmol/mol to a target of 53 mmol/mol. METHODS The IQVIA Core Diabetes Model (version 9.0) was used to model the impact of these changes in respect of micro- and macrovascular complications and the associated costs. The modelling was based on data derived from the SIDIAP-Q population database from Catalonia, taking a random cohort of 10,000 people with type 2 diabetes and dividing it into sub-groups based on their baseline HbA1c. RESULTS The CDM modelling showed that the average cost reduction per person varies depending on baseline HbA1c. The model estimates that after 25 years, people with a baseline HbA1c between 48 and 58 mmol/mol and > 75 mmol/mol show an average cost reduction of €6027 and €11,966, respectively. Applying the per-person cost reduction to the cohorts of the prevalent population in Spain (1,910,374) the overall estimated cost reduction was €14.7 billion over 25 years. The improvements in outcomes resulted in an estimated reduction of more than 1.2 million complications cumulatively over 25 years, of which more than 550,000 relate to diabetic foot and more than 170,000 related to renal disease. CONCLUSION Over a 25 year period, Spain could considerably reduce costs and avoid major complications if, on a population level, more ambitious glycaemic control, according to Spanish or EU guidelines, could be achieved among people with type 2 diabetes by reducing the HbA1c threshold for treatment intensification. Although there is a slower trajectory for benefits in earlier years, there is a much more rapid benefit gain between years 5 and 15.
Collapse
Affiliation(s)
- M Mata-Cases
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Carrer Sardenya 375, entlo 1ª, 08025, Barcelona, Spain.
| | - J Mahon
- York Health Economics Consortium Ltd, University of York, York, UK
| | - D Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Carrer Sardenya 375, entlo 1ª, 08025, Barcelona, Spain
| | - J Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Carrer Sardenya 375, entlo 1ª, 08025, Barcelona, Spain
| | - J Real
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Carrer Sardenya 375, entlo 1ª, 08025, Barcelona, Spain
| | - N Hex
- York Health Economics Consortium Ltd, University of York, York, UK
| |
Collapse
|
30
|
Bayón Cabeza M, Pérez Rivas FJ, Zamora Sarabia AL, de Las Heras Mosteiro J, Becerril Rojas B, Rodriguez Barrientos R. [Diabetic patient control in Primary Care: Influence of service portfolio and other factors]. Aten Primaria 2020; 52:617-626. [PMID: 32576384 PMCID: PMC7713397 DOI: 10.1016/j.aprim.2020.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/30/2019] [Accepted: 02/13/2020] [Indexed: 11/24/2022] Open
Abstract
Objetivo Estudiar el efecto del tipo de seguimiento según la cartera de servicios y de otros factores asociados en la disminución de las cifras de HbA1c en personas con diabetes mellitus tipo 2, nuevo diagnóstico y con mal control inicial. Diseño Estudio observacional analítico de una cohorte en condiciones de práctica clínica habitual. Emplazamiento 262 centros de salud de Atención Primaria de Madrid. Participantes 1838 personas mayores de 18 años con nuevo diagnóstico de diabetes y cifras de HbA1c inicial ≥ 7% o ≥ 8,5% si tienen más de 75 años. Intervenciones La variable exposición fue el tipo de seguimiento según la cartera, categorizado en mínimo, medio y óptimo, según el número de intervenciones realizadas y periodicidad por tipo de plan terapéutico-farmacológico. Mediciones principales Se estudiaron comorbilidad, plan terapéutico-farmacológico, consejos dieta y ejercicio, índice de privación. La variable resultado principal fue la diferencia entre la HbA1c final e inicial. Resultados Tras 2 años de seguimiento se produjo una disminución media de la HbA1c de –1,7 puntos porcentuales (IC del 95%: –1,6; –1,8), siendo 0,39 puntos mayor en los pacientes con tipo de seguimiento óptimo: –2,1 (IC del 95%: –1,7; –2,4). Los factores asociados a la disminución fueron: tipo de seguimiento óptimo –0,29 (IC del 95%: –0,5; –0,1) y medio –0,26 (IC del 95%: –0,5; –0,0), y valor de la HbA1c inicial –0,9 (IC del 95%: –0,9; –0,9) y los factores asociados al aumento: tratamiento con insulina y vivir en zonas socialmente desfavorecidas. Conclusiones Los pacientes con diagnóstico reciente de diabetes en los que se realiza un seguimiento óptimo según la cartera de servicios mejoran el control glucémico.
Collapse
Affiliation(s)
- Marianela Bayón Cabeza
- Dirección Técnica de Procesos y Calidad, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Comunidad de Madrid, Madrid, España.
| | - Francisco Javier Pérez Rivas
- Dirección Técnica de Procesos y Calidad, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Comunidad de Madrid, Madrid, España; Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | | | - Julio de Las Heras Mosteiro
- Departamento de Medicina Preventiva, Salud Pública, e Inmunología y Microbiología, Universidad Rey Juan Carlos, Madrid, España
| | - Beatriz Becerril Rojas
- Unidad de Apoyo Técnico, Gerencia Adjunta de Procesos Asistenciales, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Comunidad de Madrid, Madrid, España
| | - Ricardo Rodriguez Barrientos
- Unidad de apoyo a la investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Comunidad de Madrid, Madrid, España; Investigación en Servicios de Salud y Enfermedades Crónicas (REDISSEC), Madrid, España
| |
Collapse
|
31
|
Tamez-Pérez HE, Delgadillo-Esteban E, Tamez-Peña AL. Underutilization of insulin and better metabolic control. A NOVA clinic experience. ACTA ACUST UNITED AC 2020; 66:334-337. [PMID: 32520154 DOI: 10.1590/1806-9282.66.3.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/28/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To present the results of metabolic control in patients with type 2 Diabetes Mellitus from a private clinic in Northern Mexico. METHODS This cross-sectional study used retrospective data obtained from electronic records from a private outpatient clinic at the end of 2018. Inclusion criteria were a diagnosis of T2DM and age ≥ 18 years. Baseline characteristics (age, gender, drug use) were reported. The achievement of glycated hemoglobin goals was established as <7%. RESULTS A total of 3820 patients were evaluated. Their mean age was 59.86 years (+/-15.01). Of the population, 46.72% were men, and 53.28% were women. Glycated hemoglobin goals were adequate in 1872 (54%) patients. There were 3247 patients (85%) treated with oral medications, of which 1948 (60%) reported glycated hemoglobin less than 7%. Insulin use was reported in 573 (15%) patients, with 115 (20%) reporting glycated hemoglobin less than 7%. The most frequently used basal insulin was glargine in 401 (70%) patients. CONCLUSIONS Our findings are clearly higher than the control rate reported by our national health surveys of 25% with glycated hemoglobin < 7%, but similar to that reported in other countries. The most commonly used therapeutic scheme was the combination of oral hypoglycemic agents. The percentage of cases that include insulin in their treatment was lower. Clinical inertia to insulin initiation and intensification has been defined as an important cause of this problem.
Collapse
Affiliation(s)
- Héctor Eloy Tamez-Pérez
- . Research Subdirector, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo León, Monterrey, México.,. Clinical Hospital NOVA, San Nicolás de los Garza, N.L., México
| | - Enrique Delgadillo-Esteban
- . Research Subdirector, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo León, Monterrey, México
| | - Alejandra Lorena Tamez-Peña
- . Research Subdirector, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo León, Monterrey, México
| |
Collapse
|
32
|
Initiation and Single Dispensing in Cardiovascular and Insulin Medications: Prevalence and Explanatory Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103358. [PMID: 32408626 PMCID: PMC7277594 DOI: 10.3390/ijerph17103358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 11/16/2022]
Abstract
Background: Adherence problems have negative effects on health, but there is little information on the magnitude of non-initiation and single dispensing. Objective: The aim of this study was to estimate the prevalence of non-initiation and single dispensation and identify associated predictive factors for the main treatments prescribed in Primary Care (PC) for cardiovascular disease (CVD) and diabetes. Methods: Cohort study with real-world data. Patients who received a first prescription (2013–2014) for insulins, platelet aggregation inhibitors, angiotensin-converting enzyme inhibitors (ACEI) or statins in Catalan PC were included. The prevalence of non-initiation and single dispensation was calculated. Factors that explained these behaviours were explored. Results: At three months, between 5.7% (ACEI) and 9.1% (antiplatelets) of patients did not initiate their treatment and between 10.6% (statins) and 18.4% (ACEI) filled a single prescription. Body mass index, previous CVD, place of origin and having a substitute prescriber, among others, influenced the risk of non-initiation and single dispensation. Conclusions: The prevalence of non-initiation and single dispensation of CVD medications and insulin prescribed in PC in is high. Patient and health-system factors, such as place of origin and type of prescriber, should be taken into consideration when prescribing new medications for CVD and diabetes.
Collapse
|
33
|
Mata-Cases M, Rodríguez-Sánchez B, Mauricio D, Real J, Vlacho B, Franch-Nadal J, Oliva J. The Association Between Poor Glycemic Control and Health Care Costs in People With Diabetes: A Population-Based Study. Diabetes Care 2020; 43:751-758. [PMID: 32029636 DOI: 10.2337/dc19-0573] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 01/13/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyze the differences in health care costs according to glycemic control in people with type 2 diabetes. RESEARCH DESIGN AND METHODS Data on health care resource utilization from 100,391 people with type 2 diabetes were extracted from the electronic database used at the Catalan Health Institute. Multivariate regression models were carried out to test the impact of glycemic control (HbA1c) on total health care, hospital admission, and medication costs; model 1 adjusted for a variety of covariates, and model 2 also included micro- and macrovascular complications. Glycemic control was classified as good for HbA1c <7%, fair for ≥7% to <8%, poor for ≥8% to <10%, and very poor for ≥10%. RESULTS Mean per patient annual direct medical costs were €3,039 ± SD €6,581. Worse glycemic control was associated with higher total health care costs: compared with good glycemic control, health care costs increased by 18% (€509.82) and 23% (€661.35) in patients with very poor and poor glycemic control, respectively, when unadjusted and by €428.3 and €395.1, respectively, in model 2. Medication costs increased by 12% in patients with fair control and by 28% in those with very poor control (model 2). Patients with poor control had a higher probability of hospitalization than those with good control (5% in model 2) and a greater average cost when hospitalization occurred (€811). CONCLUSIONS Poor glycemic control was directly related to higher total health care, hospitalization, and medication costs. Preventive strategies and good glycemic control in people with type 2 diabetes could reduce the economic impact associated with this disease.
Collapse
Affiliation(s)
- Manel Mata-Cases
- Centre d'Atenció Primària La Mina, Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain.,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, Barcelona, Spain.,CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Beatriz Rodríguez-Sánchez
- Department of Economic Analysis and Finance, Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Dídac Mauricio
- 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, Barcelona, Spain .,CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain.,Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Real
- 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, Barcelona, Spain.,CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Bogdan Vlacho
- 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, Barcelona, Spain
| | - Josep Franch-Nadal
- 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, Barcelona, Spain .,CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain.,Centre d'Atenció Primària Raval Sud, Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Juan Oliva
- Department of Economic Analysis and Finance, Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain
| |
Collapse
|
34
|
Romera I, Díaz S, Sicras-Mainar A, López-Simarro F, Dilla T, Artime E, Reviriego J. Clinical Inertia in Poorly Controlled Type 2 Diabetes Mellitus Patients with Obesity: An Observational Retrospective Study. Diabetes Ther 2020; 11:437-451. [PMID: 31884573 PMCID: PMC6995792 DOI: 10.1007/s13300-019-00745-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION To evaluate clinical inertia in patients with type 2 diabetes mellitus (T2DM), obesity and poor glycaemic control in routine clinical practice. METHODS This was a retrospective, observational study based on the analysis of medical records from the BIG-PAC® database. Subjects who required medical care in 2013 with the following characteristics were enrolled in the study: age ≥ 30 years, diagnosis of T2DM, glycosylated haemoglobin (HbA1c) ≥ 8%, obesity (body mass index [BMI] ≥ 30 kg/m2) and treatment with ≥ 2 oral antidiabetic drugs (OADs). Inertia was evaluated by time (days) to the first intensification during the period while HbA1c levels were ≥ 8% and percentage of patients whose treatment was not intensified at 6 months, 1, 2 and 3 years and the end of follow-up. The minimum length of follow-up was 4 years. Descriptive analyses and Kaplan-Meier survival curves were performed. RESULTS A total of 13,824 patients with T2DM receiving ≥ 2 OADs were identified; of these 2709 (19.6%) had HbA1c ≥ 8% and BMI ≥ 30 kg/m2, thus fulfilling the inclusion criteria. Of these 2709 patients, the mean age was 65.5 (standard deviation [SD] 12.0) years; 54.9% were male, mean HbA1c level was 9.2% (SD 1.3%); mean BMI was 32.1 (SD 0.9) kg/m2; and mean time from diagnosis was 8.2 (SD 3.0) years. HbA1c remained ≥ 8% for a median of 440 (95% confidence interval [CI] 421-459) days. The median time to first intensification was 456 (95% CI 429-483) days. No intensification had occurred in 77.8, 59.5, 41.5, 28.1 and 22.4% of patients at 6 months, 1, 2, 3 years and the end of follow-up, respectively. CONCLUSIONS The patients with T2DM analysed in this study had a mean HbA1c of 9.2% at baseline, and this remained at ≥ 8% for > 1 year. The time to the first treatment intensification was longer than that recommended by guidelines. Treatment was not intensified in a large percentage of patients, with almost 60% of patients not receiving intensification at 1 year of follow-up.
Collapse
Affiliation(s)
- Irene Romera
- Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain.
| | - Silvia Díaz
- Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain
| | | | | | - Tatiana Dilla
- Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain
| | - Esther Artime
- Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain
| | - Jesús Reviriego
- Medical Department, Eli Lilly and Company, Alcobendas, Madrid, Spain
| |
Collapse
|
35
|
Galbete A, Cambra K, Forga L, Baquedano FJ, Aizpuru F, Lecea O, Librero J, Ibáñez B. Achievement of cardiovascular risk factor targets according to sex and previous history of cardiovascular disease in type 2 diabetes: A population-based study. J Diabetes Complications 2019; 33:107445. [PMID: 31668588 DOI: 10.1016/j.jdiacomp.2019.107445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/01/2019] [Accepted: 09/07/2019] [Indexed: 12/22/2022]
Abstract
AIMS The main objective was to assess, using real-practice primary care records, the degree of control of cardiovascular risk factor targets. Records were stratified by the presence of previous history or cardiovascular disease (CVD), and sex differences in the fulfillment profile were analyzed. METHODS This is a cross-sectional population-based study conducted in Spain. Type 2 diabetes patients over 20 years old (n = 32,638) were identified from primary care electronic health records, and the following information was extracted: glycated hemoglobin (HbA1c), systolic and diastolic blood pressure (SBP and DBP), LDL and HDL cholesterol levels, triglycerides, BMI and smoking history. RESULTS Patients with CVD had worse control of HbA1c than patients without it, (HbA1c < 7% 56.9% vs. 61.2%) but better control of BP (<130/80: 43.5% vs 38.2%) and lipids. In the group without prior CVD history, women had worse control of HbA1c, LDL, HDL, BMI and triglycerides and better control of blood pressure and smoking. These differences were maintained or accentuated in the group with previous CVD. CONCLUSIONS Women had poorer control of CV risk factors in both groups, and the sex-gap is accentuated in patients with previous CVD.
Collapse
Affiliation(s)
- Arkaitz Galbete
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Koldo Cambra
- Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; IdiSNA, Pamplona, Spain.
| | - Luis Forga
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; IdiSNA, Pamplona, Spain.
| | - Francisco Javier Baquedano
- Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Felipe Aizpuru
- Hospital de Txagorritxu, Servicio Vasco de Salud-Osakidetza, Vitoria Gasteiz, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Oscar Lecea
- Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain.
| | - Julián Librero
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Berta Ibáñez
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; IdiSNA, Pamplona, Spain.
| |
Collapse
|
36
|
Morillas C, Escalada J, Palomares R, Bellido D, Gómez-Peralta F, Pérez A. Treatment of Type 2 Diabetes by Patient Profile in the Clinical Practice of Endocrinology in Spain: Delphi Study Results from the Think Twice Program. Diabetes Ther 2019; 10:1893-1907. [PMID: 31359366 PMCID: PMC6778580 DOI: 10.1007/s13300-019-0671-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The aim of this Delphi study is to unveil the management of patients with type 2 diabetes (T2D) and different levels of complexity in the clinical practice in Spain. METHODS Based on the common management practices of T2D profiles reported by Spanish endocrinologists, a Delphi questionnaire of 55 statements was developed and responded to by a national panel (n = 101). RESULTS A consensus was reached for 30 of the 55 statements. Regarding overweight patients inadequately controlled with metformin, treatment with a sodium-glucose transport protein 2 inhibitor (SGLT2-I) is preferred over treatment with a dipeptidyl peptidase-4 inhibitor (DPP4-I). If the patient is already being treated with a DPP4-I, an SGLT2-I is added on to the treatment regimen rather than replacing the DPP4-I. Conversely, if the treatment regimen includes a sulfonylurea, it is usually replaced by other antihyperglycemic agents. Current treatment trends in uncontrolled obese patients include the addition of an SGLT2-I or a glucagon-like peptide-1 receptor agonist (GLP1-RA) to background therapy. When the glycated hemoglobin target is not reached, triple therapy with metformin + GLP1-RA + SGLT2-I is initiated. Although SGLT2-Is are the treatment of choice in patients with T2D and heart failure or uncontrolled hypertension, no consensus was reached regarding the preferential use of SGLT2-Is or GLP1-RAs in patients with established cardiovascular disease. CONCLUSION Consensus has been reached for a variety of statements regarding the management of several T2D profiles. Achieving a more homogeneous management of complex patients with T2D may require further evidence and a better understanding of the key drivers for treatment choice. FUNDING Logistic support was provided by ESTEVE Pharmaceuticals S.A Spain.
Collapse
Affiliation(s)
| | | | | | - Diego Bellido
- Hospital Arquitecto Marcide, Complejo Hospitalario Universitario de Ferrol [CHUF], El Ferrol, Spain
| | | | - Antonio Pérez
- Hospital de la Santa Creu i Sant Pau, CIBERDEM, c/de Sant Quintí, Barcelona, Spain
| |
Collapse
|
37
|
Mata-Cases M, Franch-Nadal J, Ortega E, Real J, Gratacòs M, Vlacho B, Mauricio D. Glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes:real-world evidence from a Mediterranean area. Curr Med Res Opin 2019; 35:1735-1744. [PMID: 31081693 DOI: 10.1080/03007995.2019.1618806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Aims: To assess clinical characteristics and factors associated with glycated hemoglobin (HbA1c) reduction in type 2 diabetes (T2DM) patients initiating glucagon-like peptide-1 receptor agonists (GLP-1RAs). Methods: Retrospective cohort study in patients with T2DM who initiated GLP-1RAs between 2007 and 2014 in primary health care centers in Catalonia (Spain). We evaluated changes in HbA1c and body weight at 6-12 months, and factors independently associated with achieving ≥1% HbA1c target reduction. Results: Overall, 4242 patients (47.9% male; mean BMI 37.5 kg/m2) initiated a GLP-1RA. At 6-12 months, the mean HbA1c level decreased from the baseline 8.8% to 7.7% (-1.0%; SD = 1.6). A 1% reduction in HbA1c was observed in 47.2% of patients. Patients lost a mean of 3.6 kg (SD = 6.2). Sixty percent of patients reduced both HbA1c and body weight, and 17% achieved only one of these targets. Independent determinants of a 1% HbA1c reduction were baseline HbA1c, age, diabetes duration and being on insulin treatment. Reduction in weight or HbA1c and the proportion of patients achieving a HbA1c reduction of ≥1% was significantly larger among subjects prescribed liraglutide than exenatide and lixisenatide. Conclusions: In this real-world, retrospective study, the magnitude of HbA1c and body weight reductions after addition of a GLP-1RA were similar to those observed in randomized controlled trials. Approximately 60% of patients attained reductions in both HbA1c and body weight, and there were significant differences among different drugs from this therapeutic group.
Collapse
Affiliation(s)
- Manel Mata-Cases
- 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
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
- Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut , Sant Adrià de Besòs , Spain
| | - Josep Franch-Nadal
- 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
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
- Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut , Barcelona , Spain
| | - Emilio Ortega
- Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Suñer, Hospital Clínic , Barcelona , Spain
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
| | - Jordi Real
- 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
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
| | - Mònica Gratacòs
- 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
| | - Bogdan Vlacho
- 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
| | - Dídac Mauricio
- 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
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
- Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Autonomous Universtity of Barcelona , Barcelona , Spain
| |
Collapse
|
38
|
Salinero-Fort MA, Mostaza-Prieto JM, Lahoz-Rallo C, Vicente Díez JI, Cárdenas-Valladolid J. Population-based cross-sectional study of 11 645 Spanish nonagenarians with type 2 diabetes mellitus: cardiovascular profile, cardiovascular preventive therapies, achievement goals and sex differences. BMJ Open 2019; 9:e030344. [PMID: 31542750 PMCID: PMC6756452 DOI: 10.1136/bmjopen-2019-030344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the risk profile, achievement of cardiometabolic goals, and frequency and optimal use of cardiovascular preventive therapies among nonagenarians with type 2 diabetes mellitus (T2DM). To investigate possible sex differences. DESIGN AND SETTING A cross-sectional population study of 11 645 persons aged ≥90 years with T2DM living in Madrid (Spain). Sociodemographic, clinical and therapy profiles were collected through electronic records in primary care. We considered antihypertensive therapy and lipid-lowering therapy to be optimal when known patients with hypertension with albuminuria received renin-angiotensin system blockers and statins had been prescribed for overt cardiovascular disease. RESULTS The prevalence of coronary artery disease was higher in males than in females (21.5% vs 12.6%, p<0.01), as was that of peripheral artery disease (8.5% vs 2.3%, p<0.01). However, the prevalence of cerebrovascular disease was similar in both sexes (16.5% vs 16%; p=0.44). Haemoglobin A1c was lower than 7% in 64.4% of cases, with female predominance in patients with known dementia (67.1% female vs 59.9% male; p<0.01). Antiplatelet therapy was significantly more frequent in males than in females (48.1% vs 44.3%; p<0.01), as were statins (43.2% vs 40.2%; p<0.01). Both in primary and in secondary prevention, rates for simultaneous achievement of the HbA1c, blood pressure, LDL-C goals were significantly lower among females (p<0.01). For each criterion of optimal use of cardiovascular preventive therapies, adherence was significantly better in males than in females. CONCLUSION Our study showed that the risk of cerebrovascular disease was similar in both male and female Spanish nonagenarians. Adherence was poorer in females for all criteria of optimal use of cardiovascular preventive therapies. Our findings indicate that the known sex differences in younger patients with T2DM persist in patients aged ≥90 years. There is considerable room for improvement in standards of preventive care in nonagenarians with T2DM, especially in females.
Collapse
Affiliation(s)
- Miguel Angel Salinero-Fort
- Subdirección General de Investigación Sanitaria, Consejería de Sanidad, Madrid, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Grupo de Envejecimiento y Fragilidad de las personas mayores, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ), Madrid, Spain
- Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Madrid, Spain
| | | | | | | | - Juan Cárdenas-Valladolid
- Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Madrid, Spain
- Dirección Técnica de Sistemas de Información. Gerencia Asistencial de Atención Primaria, Comunidad de Madrid Servicio Madrileno de Salud, Madrid, Spain
- Enfermería, Universidad Alfonso X El Sabio, Villanueva de la Canada, Spain
| |
Collapse
|
39
|
Glucagon-Like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes: Prescription According to Reimbursement Constraints and Guideline Recommendations in Catalonia. J Clin Med 2019; 8:jcm8091389. [PMID: 31491916 PMCID: PMC6780172 DOI: 10.3390/jcm8091389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022] Open
Abstract
To assess the clinical characteristics, the prescription pattern of GLP-1 receptor agonists (GLP-1RA) users, and HbA1c and weight change, we retrospectively assessed patients with type 2 diabetes by initiating GLP-1RA as an add-on to the standard of care in Catalonia. The mean change from the baseline in glycated hemoglobin (HbA1c) and weight at 6 and 12 months of therapy was calculated, and we assessed the predictors of the HbA1c reduction of ≥1% and/or the weight reduction of ≥3% as recommended by the Catalan Health Service. In 2854 patients who initiated a GLP-1RA during 2014 and 2015, the overall mean HbA1c values were reduced from the baseline by −0.84% (SD = 1.66) (−9.2 mmol/mol) and lost on average 2.73 kg (SD = 6.2). About 44% percent of patients decreased their HbA1c by ≥1%; 44% decreased their weight by ≥3%; and only 22% met both of them together. The odds of achieving a reduction of ≥1% in initial HbA1c were two-fold higher for patients with higher baseline levels, and the likelihood of a reduction of ≥3% in the initial weight was associated with a higher BMI at the baseline, but they were independent of each other. The composite outcome (target 1% HbA1c reduction and 3% weight loss) to evaluate both the GLP-1RA clinical benefit and treatment withdrawal should be judged from a patient-centered approach.
Collapse
|
40
|
Gómez García MC, Franch-Nadal J, Millaruelo Trillo JM, Cos-Claramunt FX, Avila Lachica L, Buil Cosiales P. [Blood glucose control and cardiovascular risk factors in type 2 diabetic patients with cardiovascular disease in Spain, and its treatment pattern, according to gender: CODICE study]. Semergen 2019; 46:125-135. [PMID: 31399388 DOI: 10.1016/j.semerg.2019.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/17/2019] [Accepted: 05/27/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES With the implementation of the Strategy of Health Promotion and Prevention in Spain, the scenario reflected in previous studies of low control of cardiovascular risk factors (CVRF) in patients with type 2 diabetes (DM2) and cardiovascular disease (CVD) can be modified. This study intends to determine the level of blood glucose control and other CVRF in patients with DM2 and CVD currently seen in clinics in Spain, as well as the pattern of antidiabetic treatment, and differences according to gender. MATERIALS AND METHODS An epidemiological, observational, cross-sectional, nationwide study was conducted in patients of both genders diagnosed with DM2 and established CVD. RESULTS The study included 3,143 patients with a mean age 69.0±10 years. The mean HbA1c was 7.4±1.1% in females vs 7.3±1.2% in males (P<.05) and systolic blood pressure was 137±15.0mmHg in females vs 135.6±14.7mmHg in males (P<.05). The mean LDL-cholesterol was 101.5±38.1mg/dl in females vs 91.1±37.5mg/dl in males; P<.001) and the mean body mass index (30.7±5.4kg/m2 in females vs 29.6±4.5kg/m2 in males; P<.001). The most used treatments were metformin (68.1%) and/or DPP4 inhibitors (53.7%), with no differences between genders. CONCLUSIONS The level of blood glucose control of DM2 patients with CVD in Spain can be improved. The treatment profile does not conform to the recommendations of clinical practice guidelines in general. The differences in the control of CVRF are worse in women for lipids and obesity.
Collapse
Affiliation(s)
- M C Gómez García
- Unidad de Gestión Clínica Vélez-Norte, Vélez-Málaga, Málaga, España
| | | | | | | | - L Avila Lachica
- Unidad de Gestión Clínica Vélez-Norte, Vélez-Málaga, Málaga, España
| | | |
Collapse
|
41
|
Lecumberri Pascual E, Tejera Pérez C, Muñoz-Garach A, Javier Ampudia-Blasco F. How often patients on insulin therapy measure postprandial glycemia and modify insulin doses accordingly? From an on-line survey in insulin-treated diabetes patients in Spain. Diabetes Res Clin Pract 2019; 154:43-51. [PMID: 31226281 DOI: 10.1016/j.diabres.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/02/2019] [Accepted: 06/13/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Controlling postprandial glycemia (PPG) is important to achieve optimal glycemic control, but few studies have evaluated how often is measured and evaluated. OBJECTIVES To evaluate how often patients on insulin therapy measure PPG and modify insulin doses accordantly. As secondary objectives, we evaluated the factors conditioning elevated PPG and associated issues. MATERIAL AND METHODS Cross-sectional observational study based on a web-based survey from an unselected sample of adult insulin-treated patients. A p-value of < 0.05 was significant. RESULTS 1251 patients (68% women, 38.9 ± 13 years [mean ± SD], body mass index (BMI) 24.2 ± 4.2 kg/m2, diabetes duration 17.4 ± 12.8 years, insulin dose 38 ± 18 IU) participated, 1104 with autoinmmune disease (AD) and 147 with non-autoinmmune diabetes (NAD). 59% of patients had HbA1c ≤ 7%, 92.7% of patients with AD and 55.8% with NAD were attended by specialists (p < 0.001). People with AD did more often blood glucose monitoring (BGM) (p < 0.0001) and used continuous glucose monitoring systems (CGMS) (p < 0.0001). 90.1% with AD and 68.0% with NAD received instructions on measuring PPG (p < 0.001), and more with AD received specific training to change the treatment (87% vs. 61.2%, p < 0.0001) and were more proactive. However, more with NAD discussed their postprandial glucose levels with their healthcare team during clinical visits (92.5% vs. 74.1%, p < 0.0001). Regarding bolus administration, 88.6% with AD and 68.7% with NAD injected the insulin bolus before meals (p < 0.001). CONCLUSIONS Patients with AD determine PPG more frequently. Diabetes type, follow-up setting, number of injections and CGMS use were the most important predictive factors for PPG measurement. Diabetes education programs should address how to best monitor PPG and appropriate corrective actions.
Collapse
Affiliation(s)
| | - Cristina Tejera Pérez
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol, La Coruña, Spain.
| | - Araceli Muñoz-Garach
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain; Instituto de Salud Carlos III, Madrid, Spain
| | - F Javier Ampudia-Blasco
- Diabetes Reference Unit, Endocrinology & Nutrition Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Spain; Medicine Department, Medicine Faculty, University of Valencia, Spain
| |
Collapse
|
42
|
Barquilla García A, Sánchez Vega J, Romero Vigara JC, Fernández L, Gamero Samino MJ, Buitrago F. Prevalence of diabetes and frequency of glycated haemoglobin monitoring in Extremadura (Spain) during 2012, 2013 and 2014: An observational study. Prim Care Diabetes 2019; 13:324-329. [PMID: 30630669 DOI: 10.1016/j.pcd.2018.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/14/2018] [Accepted: 12/28/2018] [Indexed: 11/27/2022]
Abstract
AIMS To analyze the prevalence of diabetes and the frequency of haemoglobin A1C (HbA1C) monitoring in the population with diabetes in Extremadura (Spain). METHODS Observational, longitudinal retrospective study in the population attended in the Extremadura Health System in 2012-2014. A total of 403,644 glycated haemoglobin determinations in 189,466 subjects (52.4% female) were studied. All patients with a prescription of antidiabetic drugs and those who, despite not having treatment, had any determination of HbA1C ≥6.5% were considered as people with diabetes. All patients without treatment but with HbA1C ≥5.7% and <6.5% were considered prediabetes patients. RESULTS The prevalence rate of diabetes was 8.3% and the frequency of HbA1C monitoring was 0.9/patient/year in the diabetic population. 48.2% of the patients with monitoring of HbA1C had diabetes, 21.2% had prediabetes, and 30.6% did not meet the criteria for diabetes or prediabetes. 12.7% of people with diabetes did not have determinations of HbA1C and only 11.8% have had ≥6 determinations in the period analyzed. CONCLUSIONS The frequency of HbA1C monitoring in the diabetic population is lower than that usually recommended. Moreover, there is an inadequate use of HbA1C determinations, since one out of every 3 patients does not meet the criteria for diabetes or prediabetes.
Collapse
Affiliation(s)
| | - Javier Sánchez Vega
- Centro de Salud de Losar de la Vera, Servicio Extremeño de Salud, Cáceres, Spain.
| | | | - Leandro Fernández
- Centro de Salud de Zafra, Servicio Extremeño de Salud, Badajoz, Spain.
| | | | - Francisco Buitrago
- Centro de Salud Universitario "La Paz", Unidad Docente de Medicina Familiar y Comunitaria, Servicio Extremeño de Salud, Badajoz, Spain.
| |
Collapse
|
43
|
Díaz Vera AS, Abellán Alemán J, Segura Fragoso A, Martínez de Esteban JP, Lameiro Couso FJ, Golac Rabanal MDS, Díaz Vera LA, Matta Solis HH. The prevalence and risk factors associated with dyslipidemia in type 2 diabetic patients in the autonomous Region of Cantabria. ACTA ACUST UNITED AC 2019; 67:102-112. [PMID: 31235401 DOI: 10.1016/j.endinu.2019.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Dyslipidemia is one of the main risk factors in cardiovascular disease in patients with diabetes mellitus type 2 (DM2). The aim of this study is to evaluate the prevalence and risk factors associated with dyslipidemia in the population with diabetes mellitus type 2 in the region of Cantabria. MATERIAL AND METHODS This is a transversal study carried out at Cantabrian primary health care centres (n=680). A representative, random sample of the population with DM2, ranging from 18-85, was selected using a multistage procedure. The medical records were obtained, and by means of interviews the data of the risk factors to be studied was secured. The correlation with dyslipidemia was analysed by means of logistic regression. RESULTS There were 52.1% of males, the average age was 69.8, the evolution of diabetes was 9.99 years, 84.3% had arterial hypertension, 76.6% were overweight or obese and the average HbA1c was 6.96%. The prevalence of dyslipidemia was 85.3%, and in the bivariate analysis this is associated with a history of peripheral artery disease, controlled diabetes, antihypertensive treatment, glomerular filtration, HbA1c>7%, body fat estimated as being either overweight or obese, a history of cardiovascular disease, age and HbA1c. In the multivariate analysis the independent factors were being female and a history of cardiovascular disease. CONCLUSION The prevalence of dyslipidemia in our study was 85.3%, and is consistent with figures found in previous published studies. The independent associated risk factors were being female and a past medical history of cardiovascular disease.
Collapse
Affiliation(s)
| | - José Abellán Alemán
- Cátedra de Riesgo Cardiovascular, Universidad Católica San Antonio de Murcia, Murcia, España
| | - Antonio Segura Fragoso
- Servicio de Investigación, Instituto de Ciencias de la Salud, Universidad de Castilla-La Mancha, Talavera de la Reina (Toledo), España
| | | | | | | | | | | |
Collapse
|
44
|
Canivell S, Mata-Cases M, Real J, Franch-Nadal J, Vlacho B, Khunti K, Gratacòs M, Mauricio D. Glycaemic control after treatment intensification in patients with type 2 diabetes uncontrolled on two or more non-insulin antidiabetic drugs in a real-world setting. Diabetes Obes Metab 2019; 21:1373-1380. [PMID: 30756446 DOI: 10.1111/dom.13663] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/26/2019] [Accepted: 02/08/2019] [Indexed: 12/14/2022]
Abstract
AIM To assess glycaemic control after treatment intensification in patients with type 2 diabetes uncontrolled on ≥2 non-insulin antidiabetic drugs (NIADS). METHODS A retrospective cohort study, using electronic health records from the SIDIAP database (2010-2014), was conducted. Intensification was defined as the prescription of any new antidiabetic drug in patients treated with ≥2 NIADS and HbA1c >7%. The primary outcome was the absolute change in HbA1c 6-12 months after any intensification. Secondary analyses included the percentage of patients reaching HbA1c <7%, HbA1c <8%, and a reduction of HbA1c >1% after the first intensification. RESULTS There were 21 241 intensifications in 15 205 patients with a mean (SD) HbA1c of 9.02% (±1.35). Insulin and dipeptidyl peptidase-4 inhibitors (DPP4i) were the most frequently added therapies. The mean baseline-adjusted HbA1c reduction was 0.78% (95% CI, -0.80 to -0.76), varying from -0.69% with DPP4i to -0.85% with glucagon-like peptide-1 receptor agonists while the addition of insulin was associated with a reduction >1%. After the first intensification, 48.9% of patients achieved HbA1c <8%, 16.2% HbA1c <7%, and 43.1% a reduction >1%. High previous HbA1c was positively associated with the reduction of HbA1c >1% [odds ratio (OR) 2.13 (95% CI: 2.05-2.21)], but inversely associated with the attainment of HbA1c <7% [OR 0.64 (0.61-0.67)] or < 8% [OR 0.63 (0.60-0.65)]. Older age, male gender, higher Charlson index, and short diabetes duration were associated with achievement of HbA1c <7%. CONCLUSIONS Despite intensification, most patients failed the glycaemic goal of HbA1c <7%. The reduction depended mainly on preintensification HbA1c values, with small differences between drugs.
Collapse
Affiliation(s)
- Silvia Canivell
- 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 Sant Martí de Provençals, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
- Department of Internal Medicine, Health Sciences Research Institute and Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Manel Mata-Cases
- 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
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
| | - Jordi Real
- 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
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Josep Franch-Nadal
- 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
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
| | - Bogdan Vlacho
- 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
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Mònica Gratacòs
- 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
| | - Dídac Mauricio
- 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
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| |
Collapse
|
45
|
Castillo-Otí JM, Cañal-Villanueva J, García-Unzueta MT, Galván-Manso AI, Callejas-Herrero MR, Muñoz-Cacho P. [Prevalence and risk factors associated with diabetic retinopathy in Santander. Northern Spain]. Aten Primaria 2019; 52:29-37. [PMID: 31109720 PMCID: PMC6939023 DOI: 10.1016/j.aprim.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 11/16/2022] Open
Abstract
Objetivos Evaluar la prevalencia, severidad y factores de riesgo asociados a la retinopatía diabética (RD) en Cantabria. Diseño Estudio transversal de base poblacional. Emplazamiento Centro de salud de Cantabria. Participantes Muestra aleatoria de 442 pacientes con diabetes mellitus tipo 2. Mediciones principales Retinografía no midriática, clasificándolas según la International Clinical Diabetic Retinopathy Disease Severity Scale. Los factores de riesgo estudiados: edad, sexo, edad diagnóstico, años de evolución de la diabetes, grado de control glucémico (HbA1c), tratamiento de la diabetes, control de la tensión arterial, control lipídico, obesidad, tabaquismo, hematocrito bajo, embarazo, déficit de vitamina D, nefropatía y eventos cardiovasculares. Resultados Prevalencia de RD del 8,56% (IC: 5,81-11,32). RD no proliferativa leve: 5,07% (IC: 2,89-7,25); RD no proliferativa moderada: 1,38% (IC: 0,17-2,60); RD no proliferativa severa: 0,27% (IC: 0,006-1,28); RD proliferativa: 1,84% (IC: 0,46-3,22); edema macular diabético: 2,30% (IC: 0,77-3,83). Edad media: 70 años, edad de diagnóstico 58,97 años; índice de masa corporal 29,86; hipertensos 78,40%; dislipidemia 67,30% y HbA1c mediana 6,76%. El déficit de 25 (OH) D fue del 77%. En el análisis multivariante los factores independientes fueron tratamiento de la diabetes mellitus tipo 2, índice de masa corporal, años de evolución y control de la diabetes. Conclusiones La prevalencia de RD ha disminuido hasta el 8,56%; esta disminución se asocia a la mejora en el control de los factores de riesgo modificables. Los factores de riesgo asociados de forma independiente fueron: tratamiento, índice de masa corporal, años de evolución y control de la diabetes. Las variables control hipertensión arterial, eventos cardiovasculares y nefropatía también mostraron capacidad predictiva para la RD.
Collapse
Affiliation(s)
- José María Castillo-Otí
- Facultad de Enfermería, Universidad de Cantabria, Hospital Comarcal Sierrallana, Torrelavega, España
| | | | | | | | | | - Pedro Muñoz-Cacho
- Unidad Docente de Atención Primaria de Cantabria, Santander, España.
| |
Collapse
|
46
|
Castelblanco E, Sanjurjo L, Falguera M, Hernández M, Fernandez-Real JM, Sarrias MR, Alonso N, Mauricio D. Circulating Soluble CD36 is Similar in Type 1 and Type 2 Diabetes Mellitus versus Non-Diabetic Subjects. J Clin Med 2019; 8:jcm8050710. [PMID: 31109109 PMCID: PMC6571689 DOI: 10.3390/jcm8050710] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/05/2019] [Accepted: 05/16/2019] [Indexed: 01/11/2023] Open
Abstract
The aim of this study was to determine whether plasma concentrations of sCD36 (soluble CD36) are associated with the presence of type 1 or type 2 diabetes. Plasma levels of sCD36 were analysed in 1023 subjects (225 type 1 diabetes (T1D) patients, 276 type 2 diabetes (T2D) patients, and 522 non-diabetic control subjects) using an enzyme-linked immunosorbent assay (ELISA). Multinomial and logistic regression models were performed to evaluate associations with sCD36 and its association with diabetes types. There were no significant differences in sCD36 (p = 0.144) among study groups, neither in head-to-head comparisons: non-diabetic versus T1D subjects (p = 0.180), non-diabetic versus T2D subjects (p = 0.583), and T1D versus T2D patients (p = 0.151). In the multinomial model, lower sCD36 concentrations were associated with older age (p < 0.001), tobacco exposure (p = 0.006), T2D (p = 0.020), and a higher-platelets count (p = 0.004). However, in logistic regression models of diabetes, sCD36 showed only a weak association with T2D. The current findings show a weak association of circulating sCD36 with type 2 diabetes and no association with T1D.
Collapse
Affiliation(s)
- Esmeralda Castelblanco
- Department of Endocrinology & Nutrition, University, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), 08907 Barcelona, Spain.
| | - Lucía Sanjurjo
- Innate Immunity Group, Health Sciences Research Institute Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Mireia Falguera
- Primary Health Care Cervera, Gerència d'Atenció Primaria, Institut Català de la Salut, Unitat de Suport a la Recerca, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 25200 Cervera, Spain.
- Biomedical Research Institute of Lleida (IRBLleida) & University of Lleida, 25198 Lleida, Spain.
| | - Marta Hernández
- Department of Endocrinology & Nutrition, University Hospital Arnau de Vilanova & Biomedical Research Institute of Lleida (IRBLleida), 25198 Lleida, Spain.
| | - José-Manuel Fernandez-Real
- Department of Diabetes, Endocrinology & Nutrition, Hospital Dr Josep Trueta & Biomedical Research Institute of Girona (IDIBGI), 17007 Girona, Spain.
- Centre for Biomedical Research on Physiopathology of Obesity and Nutrition (CIBEROBN), 17007 Girona, Spain.
| | - Maria-Rosa Sarrias
- Innate Immunity Group, Health Sciences Research Institute Germans Trias i Pujol, 08916 Badalona, Spain.
- Centre for Biomedical Research on Liver and Digestive Diseases (CIBEREHD), 28029 Madrid, Spain.
| | - Nuria Alonso
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), 08907 Barcelona, Spain.
- Department of Endocrinology & Nutrition, University Hospital Germans Trias i Pujol & Health Sciences Research Institute, 08916 Badalona, Spain.
| | - Didac Mauricio
- Department of Endocrinology & Nutrition, University, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain.
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), 08907 Barcelona, Spain.
- Biomedical Research Institute of Lleida (IRBLleida) & University of Lleida, 25198 Lleida, Spain.
| |
Collapse
|
47
|
Gómez-Huelgas R, Lara-Rojas CM, López-Carmona MD, Jansen-Chaparro S, Barba R, Zapatero A, Guijarro-Merino R, Tinahones FJ, Pérez-Belmonte LM, Bernal-López MR. Trends in Diabetes-Related Potentially Preventable Hospitalizations in Adult Population in Spain, 1997⁻2015: A Nation-Wide Population-Based Study. J Clin Med 2019; 8:jcm8040492. [PMID: 30978979 PMCID: PMC6526470 DOI: 10.3390/jcm8040492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 11/16/2022] Open
Abstract
We aimed to assess national trends in the rates of diabetes-related potentially preventable hospitalizations (overall and by preventable condition) in the total adult population of Spain. We performed a population-based study of all adult patients with diabetes who were hospitalized from 1997 to 2015. Overall potentially preventable hospitalizations and hospitalizations by diabetes-related preventable conditions (short-term complications, long-term complications, uncontrolled diabetes, and lower-extremity amputations) were examined. Annual rates adjusted for age and sex were analyzed and trends were calculated. Over 19-years-period, 424,874 diabetes-related potentially preventable hospitalizations were recorded. Overall diabetes-related potentially preventable hospitalizations decreased significantly, with an average annual percentage change of 5.1 (95%CI: −5.6–(−4.7%); ptrend < 0.001). Among preventable conditions, the greatest decrease was observed in uncontrolled diabetes (−5.6%; 95%CI: −6.7–(−4.7%); ptrend < 0.001), followed by short-term complications (−5.4%; 95%CI: −6.1–(−4.9%); ptrend < 0.001), long-term complications (−4.6%; 95%CI: −5.1–(−3.9%); ptrend < 0.001), and lower-extremity amputations (−1.9%; 95%CI: −3.0–(−1.3%); ptrend < 0.001). These reductions were observed in all age strata for overall DM-related PPH and by preventable condition but lower-extremity amputations for those <65 years old. There was a greater reduction in overall DM-related PPH, uncontrolled DM, long-term-complications, and lower extremity amputations in females than in males (all p < 0.01). No significant difference was shown for short-term complications (p = 0.101). Our study shows a significant reduction in national trends for diabetes-related potentially preventable hospitalizations in Spain. These findings could suggest a sustained improvement in diabetes care in Spain, despite the burden of these diabetes-related complications and the increase in the diabetes mellitus prevalence.
Collapse
Affiliation(s)
- Ricardo Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Carmen M Lara-Rojas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - María D López-Carmona
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - Sergio Jansen-Chaparro
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - Raquel Barba
- Servicio de Medicina Interna, Hospital Universitario Rey Juan Carlos, 28933 Móstoles, Madrid, Spain.
| | - Antonio Zapatero
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Fuenlabrada, Madrid, Spain.
| | - Ricardo Guijarro-Merino
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - Francisco J Tinahones
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
| | - Luis M Pérez-Belmonte
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - M Rosa Bernal-López
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| |
Collapse
|
48
|
Standards for global cardiovascular risk management arteriosclerosis. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2019; 31 Suppl 1:1-43. [PMID: 30981542 DOI: 10.1016/j.arteri.2019.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
One of the main goals of the Spanish Society of Arteriosclerosis is to contribute to a wider and greater knowledge of vascular disease, its prevention and treatment. Cardiovascular diseases are the leading cause of death in our country and also lead to a high degree of disability and health expenditure. Arteriosclerosis is a multifactorial disease, this is why its prevention requires a global approach that takes into account the different risk factors with which it is associated. Thus, this document summarizes the current level of knowledge and integrates recommendations and procedures to be followed for patients with established cardiovascular disease or high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or those in special situations. It also includes the estimation of vascular risk, the diagnostic criteria of the different entities that are cardiovascular risk factors, and presents general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not often mentioned in the literature, such as the organisation of a vascular risk consultation.
Collapse
|
49
|
Gomez-Peralta F, Abreu C, Gomez-Rodriguez S, Ruiz L. Insulclock: A Novel Insulin Delivery Optimization and Tracking System. Diabetes Technol Ther 2019; 21:209-214. [PMID: 30896261 DOI: 10.1089/dia.2018.0361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Achieving and maintaining controlled glycemic levels are challenging in people with insulin-treated diabetes mellitus, suboptimal insulin injections being the main obstacle to treatment success. METHODS This research article presents the main functionalities and performance tests on Insulclock®, an electronic device plugged into insulin pens and connected with a smartphone app to improve insulin management. Insulclock tracks the date, time of day, dose, type of insulin, temperature, and duration of insulin injections. Information is stored in the device memory and is available for analysis by patients and health care providers. Insulclock device also has a reminder system with visual and acoustic alerts to reduce insulin omissions and mistiming. RESULTS The main performance tests reveal that Insulclock can detect seven types of insulin pens with a 97% correct classification rate. Among 556 injections, most of the doses were accurately detected (deviation = 0), with relative errors ranging from 3% to 7% across different dosages. The duration of injections recorded by this device strongly correlated with that detected by an external chronometer (R2 = 0.99, root-mean-square deviation [RMSD] = 0.39). Moreover, the precision of the temperature sensor was evidenced by high correlation of temperatures detected by Insulclock and by an external thermometer (Pearson's R2 = 0.90, RMSD = 0.45). CONCLUSIONS Insulclock is a novel device capable of tracking dosing, timing, and missing insulin injections. The promising capabilities it offers for diabetes mellitus self-management may help health care providers, researchers, and insulin users avoid frequent errors in insulin administration.
Collapse
Affiliation(s)
| | - Cristina Abreu
- 1 Endocrinology and Nutrition Unit, Segovia General Hospital, Segovia, Spain
| | | | - Luis Ruiz
- 2 Insulcloud S.L. (B87131454), Madrid, Spain
| |
Collapse
|
50
|
Generalizability of results from the recent FDA-guided cardiovascular outcomes trials to a representative population with Type 2 Diabetes attending primary care clinics. ACTA ACUST UNITED AC 2019; 66:467-468. [PMID: 30890422 DOI: 10.1016/j.endinu.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/17/2019] [Accepted: 01/20/2019] [Indexed: 11/23/2022]
|